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Research solves pancreatic cancer mystery

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A NEW technique to study tissue samples in 3D has revealed that pancreatic cancers can start and grow in two distinct ways, solving a decades-old mystery of how tumours form.

The new method could help researchers to get more information from tissue biopsies and may lead to improved treatments for pancreatic cancers. The technique was developed by scientists at the Francis Crick Institute, and their results are published in Nature. The work was supported by the European Research Council and core funding from the MRC (one of the Crick’s founding partners).

The pancreas is a crucial organ that sits behind our stomach and plays a key role in digestion. It relies on a network of ducts linking it to other digestive organs, and the most common pancreatic cancers are found in the ducts. However, until now it has only been possible to see 2D slices of these ductal cancers, which contained an unexplained variety of abnormal shapes.

“To investigate the origins of pancreatic cancer, we spent six years developing a new method to analyse cancer biopsies in three dimensions,” explains Dr Hendrik Messal from the Francis Crick Institute, co-lead author of the research paper. “This technique revealed that cancers develop in the duct walls and either grow inwards or outwards depending on the size of the duct. This explains the mysterious shape differences that we’ve been seeing in 2D slices for decades.”

By analysing developing cancers in 3D, the team defined two distinct types of cancer formation: ‘endophytic’ tumours which grow inwards and ‘exophytic’ tumours which grow outwards. To find out what makes cancer cells grow in a particular way, they analysed detailed 3D images and worked with biophysicists at the Crick who created sophisticated computer models.

“We made a simulation of the ducts, describing individual cell geometry to understand tissue shape,” explains biophysicist Dr Silvanus Alt, co-lead author of the paper. “The model and experimental results both confirmed that cancer grew outwards when the diameter of the duct was less than approximately 20 micrometres, around a fiftieth of a millimetre.”

The work was made possible by an interdisciplinary collaboration between two research groups at the Crick, led by Dr Axel Behrens and Dr Guillaume Salbreux. Axel’s group works on stem cells and pancreatic cancer, while Guillaume focuses on using physics to understand biological processes.

“I think we first started discussing this when we bumped into each other in the bike shed,” says Axel. “It’s amazing what can come out of a chance encounter, we now have a patented technique to see the three-dimensional shapes of cancers and a biophysical understanding of the emergence of tumours. Now that we know pancreatic cancer can develop in these two different ways, we can start looking at whether one is likely to be more aggressive or spread in a different way. Many years from now, this could lead to improved diagnostic or treatment options.”

The team also applied the technique to other organs and found that cancers in the airways of the lungs and ducts in the liver behave in the same way. This shows that the mechanism the teams discovered is not specific to the pancreas and also applies to other cancers.

“Both the data and our models indicate that the two different mechanisms of tumour growth are purely down to the innate physics of the system,” explains Dr Guillaume Salbreux. “Like most cancers, ductal pancreatic cancer starts with a single defective cell that starts dividing. We found that very quickly, when there are only a few cells, the tumour has already started to grow either inwards or outwards depending on duct diameter. Defining this fundamental process will help us to better understand how cancer grows in many places across the body.”

Dr Mariana Delfino-Machin, Programme Manager for Cancer at the MRC, said: “Pancreatic cancer remains a very difficult disease to treat but understanding that it can grow in different ways will inform the development of more accurate treatments in the future.

“These findings came about thanks to researchers working in very different fields coming together to successfully tackle the same problem.”

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Proton therapy centre officially opened

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HEALTH Minister Vaughan Gething has set out his vision for cutting edge precision medicine to improve health and deliver a sustainable future for NHS Wales.

During, a visit to the Rutherford Cancer Centre in Newport, Mr Gething announced new strategies to transform pathology and precision therapeutics in Wales.

He said: “To address future challenges from the increasing burden of disease we must focus more on prevention, early detection and personalised targeted treatments. Precision medicine will increasingly support a more personalised approach to health and care.

“In Wales, we are already making progress in the field of precision medicine and I am confident that we can be a global player in the race to harness its potential. NHS Wales is on the cusp of realising the significant benefits that can be delivered by advances in precision medicine for patients by offering the right test or treatment at the right time.

