Rapid diagnosis, rapid treatment in cancer

DIAGNOSIS WITHIN 24 HOURS IN CANCER!

Many antibodies developed against a group of molecules called “biomarkers” are used in pathology. When these antibodies are used correctly, the results are conclusive. For example, when a sample taken from the bone of a patient presenting with bone pain is analyzed, it can now be understood that it is not bone related but metastasis of breast cancer.

CThe importance of specialized pathology in the management of cancer treatments is undoubtedly enormous. In the pathology department, where the definitive diagnosis of cancer is determined, the first priority is to run things quickly and at the same time completely and flawlessly. At Anadolu Medical Center, this priority is followed, and the diagnosis is made within 24 hours with new technology and advanced methods, and cancer treatment is started without wasting time. M.D. Prof. Hüseyin Baloglu, MD. Prof. Önder Öngürü, MD. and Prof. Zafer Küçükodaci, MD., pathologists at Anadolu Medical Center, talk about what is done in the pathology department, the latest developments in this field and the details of the meticulous works carried out in the background.

CANCER IS NOT A SINGLE TYPE OF DISEASE!

An important part of modern medical developments in the disease and recovery process is in pathology. The magnifying glass, which began to be used in the 1200s, turns into a sophisticated auxiliary tool over time. This tool, which we call the microscope, is now an indispensable element in pathological diagnosis. Basically, it allows us to examine small parts taken from our body (defined as a biopsy). It is possible to examine biopsies taken from tissue considered to be cancer by thinning them to the point that light can pass through them. In the next stages, appropriate contrasts are created with various histochemical staining techniques and cells and intermediate tissues in the diseased area are examined.

First of all, cancer is not a single disease, but a group of diseases. It is a large area with around 200 main groups and many of their subgroups. So there are numerous details to consider during diagnosis. In this respect, it is critical to correctly identify each type of cancer. Because the treatments to be administered after diagnosis may differ according to the type of cancer and each patient. Therefore, it is not enough to simply state that the biopsies taken are abnormal, that is, contain cancer cells. It is necessary to determine the specific name of the cancer. Thus, planning can be made for specific treatments. For example, a biopsy taken from the breast is not just called breast cancer after pathological analysis. Its type is also determined. In addition, the drugs to be used for treatment are determined and a treatment is planned. Another important point is that all these processes are carried out according to international standards. In other words, even if the biopsy is analyzed in another country, a pathology report containing the same diagnosis and information is issued. This is possible with the meticulous application and follow-up of knowledge-based rules.

DIAGNOSIS WITHIN 24 HOURS!

It is very normal for patients to get stressed while waiting for the pathology results. Therefore, it is important to have all the necessary equipment to determine the diagnosis and direct the patient to the treatment as soon as possible without stressing out the patient. Adequate equipment, qualified and sufficient personnel, quality consumables and correct operation of the laboratory are required. When all these come together, the process is much more efficient and faster. Apart from rare exceptions, for example, a routine breast biopsy can be diagnosed within 24 hours. In this way, the waiting stress of patients is minimized and the appropriate treatment is started without wasting time. Medications and treatment methods vary for each patient. At Anadolu Medical Center, the most appropriate treatment for each patient is determined by tumor boards from a multidisciplinary perspective. This is also one of the international standards of the Organization of European Cancer Institutes (OECI), of which Anadolu Medical Center is a member of. In the pathology laboratory of Anadolu Medical Center, molecular pathology tests are also concluded quickly. In addition, through liquid biopsy applications, tumoral cells and genetic material analyzes in blood samples can be detected when the tumor is still very small.

Prof. Hüseyin Baloglu, MD. the head of pathology department at Anadolu Medical Center, says “Equipment, qualified and sufficient personnel, quality consumables and correct operation of the laboratory… When it all comes together, cancer diagnosis and treatment processes are much more efficient and faster”.

WHAT ARE THE INNOVATIONS IN PATHOLOGICAL SCIENCE?

