5 Circulating Tumor Cell Testing – The What How and Why.mp3: Audio automatically transcribed by Sonix
5 Circulating Tumor Cell Testing – The What How and Why.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Speaker1:
Welcome to the Cancer Secrets podcast. Changing the Cancer Paradigm. Hosted by Dr. Jonathan Steagall, a medical doctor and cancer specialist practicing in Atlanta, Georgia, deeply affected by his grandmother's death from stomach cancer, as well as patients he cared for in medical training, he realized there has to be a better way to treat cancer. Dr. Stegall has a unique and innovative approach to treating cancer called integrative oncology, combining modern medicine with alternative therapies personalized to each patient. This podcast is designed to educate, support and give you a positive voice you can trust. We invite you to join us on this journey as we seek to change the cancer paradigm.
Speaker2:
Hello and welcome back to the Cancer Secrets podcast. I'm your host, Dr. Jonathan Stegall. This is episode number five. If you're new to the show, please go back and listen to my introductory episode to learn more about me and my vision for this podcast. In today's episode, I'm going to introduce some very important blood tests that I use to evaluate cancer. Now, these are tests which most oncologists don't even know about. I will talk to you about the what, the how and the why behind these tests and why I believe they're extremely important, not only for how we understand cancer, but also how we develop personalized treatment plans for each patient. I invite you to grab a family member or a friend to listen in together? Today's show is going to be foundational to our podcast as a whole and reveal the basics behind my personalized approach to blood tests and cancer treatment. If you've been diagnosed with cancer or has a family member or friend who's been diagnosed with cancer, you're aware of the standard procedure. A diagnosis is made based on a biopsy or a surgery of some sort. The diagnosis is formally made. A stage is given and treatment has started. In many cases, these treatments will be successful and the patient will be told, congratulations, you're in remission, your cancer free. Everything's good. In this cancer is typically going to be evaluated on an ongoing basis, technically with some sort of scan or lab test. However, this is a very reactive approach.
Speaker2:
We're basically waiting for cancer to come back and not until it's seen on an image or in some sort of blood test. Will there be any indication that that's occurred? Or perhaps cancer treatment is ongoing. Cancer is active. But what are we really basing our results on? In either case, we need to be aware of what are called circulating tumor cells. These are sometimes abbreviated as ctcs, but circulating tumor cells are essential to monitor so that we can actually track our progress, whether we're fighting cancer or whether cancer is considered in remission. Circulating tumor cells are released by all types of cancer before tumors are even large enough to show up on a scan. They're already releasing these circulating tumor cells, and as their name suggests, they're floating around in the blood and they're just waiting for the right opportunity to form cancer elsewhere in the body. This is the main way cancer spreads. I have many patients who come to me as a new patient, and unfortunately their cancer has come back. Many of them are extremely confused as to how that could have happened. They say, Dr. Segal, I did all the right things. I had surgery to remove my tumor. I went through chemotherapy, radiation, immunotherapy. I was told I was cancer free. Now it's a year later. It's two years later. It's five years later. How did my cancer come back? How is that possible? And I explained to them that circulating tumor cells were release into the blood when the tumor was present.
Speaker2:
And that even though the tumor was removed and even though treatments occurred, those circulating tumor cells were not appropriately targeted. Unfortunately, I see this all the time in my practice. The circulating tumor cells are like any other cancer cell. They're immortal unless we kill them and they have no incentive to die if we simply ignore them. Now that we know what circulating tumor cells are, let's talk more about why we want to measure them. Measuring them as early as possible in the diagnosis is critical because it gives us an idea of the systemic burden of cancer. I've spoken in other episodes about needing to avoid having tunnel vision when it comes to cancer. It's easy to fall into the trap of viewing it a problem in the cancer location only. For example, if a patient has breast cancer, it's easy to get focused on the breast and the health of the breast. And thus, how do we treat the breast? How do we remove a tumor? How do we apply radiation to a tumor in the breast? However, cancer, as we know, is a systemic disease. It affects the whole body. And these circulating tumor cells are an excellent way to measure the systemic nature of cancer. This baseline level of circulating tumor cells also gives us a good prediction for the risk of cancer spread. Now, I'm sure you're probably thinking, what about other cancer markers I've had on blood tests? Some examples of these are the PSA for prostate health or breast cancer markers such as C-A 27.29 or CA 15 three, or for gastrointestinal cancers, the CA 99.
Speaker2:
These are called tumor antigens or cancer antigens, and they are released by cancer cells. But these are not diagnostic markers. Nor are they reliable predictors of. Treatment success. Circulating tumor cells, in contrast, are a wonderful way to measure the burden of disease. With a tumor markers I just mentioned, such as PSA CE 27.29 C 15 three and CA 99, among others. They're very unreliable. I've had stage four cancer patients who had normal levels of these markers. And in contrast, I've had patients who don't have cancer, have elevations in these markers. In some circumstances, they can be helpful to us. When a patient with known cancer has a very high levels of some of these markers, and we can follow those markers over time to evaluate response to treatment. The problem, though, is increases in these numbers occur not only when cancer is worsening, but also as there is die off when cancer cells are being killed. So I do monitor these cancer antigens, but I don't put all of my trust in them. Now you're probably wanting to know why are circulating tumor cells not the standard of care. The temptation is to assume that they're not the standard of care because they're not valid tests. The problem is that insurance companies have not yet recognized.