“Our long term plan ‘A Healthier Wales’ recognises the importance of moving towards earlier detection and intervention to prevent illness and prolong independence.”

One of the first patients in the UK to receive high-energy proton beam therapy has today praised UK oncologists for embracing proton beam therapy and the transformative effects it has had on his treatment.

Ryan Scott, 23, from Cardigan in Wales, underwent treatment for a brain tumour (grade 1 craniopharyngioma) at the Rutherford Cancer Centre South Wales in Newport as part of NHS Wales’ proton beam therapy treatment pathway for adults.

Ryan Scott said: “I was very pleased when my consultant recommended proton beam therapy and told me that it was available close to home in South Wales. I was due to be treated with proton beam therapy over the course of eight weeks in the United States, a disruption I was not looking forward to. Happily, however, the agreement between NHS Wales and the Rutherford Cancer Centres was struck just in time for me to be treated a short drive from home.

“The process of undergoing proton beam therapy was much better than anticipated. There have been hardly any side effects and being able to sleep in my bed after a day’s treatment is a real plus.”

Mr Gething explained the Welsh Government had a clear vision for harnessing technology to deliver precision medicine in diagnostics and therapy that will ensure a sustainable future for NHS Wales.

“The Rutherford Cancer Centre in Newport, which was the first facility in the UK to offer proton beam therapy for cancer patients, is an excellent example of the development of new cancer therapies, here in Wales. It’s a perfect illustration of how we are working collaboratively to deliver technological innovations to improve treatment,” he said.

“Today I have published our Statement of Intent for Advanced Therapeutic Medicinal Products, which sets out how we will deliver precision therapeutics, like new cell therapies, in Wales.

“Alongside this, I have published a Statement of Intent to transform pathology services. All this builds on our recent investment in diagnostic services such as the new Imaging Academy for Wales.

“In this financial year, I am pleased to provide additional funding of £2.3m to support the delivery of new genetic tests together with a further £2m to support national plans for transforming diagnostic, health science and advanced therapeutic medical services in NHS Wales.”

Andrew Goodall, chief executive of NHS Wales, also attended today’s official opening.

The centre is part of a nationwide network that provides state-of-the-art cancer services including imaging, chemotherapy, immunotherapy, radiotherapy and high energy proton beam therapy.

The Newport centre was recently approved by the Welsh Health Specialised Services Committee (WHSSC) to provide high energy proton beam therapy to adult patients referred from the NHS in Wales, the centre also treated the first patient in the UK with proton beam therapy in April last year.

Mike Moran, chief executive of Proton Partners International which operates the Rutherford Cancer Centres, said: “It is gratifying to see UK oncologists becoming increasingly aware of proton therapy and embracing the treatment. Our collaborative partnership with the NHS in Wales means that adult patients have an option to be treated closer to home.”

“I am delighted by the support we have received from the Health Minister, the Welsh Government, the Wales Life Sciences Investment Fund and the NHS in Wales which has meant that Wales has been the pioneer in proton beam therapy in the UK. Patient demand is increasing and it is encouraging that the UK is beginning to catch up with Europe in the provision of this therapy.”

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Health

Bounty sold mums’ and babies’ data

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THE INFORMATION Commissioner’s Office (ICO) has fined Bounty (UK) Limited £400,000 for illegally sharing personal information belonging to more than 14 million people.

An ICO investigation found that Bounty, a pregnancy and parenting club, collected personal information for the purpose of membership registration through its website and mobile app, merchandise pack claim cards and directly from new mothers at hospital bedsides.

But the company also operated as a data broking service until April 30, 2018, supplying data to third parties for the purpose of electronic direct marketing.

Bounty breached the Data Protection Act 1998 by sharing personal information with a number of organisations without being fully clear with people that it might do so.

The company shared approximately 34.4 million records between June 2017 and April 2018 with credit reference and marketing agencies, including Acxiom, Equifax, Indicia and Sky.

