Issue No. 1
Finding Cancer Sooner
Date: March 1, 2010
As every physician who has confronted cholangiocarcinoma knows, the challenge isn’t only treating the biliary tract cancer. It’s diagnosing it in time to treat it.
In its earliest stages, cholangiocarcinoma may linger unnoticed for months or longer before its symptoms—such as jaundice or abdominal pain—begin to manifest. Surgery is the only viable treatment, but the traditional diagnostic techniques for most cancers are typically not sensitive enough to pick up on this one’s presence. Consequently, by the time a physician makes the diagnosis, it may be too late to operate.
“The problem with cholangiocarcinoma,” says gastroenterologist Florin Selaru, “is that it doesn’t cause many symptoms early on, so patients never see a doctor because they feel fine. Unfortunately, by the time we realize that it’s cancer, there’s nothing left to do for the patient.”
Selaru studies cancer, he says, from the perspective of micro-RNAs. He believes that these short, very stable strands of RNA show promise for distinguishing between patients who may or may not harbor cholangiocarcinoma. And, because obvious symptoms typically appear late in the disease’s progression, the best-case scenario for cholangiocarcinoma patients requires that physicians find the cancer before it ever makes its presence known.
At least some patients may have a shot at beating the clock because of a condition they’re already aware of: primary sclerosing cholangitis (PSC). An estimated 40 percent of patients with this chronic liver disease that’s marked by progressive inflammation of the bile ducts eventually develop cholangiocarcinoma.
“We know they’re at extremely high risk of developing cancer,” Selaru says. “But now we don’t know when or which ones, so we can’t implement any of our normal treatment strategies.”
Selaru’s goal is that physicians could determine which PSC patients might face the highest risk of cholangiocarcinoma by using endoscopy to perform bile-based diagnostic tests of their micro-RNA early on.
“If we can diagnose the disease early,” Selaru says, “we can offer surgery, and therefore a much improved survival.”