Bladder cancer progress, studying cancer spread and protecting children from tobacco

Cancer Research UK
This month we discuss new trial results in bladder cancer, fresh findings on how cancers spread, and our campaign to help stop children smoking.

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This month, trial results help bladder cancer patients avoid major surgery, prostate cancer cases reach an all time high, fresh findings on how cancers spread, an important step forward for pancreatic cancer, our new campaign to help stop children smoking, and we speak to scientists trying to tap into cancer’s energy supply.

Transcript

Welcome to the Cancer Research UK podcast, I’m Angela Balakrishnan.

Combining radiotherapy with low doses of chemotherapy halves the chances of the most dangerous form of bladder cancer coming back after treatment, according to the results of a major clinical trial funded by Cancer Research UK.

The results, published earlier this month, mean that fewer patients are likely to need their bladder removed and provides a viable alternative for older patients who may be too frail for major surgery.

Anne Croudass, Cancer Research UK Lead Research Nurse, tells us how these results will benefit patients.

“These findings provide us with a new gold standard for treatment that will be particularly important for elderly patients because surgery to remove the bladder can have really severe impact on their quality of life. Survival rates for bladder cancer have been increasing in recent years with around half of all patients now surviving for ten years or more, compared with around a third back in the 1970s.”

New figures from Cancer Research UK show that prostate cancer cases have risen above 40,000 per year for the first time in the UK.

In 2009, around 40,800 men were diagnosed with prostate cancer, compared to around 14,000 twenty years ago.  However, the rise in the number of cases of prostate cancer hasn’t tallied with a big rise in death rates.

Much of the increase is thought to be linked to greater use of PSA testing - which measures a chemical produced by the prostate that may be raised when a man has prostate cancer. But at the moment it’s difficult to tell whether a cancer detected through PSA testing is aggressive and needs treating urgently – which can cause significant side effects - or if it can be safely monitored.

We spoke to Martin Ledwick, head information nurse at Cancer Research UK, about the key warning signs that men should be aware of.

“The symptoms of prostate cancer are needing to pee more often than usual, more frequently, especially if that’s at night. So if a man finds that he needs to get out of bed several times during the night to go to the loo to pass water then that can be a symptom of prostate cancer.

Also having some difficulty starting when you want to go and have a pee, that can also be a symptom, as can be straining or taking a long time to finish off. Or pain when passing urine or during sex – particularly when they have an orgasm.

Less commonly, things like blood in the urine or semen, and sometimes impotence and pain in the back hips or pelvis. But it’s important to remember that all of those symptoms that I’ve mentioned, both the more common ones and the less common ones, are usually caused by something else.”

Cancer Research UK-funded scientists at UCL have found that increasing pressure pushes out surplus healthy cells from overcrowded tissues, revealing a possible link between this process and the spread of cancer.

The team believe excessive cell growth in tumours could create the same effect, ‘popping out’ surplus cancer cells that could potentially spread around the body.

Science Information Manager Josephine Querido explains what the researchers have discovered.

“It’s really important to study how cancer cells might spread because most people who die from cancer do so because their disease has spread to another part of the body and that makes it very difficult to treat.

The exciting part of Professor Baum’s research is that he’s used high-tech imaging methods to find out exactly how cells behave. What he’s found is that they jostle for position – a little bit like we do on a crowded tube train – and when there’s not enough space then one of the cells pops out. What he’s hoping to do now is to see if this effect is also seen in cancer cells.”

Scientists at our Cambridge Research Institute have shown how a promising new class of drugs could potentially treat pancreatic cancer.

Working with scientists from the Wellcome Trust Sanger Institute, they discovered how a gene called USP9x becomes switched off through chemical tags added to DNA.

The researchers believe the gene may be switched off in this way in up to 15 per cent of pancreatic cancers.

Study leader Professor David Tuveson tells us why this is a significant step forward in understanding the molecular faults behind pancreatic cancer.

“This gene appears to be regulated at the level of chromatin structure in human pancreas cancer cells, and patients that have this gene silenced by modifications in their chromatin have a very poor outcome – they die very soon and they have many metastases.

