Early diagnosis and the Be Clear On Cancer campaign

Cancer Research UK
Find out why it's important to see your doctor if you pass blood when you wee, and the evidence linking pollution and cancer risk.



Nell Barrie: This is the Cancer Research UK podcast for November 2013. This month we’re discussing what to do if you spot blood in your wee, plus we hear how Standing Up To Cancer is helping research. And we’ve got this month’s heroes and zeros.

Hello and welcome. I’m Nell Barrie, and with me to discuss the latest news is Anthea Martin, Science Communications Manager at Cancer Research UK.

You may have seen adverts over the last week asking you to check for blood when you wee. Anthea – what’s this about?

Anthea Martin: This is a new strand of the government’s Be Clear On Cancer campaign. You may have seen adverts over the last few months highlighting the key symptoms for a number of different types of cancers: lung, bowel and oesophageal. And this latest campaign is highlighting one of the key symptoms for bladder and kidney cancer, and that’s passing blood when you wee.

Nell: It seems to me that blood in the wee would be quite an obvious sign that something is wrong, so why do we need to make sure people are really aware of this – isn’t this something that people would do anyway if they notice this kind of thing?

Anthea: Well I think there are a few different things in play here. I think that the very British attitude towards anything to do with wee means that people are often embarrassed about things like this and they don’t want to go and talk to their doctors about it. And people also don’t want to waste the doctors time, especially if it’s something that’s just happened the once. But what this awareness campaign is highlighting is that, even if you’ve just seen blood in your wee once, you should go and speak to the doctor about it.

Now the vast majority of cases won’t be cancer – it could be something like an infection – but we know if we can diagnose bladder and kidney cancers at an earlier stage, they’re more likely to be successfully treated. So the campaign is really there to encourage people to go along and speak to their doctors, even if they’ve seen blood in their wee just the once, and have a chat and perhaps have some further tests to find out what’s going on.

This is really important. Bladder and kidney cancers are actually quite common cancers – they affect between them about 20,000 people each year in the UK. And kidney cancer in particular is on the increase, so the more people we can get diagnosed at an early stage the better.

Nell: Sticking with the topic of blood, there has been an important breakthrough in treating cancers that have spread to the brain, by getting through the blood-brain barrier. Anthea – can you tell us a bit more about this?

Anthea: Yes – so this is some research that has been led from the University of Oxford and scientists have found a way of delivering drugs more effectively to the brain. Getting drugs into the brain is something that’s always been a real challenge because of something called the blood-brain barrier. This is a protective shield around the brain and it stops things like bacteria from getting in. But what it also does is stop many drugs from entering the brain, and that means it’s very difficult to treat brain tumours or tumours that have spread from other parts of the body into the brain with drugs.

This research has shown that it’s actually possible to temporarily open this blood-barrier to allow drugs in, and the way the researchers have doe this is using a protein called TNF. They found that, when they applied this protein, it opened up the blood-brain barrier but only in tumour cells. That means they might be able to get drugs into a brain tumour but not affect the rest of the healthy tissue in the brain. This could be a really important step forward in the way we treat brain cancers.

What’s also interesting is that it might also help diagnose brain tumours more easily as well. Often, to diagnose a cancer, dyes are used and usually these can get into the tumour but these are kept out by the blood brain barrier. By giving the dyes in combination with TNF, it might be possible to be bale to more clearly see the brain tumour and diagnose it.

Nell: So it’s got two different applications I guess – we have an exciting possible new way to treat brain tumours and cancers that have spread to the brain and also a way to diagnose them sooner as well. Can you tell us a little bit more about what the researchers have actually done to get around the blood-brain barrier?

Anthea: This is lab research, which has shown that if you give the TNF protein in combination with drugs it allows them to get into tumour cells in the brain. So the drug they actually used was herceptin, which is used to treat breast cancer. Unfortunately, breast cancer does sometimes spread to the brain and herceptin can’t cross the blood brain barrier. But they’ve shown that giving it with TNF allows it into to the tumour cells that have spread into the brain.

This holds a lot of potential for making drug treatment of brain tumours, or tumours that have spread into the brain, much more effective in the future. This was just done in the lab so we do have to see whether the same holds true in patients but it could be a really exciting way forward.

Nell: Thanks Anthea.

Now we’ve also heard that the evidence is clear on pollution in the air we breathe. The International Agency for Research on Cancer has now classed air pollution in the same category as tobacco smoke, UV radiation and plutonium – so they’re saying it definitely increases our risk of lung cancer.

Our reporter, Flora Malein, spoke to Cancer Research UK’s health information officer Dr Sarah Williams, to find out more about the announcement.

