Issue 17 | May 2018
May is Skin Cancer Awareness Month
Summer has well and truly arrived across many parts of India this month and with the UV index at its highest for most parts of the country on most days, protecting your skin from the damaging effects of ultraviolet rays (aka sunlight) should be on the top of your agenda whenever you are venturing outdoors. This month, we also bring liquid biopsy and its power to catch cancer in the act back into focus.
The myStrand Team!
Be Aware of Skin Cancer
Yes, summer has descended on most parts of the country, in some places with more vengeance than others. Yet besides the obvious risk of heat related illnesses like sun stroke, or heat stroke, there is another, arguably less visible danger. Ultraviolet (UV) light is one of the components of sunshine and the leading cause of skin cancers. In the US, skin cancer is actually the most common type of skin cancer with over 91,000 new cases expected in 2018. Here in India, skin cancer is not exactly one of the main cancers afflicting the population, but it is nonetheless worth writing about, because every life counts and most cases could be prevented by following simple preventive measures. And if detected and treated early, it is almost always curable.
How do you prevent skin cancer?
Let us start with the first question. There are a handful of simple rules to follow, to protect your skin, regardless of whether you are light-skinned or a darker shade. They are:
Key rule to remember here is: “Never get burnt!” Getting sunburnt on any part of your body more than 5 times doubles your lifetime skin cancer risk. With a UV index of 10 and above across the country and on most days, even those among us blessed with a darker complexion are at risk of sunburn according to this scale on weatheronline.in.
And you should follow this advice to the letter, especially if you are genetically predisposed to a certain type of skin cancer. 5-10% of melanomas (the kind that is most likely to metastasize) can be attributed to a genetic predisposition (with a genetic mutation running in the family that gives skin cancer a head start). Plus, even for the other two major types, basal cell carcinoma and squamous cell carcinoma, genetic syndromes have been identified. Always talk to your doctor if you suspect such a syndrome in your family!
How do you spot the first signs of skin cancer?
This is one thing I had been wondering about myself for some time, having burnt my skin a couple of times and therefore looking suspiciously at any new blotch or blemish I discover in the mirror. But hey, who is going to run to the dermatologist every other month to check. That would be burning a serious hole in mine and I’m sure most other people’s pocket. However, while researching for this article, I learnt that all it takes is to relearn your ABCs. Yes, you read that right. Skin experts across the globe have boiled down the process of self-examining your skin to these 5 simple points:
A for Asymmetry: Look out for moles or birthmarks that are not symmetrical in shape.
B for Border: Caution is advised if an existing or new mole or other mark develops an irregular, ragged, notched, or blurred border
C for Color: Harmless freckles and spots usually are the same color all over. If you spot a mark that appears in several shades of brown or black, sometimes even with patches of pink, red, white, or blue, seeking professional advice is called for.
D for Diameter: The size (or diameter) of any lesion you might discover or monitor for changes is important, too. Any spot larger than a ¼ inch across in combination with any of the other signs warrants a visit to the dermatologist.
E for Evolving: This is where the ‘check your skin regularly for any changes’ comes in. Cancer is an evolving process with the tumour typically growing over time (or the number of cancerous cells increasing over time). The only way to spot if a mole is changing in size, shape, or colour is to check your existing spots regularly and take notice of any new ones. Contrary to a common assumption, many skin cancers do not originate from existing moles or birthmarks, but arise as new blemishes and evolve from there.
We found the following website particularly helpful thanks to its clear visual references as to what each of these points could look like: https://www.cancer.org/latest-news/how-to-spot-skin-cancer.html
Some additional reading
Here’s a list of some additional links with useful information on skin cancer, prevention, the role of genetics, and guides on how to spot the disease early.
About skin cancer: https://www.cancer.org/cancer/skin-cancer.html
Defining skin cancer: https://blog.skincancer.org/2017/11/13/defining-skin-cancer/
ASK THE EXPERT: Can darker-skinned people get skin cancer? https://www.skincancer.org/skin-cancer-information/ask-the-experts/can-darker-skinned-people-get-skin-cancer
Cowden Syndrome – a patient story: https://www.cancer.org/latest-news/melanoma-and-thyroid-cancer-survivor-has-inherited-syndrome.html
Genetics of skin cancer: https://www.cancer.gov/types/skin/hp/skin-genetics-pdq
Disclaimer: The information provided in this article is in no way intended to replace expert medical advice. Always discuss any concerns with your doctor.
Indians get skin cancer, too!
Many Indians mistakenly believe that their darker complexion (caused by extra melatonin in the skin) protects them from the harmful UV rays that cause skin cancer. Unfortunately, this protection is nearly cancelled out by the fact that UV radiation is much more intense in tropical countries like India. Therefore, even in India, dermatologists recommend the use of sunscreen, or even better to cover up, especially if you work a lot outdoors. And don’t forget, your car window does not block the harmful UV rays!!