These organisations represented the four largest recipients out of a total of 39 organisations which Bounty confirmed it shared personal data with.

The personal information shared was not only of potentially vulnerable, new mothers or mothers-to-be but also of very young children, including the birth date and sex of a child.

Steve Eckersley, ICO’s Director of Investigations, said: “The number of personal records and people affected in this case is unprecedented in the history of the ICO’s investigations into data broking industry and organisations linked to this.

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Health

Get Mouthy About Cancer

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THE HEAD and Neck Cancer Foundation (HNCF) is calling all Brits to ask their dentists to conduct mouth cancer screens at their next appointment. This should be routinely included within the price of a dental check-up and should take no more than one minute.

Consumer research conducted by HNCF in partnership with YouGov – as part of its Get Mouthy About Cancer campaign – shows that we could all be doing more to specifically drive early diagnosis of mouth cancers.

Early detection is paramount to improving patient outcomes – as these types of cancers can be extremely aggressive, disfiguring and life-limiting.

HNCF’s research asked people in Wales how often they have routine dental check-ups and if they are receiving mouth cancer screening.

6% of people in Wales admit to never going to the dentist for a check-up and a further 3% said they do not recall the last time they went to the dentist

Only half of the Welsh population visit the dentist every six months for a routine check-up.

Shockingly, over half (51%) of those in Wales stated that they were not sure if their dentist had carried out a mouth cancer check at their last check-up

When looking nationally at overall awareness of mouth cancer screening – nearly three-quarters of all Brits stated their dentist does not do a regular mouth cancer screen, or they are unaware of it being done during their last check-up. Which means the vast majority of us are missing out on this simple routine and potentially life-saving screen.

Michelle Vickers, CEO at The Head and Neck Cancer Foundation commented on the findings: “As a nation, we are regrettably unaware that our dentists can play a huge role in oral cancer detection and be routinely screening for signs of mouth cancer during check-ups. Dentists are taught to do this as part of their standard oral check-up process. If people were screened they would know – as the tongue is held to either side of the mouth and the dentist is likely to follow the gums for signs of abnormal growth. We are asking everyone to ask their dentist for a routine screen the next time they visit – it’s really that simple.

“We’ve introduced our Get Mouthy About Cancer campaign because we all hear so often (and know how) to check our boobs or balls – but I bet the majority of people are unaware of what they’re looking for in their mouth! 31 people are diagnosed with head and neck cancers each day in the UK – so it’s time to get talking about what to look for. We brush our teeth daily – just an extra 30-60 seconds to check oral health could save your life!”

To find out how to check please watch HNCF’s video: http://bit.ly/HNCFWales. Once you’ve seen this video you will know whether your dentist is checking your mouth, or not, and how to check yourself at home.

Professor Mark McGurk, world-renowned surgeon and founder of HNCF added: “We want everyone to be having a conversation about mouth cancers. By bringing routine mouth checks front-of-mind and putting it on the agenda – we will raise awareness, raise the number of early detections and reduce the number of people facing stage two and three mouth cancers.”

For those patients who do detect mouth cancer early, technological and medical innovation means that treatment can now be offered in a much less invasive manner, by using the Sentinel Node Biopsy technique (SNB). SNB is an alternative and significantly less invasive treatment for dealing with head and neck cancers. The fluorescent camera and technology locates the nodes in the neck that will contain migrating cancer cells so that these can be targeted and removed – this saves over 70% of patients with early disease from a neck dissection. It spares vital glands and helps patients get back to a normal life more quickly, compared to traditional neck dissection techniques.

SNB has been endorsed by the National Institute for Health and Care Excellence (NICE), is fully adopted in Denmark and the Netherlands, and is growing in deployment across Europe and the US. This practice, pioneered by Professor Mark McGurk, is the result of 15 years’ development and is based on the findings of nearly 500 cases.

HNCF works to educate and train both surgeons and nurses around the UK on this treatment and state-of-the-art technology, to bring a better outcome and time-saving treatment to oral cancer patients.

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