Sarah Williams: So the IARC stands for the International Agency for Research on Cancer and they’re part of the World Health Organisation. Their job is basically to advise the World Health Organisation and through that, sort of the rest of the world really, on everything to do with cancer.

One of the most important jobs that they have is looking at kind of the evidence and how good the evidence is for whether various different things do cause cancer in humans. In this case they’ve been considering outdoor air pollution.

Flora Malein: What did this latest study find?

Sarah: The IARC has decided that the evidence is strong enough to say that outdoor air pollution and also particulate matter which is basically very tiny particles, solid particles, that are found within air pollution, do cause cancer in humans.   

Flora: Is it any one particular type of cancer, or is it a variety?

Sarah: The judgements from the IARC just tend to relate to whether it can cause ‘cancer’ but we do know that it’s been particularly linked with lung cancer.

Flora: So what can we do about reducing this cancer risk?

Sarah: It’s really important to remember that the judgements of the IARC relate to how strong the evidence for something is and not to how big the risk is. So although we can say that there is enough evidence to be fairly sure that air pollution can cause cancer in people, the degree of risk – the amount that it’s going to increase your risk – is going to depend on how high the amounts of air pollution you’re exposed to.

In this country, in the UK, it’s quite likely that most people aren’t going to be exposed to high enough levels that will make that much difference to their risk. But obviously we do think it’s really important that the Government and other relevant authorities can take action to reduce the amounts of air pollution in the UK and make sure that they’re within the EU limits.

Nell: That was Flora Malein speaking to Dr Sarah Williams.

During October we’ve been Standing Up To Cancer, with people across the UK getting involved in a huge range of fundraising activities. All the money raised by Stand Up To Cancer goes towards clinical trials to improve treatments for people with cancer.  Professor Richard Shaw works at our Liverpool Cancer Research UK Centre, specialising in surgery for head and neck cancers, such as mouth and throat tumours. Our reporter Kat Arney spoke to him about the outlook for patients with head and neck cancers, and how Stand Up To Cancer is funding a clinical trial that could make a difference to people going through treatment for these diseases – with the help of a technique more commonly associated with deep sea diving.

Richard Shaw: The treatment of head and neck cancer is evolving and continues to evolve, but the good news is usually over half of these tumours are cured. And in some categories the cure rates are 80 or 90 per cent. So it isn’t necessarily a reason to have a very grave diagnosis or something that’s universally going to be fatal.  

The treatments usually involve a combination of surgery, radiotherapy or chemotherapy, and with early stage tumours they can often be treated with just a small operation or just radiotherapy. And those can be curative – an outright cure just from a one-day operation, one day in hospital, or from a single course of radiotherapy. For more advanced tumours, what we tend to use is combinations, so there’s more complex surgery followed by radiotherapy or a combination of radiotherapy with chemotherapy.

Kat Arney: Round about this time last year we were all getting very excited here at Cancer research UK about a big event called Stand Up To Cancer that was raising a lot of money to fund clinical trials –and one of them is one of yours. Tell me about this trial.

Richard: So for the very large number of patients who are cured of cancer, there are still quite a few challenges facing these patients, and we have a large number of our patients in our clinic who’ve had some damage to their jaws from radiotherapy as a result of their treatment. Obviously it’s a success that these patients are cured of cancer, they’re often several years into their treatment, and they’re at risk of a condition with a bit of a long name called osteoradionecrosis. What can happen as a side effect of radiotherapy is that the jawbone is less resistant to healing problems and what can happen is the jaw can break down and become what we call necrotic, when the cells in the jawbone die. And the patient has a lot of pain and difficulty, and ultimately can end up with a broken jaw.

Kat: That’s terrible, to say “we’ve made your cancer better” but you have this terrible long term symptom that you have to live with.

Richard: That’s right, and I think osteoradionecrosis is probably the most feared and most serious common complication of head and neck radiotherapy.

Kat: So what’s the new trial trying to find out to make this better?

Richard: We’ve managed osteoradionecrosis in a number of ways. Of course as a surgeon I’m involved in treating osteoradionecrosis and rebuilding people’s jaws. But we’d rather prevent it in the first place if we can. One of the ways of preventing it that was accepted but without necessarily very good evidence was a technique called hyperbaric oxygen. So if a patient who we thought was at risk of developing osteoradionecrosis they would traditionally, in many centres in the UK and overseas, have spent time in a hyperbaric oxygen chamber – a daily treatment for several weeks, and that was done with the aim of reducing the risk of osteoradionecrosis.

Kat:  Now, these hyperbaric oxygen chambers, I’ve heard of them in the context of deep sea divers – they pop you in one of those to stop you getting the bends. How common is this kind of treatment in cancer?