Pathology is not just a diagnostic department. Many diseases, not just cancer, are diagnosed by pathologists. Pathology is a field that guides us about the detailed diagnosis of the disease, whether the disease recurs, about follow-ups, that is, at almost every stage. In the years when medicine was not as developed as it is today, it was essential to diagnose the disease through microscope and to repeat it, but starting from the 1970s, some changes, new information about the treatment of cancer, and the reflection of this information on the clinical process came to the fore. We can say that it first started in breast cancer with hormonal therapy. It is a standard today to look at the receptors that pass the estrogen hormone into the cell in women. HER2 biomarker tests are now being conducted to show whether drugs that will disable the receptors that contribute to the proliferation of tumor cells will work, and more sensitive molecular genetic methods are used for special cases (HER2 FISH analysis).

Artificial Intelligence in Pathology

It is a reassuring power of course to do a job that can also be done by the human eye, with the help of machines, on more complete, more reproducible and larger samples. For example, if a 10-year-old boy is diagnosed with glioblastoma, the artificial intelligence software asks, “Would you like to think again?”. This is exactly a control mechanism that shows whether all algorithms required in diagnostic processes are carried out completely. This type of artificial intelligence applications have been around for years, but there is no application that can take on the role of a physician.

We can talk about an FDA-approved application in the field of pathology. This system, which is used for the evaluation of the “PAP Smear Test” test, proved to be competent and reliable enough to directly archive 1 out of every 4 cases. Today, it is mostly used in centers with a high number of cases in the world.

MD. Prof. Önder Öngürü, a pathologist at Anadolu Medical Center, says “At Anadolu Medical Center, the most appropriate treatment for each patient is determined by tumor boards from a multidisciplinary perspective.”

A NEW MEASUREMENT: WHAT CTDNA OFFERS?

Cancerous cells die after a while in the area where the cancer developed or spread, and some of them enter the vessels, the rest are destroyed by the defense cells, and sometimes some of them are enter the blood in a live form. Regardless of which of these ways, one of the components of the tumor that circulates in the blood is the DNA of the tumor cell (Circulating tumor DNA-ctDNA). Suppose a certain amount of ctDNA is taken from the blood of a person who has not received treatment. When the same person is started on cancer treatment, the more tumor cells die at the end of the effective treatment, the higher the amount of ctDNA to be detected in the blood. This pre-treatment measurement is also made during and after the treatment and the results are compared. After the treatment is over, when the tumor cell to die is very low or no longer, for example, the value that was 10 at the beginning suddenly drops below 10 or disappears. This change in ctDNA level becomes a good follow-up parameter for response to therapy. In other words, with this measurement, the response to any cancer treatment can be predicted earlier.

Is progression of cancer “real or not?”

In patients receiving immunotherapy, the progression of cancer is followed by PET-CT before and after the treatment. Although a good response is seen in approximately one third of the patients, sometimes it can be seen as active as if there is no response to the PET-CT. Therefore, it becomes difficult to distinguish whether this activity belongs to the tumor or lymphocytes. Is it progression or pseudoprogression? In such a case, looking at the ctDNA result, it turns out that it is misleading if the tumor components are too few. Based on this measurement, it appears that treatment should be continued. Resulting in 24 hours, ctDNA can be applied to all patients, especially those receiving immunotherapy. It can be used for all solid tumors requiring immunotherapy (such as breast, bladder, kidney, sarcomas, melanoma, head and neck, pancreas, ovary, colon and uterus). As a result, ctDNA measurement will enable this distinction in cancer treatments by detecting that cancer that appears to be progressing on PET-CT is actually progressing.

Response to treatment will be monitored more accurately through ctDNA values.

MD. Prof. Zafer Küçükodaci, a pathologist at Anadolu Medical Center, says “Molecular pathology tests are also quickly concluded in our pathology laboratory.”

In addition, through liquid biopsy applications, tumoral cells and genetic material are analyzed in blood samples can be detected when the tumor is still very small”.