Metabolic fingerprinting can indicate colorectal cancer advancement

The metabolic “fingerprint” of a colorectal cancer can indicate how advanced it is, according to new research.

Colorectal cancer is the third most common type of cancer globally, with over one million new cases diagnosed every year. Accurately determining what stage a tumor has reached is crucial for deciding which treatments to offer.

Metabolites are the products of chemical reactions in the body's cells, and metabolic fingerprinting assesses their levels in samples of blood, urine, or tissue. This mix of metabolites alters as cancer develops and grows. The researchers behind the new study, from Imperial College London in the United Kingdom, suggest that doctors could use metabolic fingerprinting alongside existing imaging technology to give them the most accurate possible analysis of a tumor. The work was published in the journal Annals of Surgery (2013; doi: 10.1097/SLA.0b013e31829d5c45).

Doctors currently use a combination of CT, MRI, and ultrasound scanning to evaluate how advanced a tumor is, but because these scans rely on visual estimations of a tumor's size and location, they are not always sufficiently sensitive or specific. Previous studies have shown that these techniques regularly suggest that a tumor is more or less advanced than it really is.

"Working out the stage of a tumor is critical for planning a patient's treatment. Increasingly, before we surgically remove a tumor, we will give therapies to try and shrink it down, but the kinds of therapies we offer depend on our assessment of how advanced that tumor is. The more accurate we can be, the better the patient's chances of survival,” said lead author Reza Mirnezami, MBBS, MRCS, of Imperial College London. "Our research suggests that using metabolic fingerprinting techniques in addition to scanning could give us the clearest possible picture of how the cancer is progressing."

For the new study, researchers analyzed the metabolic fingerprint of 44 colorectal tumor tissue samples using high-resolution magic-angle spinning nuclear magnetic resonance spectroscopy (HR-MAS NMR). Their results were as accurate at determining the stage that the cancer had reached as existing radiological methods.

Senior author Lord Ara Darzi, MD, also of Imperial, said, "We know that even with the impressive scanning technology we have available at the moment, it's not always possible to correctly ascertain the local stage of a cancer. Our study suggests that used alongside medical imaging, metabolic fingerprinting could enable us to gain more accurate information. This would give us greater certainty about the right course of treatment to give to patients, sparing some patients from invasive treatment where they don't need it."

The research also suggests that tumors take on unique metabolic properties as they become more advanced, opening up new avenues for treatment. The researchers hope that, ultimately, it may be possible to take out different metabolic targets when the cancer is at different stages in order to disable or slow down the tumor.
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