Richard: So I guess there are three common indications for hyperbaric oxygen. The first one, as you mentioned, is decompression illness from diving accidents. The second is treatment of carbon monoxide poisoning in patients who’ve got burns and inhaled smoker, and the third one is these healing issues. And there are a variety of conditions for which hyperbaric oxygen has been suggested to be sued, with some evidence for each. And in fact probably the top of the list is patients who’ve had damaged to some part of their body through radiotherapy.  So there are CRUK trials at the moment, not only in the area I’ve talked about, with the HOPON trial, but also they’ve helped fund a trial that has initially run from Denmark in the treatment of jaw osteoradionecrosis, and also another investigator in London who’s looking into radiotherapy to the pelvis and how that might affect the bowel function.

Kat: So how does this work? How can this high pressure oxygen, the hyperbaric oxygen, help with healing?

Richard: The theory goes that the high pressure oxygen increases the cellularity of the bone, increases the ingrowth of new blood vessels, stimulates stem cells within the bone that were on the point of not being viable to be viable, and essentially allows the jawbone to heal better. That’s the theory. So, it’s an interesting thing. It’s not new treatment – it’s treatment that, as you’ve probably guess is quite expensive, and it’s been out there and it’s been used for these reasons for several decades in the UK, and a group of us who meet together under a national guise of our clinical studies group for the NCRI in head and neck cancer, we felt that this was one of our priorities. Because we have these survivorship issues, one of our priorities was to find out if this very expensive treatment was in fact worthwhile. So the only way we could really establish it was to say although we’re using this treatment routinely, we’ve got to ask our patients to go into randomised trials, and only through that means will we actually get an answer.

Kat: Now Stand Up To Cancer is funding several clinical trials, and obviously Cancer Research UK funds a lot of trials as well – how important are clinical trials, and the fact that we do support them, for making life better for patients?

Richard: So there are different levels of evidence and different ways you can show things. But often, the highest level of evidence and the conclusive data that will change people’s minds about whether a treatment is worthwhile or not, all of that will come from a randomised controlled trial. And although it’s difficult and expensive, and you have to change the culture of some doctors about how they approach their patients, and approaching patients with the uncertainty that I’m not sure whether this treatment works, I think it’s very much worthwhile. Cancer Research UK has invested hugely in randomised trials and other forms of clinical research that are close to them, and I think a lot of us who are triallists are very grateful for that support because, as I say, they’re difficult to organise and they are very expensive.

Kat: And talking of expensive, we do need to do a lot of fundraising through our own fundraising and Stand Up To Cancer – are you doing anything to Stand up To Cancer this year?

Richard: What we’re doing in the Liverpool CRUK centre – I’m a keen cyclist, and we’re keeping an exercise bike going in the Liverpool One Shopping Centre for a 24 hour period, and several of us are helping by doing a stint on the bike.

Kat: So helping cancer patients and getting a bit saddle sore?

Richard: Yeah, potentially!

Nell: That was Professor Richard Shaw, talking to Kat Arney.

And finally, it’s time for our heroes and zeros.  Our hero this month is Professor Tony Kouzarides, who has been made a Gibb Fellow in recognition of his significant contribution to our understanding of the complex processes that underlie the development of cancer.

The award acknowledges his world-leading research into chromatin modification – an area of research known as epigenetics – that looks at how our genes are switched on and off in healthy cells, and why this goes wrong in cancer. Cancer Research UK has funded Professor Kouzarides's research since the early 1990s.

And our zero this month goes to the headline writers who told us ‘tight belts cause cancer’. Both the Telegraph and Mail explained that researchers from Glasgow University had found that wearing a belt too tightly could raise the risk of developing throat cancer because it increases the risk of acid reflux.

But, as NHS choices was quick to point out, this was a very small experimental study lasting only a few days. Participants were asked to wear a weightlifter’s belt – not the sort of thing many of us wear around our waists - and the researchers went on to find changes in the cells at the junction between the stomach and the oesophagus.

These changes can cause acid to leak back up from the stomach and into the junction. But it’s unlikely this would trigger the onset of throat cancer.

Before we go there’s time to mention the National Cancer Research Institute Cancer Conference, which takes place at the start of November. The NCRI conference brings together some of the world’s leading researchers and clinicians to discuss the latest work into cancer.

We’ll be bringing out a special edition of the podcast featuring interviews with researchers at the conference – so keep an eye out later in the month.

That’s all for November’s podcast, we’ll see you again next month for a look at all the latest cancer news.

We’d also like to answer your questions in our podcast, so please email them to podcast@cancer.org.uk, post on our facebook page, or tweet us – that’s @CR_UK. And if you’re listening to this on Soundcloud, please leave us a comment with your feedback. Thanks very much and bye for now.