So our study has shown that we can ‘wake’ the gene back up by applying chemicals that modify chromatin structure, and we’re pursuing such experiments now in the clinic, and we hope this will benefit patients suffering from this disease. It’s on of the priorities for CRUK to find new treatments and offer new hope for patients with this disease.”

This month saw the launch of Cancer Research UK’s new campaign - ‘The Answer is Plain’ - calling for all branding to be removed from tobacco products.

We hope everyone will get behind the campaign, not just because removing branding could help people quit, but because of the profound influence that we know the brightly coloured and slickly designed cigarette packs have on children.

To accompany the campaign we’ve published a report about the impact of tobacco branding on children, alongside a hard-hitting short film illustrating children’s attraction to the carefully designed packs.

Here’s a short clip from the film, which can be found on our website and YouTube channel.
“I think it would be quite fun to play with because it’s almost... it just makes you almost happy by looking at it; I think this one looks quite pretty – yeah, pink, pink, pink!; It looks quite girly, I like it; The pictures actually look quite nice and... ice cubes and mint. It makes you feel like you’re in a wonderland of happiness; That one’s cool... that one’s cool... that one’s cool... that one? Yeah that one’s cool.”

Our reporter Paul Thorne spoke to Robin Hewings, Cancer Research UK’s tobacco control manager, to find out more about the campaign and the impact it could have on stopping youngsters from taking up smoking.

“Robin: We’ve launched our campaign called The Answer Is Plain, which is calling for the government to introduce plain, standardised packaging of cigarettes so that cigarettes – rather than having attractive branding at the moment – so they all look the same, boring and unattractive.

Paul: So this is coming at a time when the government has launched a consultation – can you tell us a little bit more about that?

Robin: That’s right. The government is consulting on this and we as part of our campaign launch we have a new report from a Cancer Research UK researchers who are leaders in their field.

This report brings together the evidence on the role of packaging in tobacco, so it shows how important tobacco is, packaging generally in marketing. Then it looks at internal industry documents that were released as part of legal action in the US and the parliamentary inquiry in the UK which shows how important the packaging is to making their products attractive. And then they’ve also spoken to teenagers about tobacco packaging and reflecting a big, big body of evidence.

What they found is that they find the packaging with branding much more attractive and compelling and interesting than the plain standardised packaging. They say that the branded ones can be cool and make you look like a more attractive... make you feel better as a person, whereas the plain ones are kind of boring and rubbishy.

Paul: The campaign is now launched, you’ve launched it with the video and the report. What do you hope to see as a result of these two and the campaign being live now?

Robin: What we hope to see is a lot of people signing up to support the campaign, which is really important to making sure that the government goes ahead with this. It’s a measure that the tobacco industry absolutely hates and they will do everything they can to stop it from happening. What will get in their way is if Cancer Research UK supporters lend their voice to the campaign and give the politicians the courage to take on the tobacco industry and make this a reality, so that it will help fewer people take up smoking, and therefore fewer people getting cancer.

Paul: Cancer Research UK and the report shows that children and young people find branding and packaging attractive on tobacco. What sort of impact do you think will happen if all cigarette branding was removed and all packaging was standardised?

Robin:  It’s not a policy which has happened anywhere else in the world yet, so trying to give specific numbers to one policy when there’s lots of other things going on at the same time is – to be frank – a bit of a mug’s game. But we are very confident that it will have a very significant effect. We know that through the primary research we’ve done which is both looking at big numbers and also working on a more qualitative basis, talking to people, that kind of research.

We know from the internal tobacco industry documents that the packaging is really important to making their products more attractive. We know that when we’ve taken action on reducing the promotion and advertising of tobacco products before, it’s been really successful. For example, since tobacco advertising has been banned on billboards and sports sponsorship, the quantity of 11-15 year olds who smoke has halved. It’s not the only reason why that has happened, but it’s clearly been a very significant part of it. So what it shows is that when we take action like this, it can have a very, very worthwhile impact.