If in doubt about a growing mole, warts, or abnormal patches on your skin, go to a dermatologist for professional screening and testing! Early diagnosis is the key to the best treatment outcomes in skin cancer, just like in any other cancer! Take care! Read More …
Caught in the Act – The Power of Liquid Biopsy
How does your doctor determine what is wrong when you present him or her with an array of symptoms, let’s say fatigue, rapid heartbeat, especially following exercise, dizziness, pale skin, and insomnia. The doctor will ask you to get some tests done – most probably a blood test in our example. You get it done and your report says that you have low hemoglobin, which means your doctor will likely diagnose anemia. Practically all forms of anemia are treatable and your blood test has given your doctor the opportunity to take a close ‘look’ at the underlying causes of your health problem.
Other diagnostic tests follow the same pattern:
For most illnesses, there are techniques to visualize what is going on in our bodies and help doctors understand what went wrong. These reports and images are powerful tools that help your doctor accurately evaluate your condition.
So what about cancer? There are many methods by which suspected tumours can be visualized for diagnosis and preparation of surgery – some the same as listed above, some more specialized like PET scans. However, one of the key issues of cancer is metastasis, when individual cancer cells have detached from the original tumour and either still move through the blood stream or have started to start another tumour elsewhere in the body? How can we ‘see’ what is going on in the rest of the body, especially after surgery and starting treatment? Is the treatment working? What if the cancer comes back and starts growing on another organ, where symptoms will appear much too late to discover a tumour using these visual techniques in time to adjust or change treatment?
Well, almost exactly one year ago, a new test was introduced to the Indian market. Everyone called it Liquid Biopsy, but really it is just another blood test. Ok, fair enough, when it comes to the work happening back in the laboratory analyzing your blood, it is not your average blood test because a whole lot of technological innovation and data crunching goes on before you get your report about a week later. But yes, for the patient it is just another blood test when it comes to not having to go to the hospital and wait in line for an X-ray, MRI, or CT scan, or maybe even be injected with radioactive dye for specialized diagnostic tests like PET scans often used to look for cancer recurrence.
This so-called Liquid Biopsy is a method that allows scientists to check for clues that cancer cells leak into the blood stream when they die – their DNA, sometimes also called circulating tumour DNA (ctDNA). Most tumours have a unique pattern of gene mutations that allowed its constituting cells to turn cancerous in the first place. This pattern is like a tumour fingerprint or a unique barcode.
Now, when we laboratory receives a slice of a tumour (the tumour biopsy), it is possible to extract DNA from it and determine this ‘barcode’ because we know what mutations to look for depending on the type of cancer..Actually, these days we can even determine this barcode from a liquid biopsy, appropriate for situations where the doctor is not able to surgically remove or biopsy a tumour, which is often the case for lung cancer or brain cancer.
How does establishing this barcode help the doctor and patient? For one, knowing the barcode, or the various mutations present in a tumour, can help choose targeted treatments known to target exactly those mutations to be prescribed alongside or instead of chemotherapy. Further down the line, once a patient starts therapy, liquid biopsies can be used at the desired frequency to check whether the tumour DNA barcode still shows up in the blood, or not, providing a look at what has happened after surgery and what effect treatment has had on the tumour or any remaining tumour cells.
Skeptics are bound to say, “So what? There are PET scans to ‘see’ if the cancer spots are back or not.” And that is true, however, you can perform a PET scan only once in 6 months, because of the exposure to radioactive dyes. Liquid biopsy tests are NOT radioactive and can be performed at any frequency. Also, more and more research is showing that DNA evidence of recurrence is usually present in blood (and other bodily fluids) much AHEAD of development of cancer spots that are visible on a PET scan.
Since introducing this Liquid Biopsy for cancer, we have seen this test option used by patients and doctors in different ways. Take one of our colorectal cancer patients, for example. We determined the tumour barcode from a blood sample drawn ahead of his surgery to remove the tumour and found a mutation in the KRAS gene, which is known to cause colorectal cancer. Thereafter, he opted to get blood tests done to look for the same mutation every four months and was relieved to find that the mutation was not detected in his blood on any of those occasions.
For another patient suffering from lung cancer the doctor was able to make an informed decision to switch targeted treatments when resistance to the first-line treatment was detected. Liquid Biopsy further provided a more detailed picture of overall tumour load helping with overall evaluation of the patient’s health status and prognosis.
Will this work for all types of cancer, you ask? Not quite yet, scientists are still working on this ‘holy grail’ of early detection of any type of cancer, which is largely elusive because cancer is not one single disease but rather many individual diseases with their own characteristics and ‘barcodes’. However, for many well-studied solid cancers, these liquid biopsy tests are already a reality. So in the unfortunate event that you or a loved one is affected by cancer, we encourage you to discuss these options with the doctor to see whether they can benefit.
To find out more about how Liquid Biopsies and other genetic tests have helped patients, read their stories.
Disclaimer: The information provided in this article is in no way intended to replace expert medical advice. Always discuss the best possible course of action for your situation with your doctor.
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