Patient Experience
The Cancer Molecular Diagnostics (CMD) laboratory provides a range of tests designed to improve the diagnosis and treatment of different forms of cancer (leukaemia, lymphoma and solid tumours). Cancer cells differ from healthy cells due to small changes in cancer cells’ DNA. These DNA changes, or mutations as they are commonly described, enable cancer cells to grow in an uncontrolled manner. While these mutations enable cancer to grow they can also be used to identify certain cancers or to predict more accurately what treatment would best suit a particular type of cancer. This type of testing is referred to as ‘molecular testing’ as it assesses the makeup of the cancer at the molecular, i.e. DNA, level.
The selection of treatment based on the type of mutation present in a sample is referred to as ‘Stratified Medicine’. With a stratified medicine approach the treatment selected by a haematologist or oncologist is better targeted to the specific type of cancer. In the case of leukaemia it might mean that a haematologist can select between different types of chemotherapy or bone marrow transplantation. In the case of a solid tumour such as lung cancer it might mean that a mutation profile of a cancer will be obtained to help the oncologist decide if a particular cancer will respond better to chemotherapy or targeted therapy. Targeted therapies are designed to target the specific mutations present in some cancers and ‘switch-off’ the process in the cancer cell that allows it to grow in an uncontrolled manner. Haematologists and oncologists refer samples directly to the CMD laboratory for specific types of cancer where there is a proven benefit to molecular testing. This approach is referred to as ‘standard-of-care’ testing and represents the significant majority of testing performed by the CMD laboratory.
In some cases a haematologist or oncologist may be aware of a clinical trial that may be recruiting patients with a specific cancer type. Where the inclusion criteria for the clinical trial require a molecular test then this testing may also be performed by the CMD laboratory. The CMD laboratory accepts requests for clinical trials testing from designated clinicians in line with clinical trial protocols. Additionally, in some rare cases it may be of benefit to screen a patient’s cancer for a broad range of mutations to try and identify a suitable clinical trial. In this case the potential benefits of testing with a multigene mutation panel will vary from case to case and the decision to submit samples for testing is often reached following discussion between patient and clinician. The laboratory provides multi-gene testing for a range of cases using a test known as the Oncomine® panel from ThermoFisher. This panel covers a range of high-value genes which may be used to select an appropriate clinical trial. Requests for Oncomine® testing are submitted directly by oncologists who will also arrange for tissue to be forwarded for testing.