Paul: But smoking rates are coming down, I’ve seen some figures recently to show that smoking rates are coming down – they’re half of what they used to be, specifically in younger age groups. Why doe Cancer Research UK continue to lobby and continue to focus so much on tobacco control. I mean, you’re a research organisation, why are you still banging this drum?

Robin: Our mission is to beat cancer, and that means that you’ve got to deal with smoking. Tobacco kills over 100,000 people each year, it’s responsible for more than a quarter of deaths from cancer, and that means that while it’s great that we’ve made so much progress, we have to continue building on that progress and learning the lessons from what has got us here to give us new policies going into the future so that we can continue that.

I think a big mistake that people can make is to think that somehow falling smoking rates are just kind of inevitable. That’s not true. There have been times when smoking rates have gone up amongst women, even after people knew that smoking caused cancer. In the late 1990s smoking rates among 11-15 year olds were going up. It’s partially about individuals, but it’s got a lot to do with the government setting the overall environment in which people make their decisions.

Cancer Research UK does research about what policies will be most effective to bring down smoking rates, but what we’ve found over the years is that we can’t let that research just sit on the shelf – we’ve got to go out there and tell people about it, and make sure that the government takes action.

Paul: So what would you like to see from here then?

Robin:  What’s really important is that people sign the petition, tell their friends about it, and the more people that sign the petition, the better the chances that we can make this reality, and the better the chances we have of fewer people smoking and fewer people getting cancer.

Last month, scientists from Cancer Research UK’s London Research Institute published a study looking at the genetic changes that influence energy production in cancer cells.

The researchers, led by Dr Almut Schulze, showed that blocking a key enzyme that helps convert glucose into energy could provide a new way of killing prostate cancer cells.

Importantly, this energy production process is common to many different types of cancer, suggesting that drugs that target it could potentially be used to treat a variety of cancers.

Our reporter Safia Danovi visited Dr Schulze to find out more about her work and how targeting cancer’s energy production could lead to powerful future treatments for the disease.

Almut: So as all of the cells in our body, cancer cells also need to use the nutrients that they usually get from the bloodstream and they need this to produce energy for all of the functions that the cell usually has. But they also need these nutrients to make those molecules that they need to produce daughter cells. So cells need to make more of a cell, more of the component of a cell, and only when this is reached cells can grow and can divide. For tumours it’s really important because tumours grow usually very rapidly, so they have a very high demand for nutrients.

Safia: Do tumour cells have different metabolism than healthy cells?

Almut: Already quite a long time ago in the first half of the last century biochemists have found that cancer cells and tumours have these changes in their metabolic activities. This was quite puzzling at the time and the explanation for this was not known. But over the last few years, much more research has taken place and now we know that cancer cells alter their metabolic activity, and we believe that this is one of the properties that is very important for cancer cells growth.

Safia: Could you tell us a bit about what you’re doing in cancer metabolism?

Almut: so we are trying to understand how the metabolic activity of cancer cells is changed, and the ideas behind this is that if we can target those metabolic activities, we think that we can also prevent tumours from growing.

Safia: What results have you got so far?

Almut: we are mainly working with cancer cells in laboratory conditions, so we basically work with these cells in culture, and we can now try to investigate how they have changed their metabolism, and particularly which of the metabolic enzymes are required for the cells to grow and to proliferate.

Safia: And where would you like to see this research going in the future?

Almut: When we understand how cancer cells have changed their metabolic activity, we certainly hope that this knowledge can be used to devise particular specific treatments with which we can block these changes to their metabolic activity, and this should be useful for the development of new treatments for cancer.

Safia: Are you studying any particular cancer type?

Almut: We have studied particular cancer types but we’re interested in finding changes that apply to several different cancer types. We also have to understand why these different cancer typesa show these specific changes. This knowledge will then hopefully help to identify patients that could benefit from specific treatments.

We’ll be back next month with all the latest news and features. In the meantime, why not get involved with our campaigning work at cancercampaigns.org.uk or keep up to date by joining our Facebook group that’s facebook.com/cancerresearchuk