Speaker2:
Their value and thus they don't reimburse for them. If insurance doesn't reimburse for it, it's not going to be the standard of care you're likely to get when you discuss this with your mainstream oncologist. There are several different labs which measure circulating tumor cells, and all of these tests involve collecting blood in the office. The blood is then sent off to the lab, just as we would do for routine blood tests. Now there is one circulating tumor cell test that is FDA approved, and it's called the cell search test. It's approved to monitor breast, colorectal and prostate cancer. Now, this is a test that's available through conventional labs such as LabCorp and Quest Diagnostics. This is a good test to measure as a baseline. However, it only measures one type of circulating tumor cell. It turns out there are many types of circulating tumor cells. The test I use in my office for this purpose is called the bio sept test. Now this is a newer test. It's not FDA approved, but it is from a lab in California. So turnaround time is generally about a week or so. This test uses advanced technology, which allows for a wider variety of circulating tumor cell types to be measured and detected. Measuring this as early as possible in the diagnosis and then monitoring it as we go through treatment, is an excellent way to get feedback as to how we're truly doing. Now, of course, this information is going to need to be balanced with other lab testing and imaging as well as symptoms, if any.
Speaker2:
But I do feel that this should be the standard of care. There's another circulating tumor cell test which some of you may have heard of. It's through a lab in Greece known as the Research Genetic Cancer Center. Now they have several tests centered around measuring circulating tumor cells. Their general tests for measuring ctcs is known as the onco count test, but they've developed technology which allows them to not only measure circulating tumor cells, but also do additional testing. For example, their Rolls Royce test is known as the economics plus test and the economics plus test measure circulating tumor cells. But then it takes it a few steps further. It also evaluates the genetics of those circulating tumor cells, which allows us to see which genes have been mutated and even the degree to which they're mutated. This allows us to see and to make predictions based on these genetic changes. Probably the most well known aspect of the economics plus test is the sensitivity testing that's provided. The Research Genetic Cancer Center is able to replicate the circulating tumor cells they detect so that they have thousands of copies of the same cell, which of course, are the patient cells. In the sensitivity testing they perform includes not only chemotherapy agents, but also immunotherapy agents, other pharmaceuticals and even nutritional supplements. The sensitivity testing they provide. We'll test each substance one by one against a group of these circulating tumor cells, and a kill rate will be obtained.
Speaker2:
So the report provides us with agents which killed cancer in the lab and also shows us the ones that did not have any effect on the cancer cells. So it's normal for most patients to have. Some agents, which worked very well, and other agents that didn't really do anything at all, and then a mix of other agents in between. As you can imagine, testing through the research genetic cancer center is controversial. It is not FDA approved and it's not generally accepted in the United States. I've done many of these tests on my patients, and I do feel that it provides valuable information. The nice thing about their testing is that it allows us to not only measure circulating tumor cells, but also to provide additional information as to the sensitivities and potential effectiveness of various agents. The problem we run into with this test is that it is a lab based test. It's in vitro testing done in a petri dish is very controlled. It's a nice, simple, controlled environment. Just because things kill cancer in the lab. That does not mean that it kills cancer in the body. I'm always careful to tell patients that we need to use the results from tests such as the economics plus test as a guide, as a potential predictor of success, not as a guarantee that the substances that were successful on the test will necessarily kill cancer in the body.
Speaker2:
However, if we're simply trying to monitor circulating tumor cells, I do not feel that the onco count test through the Research Genetic Cancer Center is the best one in that situation. I always recommend the bio test. There are some other blood tests I'd like to discuss today, the first of which is known as the IV gene test. This is a newer test, and it not only measures circulating tumor cells, but it measures methylated circulating tumor cells. Now, methylation is important. Some of you may have heard of methylation and its importance in the body. Many people now are able to measure what is known as the MTA gene, and when that gene is mutated, it can tell us certain things about health risks for that patient. Methylation when it comes to cancer cells and more specifically methylated circulating tumor cells is not exactly the same thing, but it's still involves the idea of methylation, which is tagging certain cells with methyl groups. Now going back to high school chemistry, a methyl group is one carbon and three hydrogens. So when cancer cells are methylated, that turns them on and actually makes them more active in the body. So by measuring methylated circulating tumor cells, we get a good idea of not only the presence of cancer, but also the activity of cancer. I feel that this has a lot of potential benefit. As one more tool we can use to measure along with a regular circulating tumor cell number such as that found through the bicep test.
Speaker2:
So as you can see, we have a lot of great tools in our toolbox when it comes to laboratory testing. I highly recommend that if you have cancer, that you have some sort of measurement taken of your circulating tumor cells. And again, my recommendation would be to definitely obtain a baseline level, such as the bicep test, to see what the circulating tumor cell is. And the bicep test is going to give us the most accurate measurement available today. Since it's technology is the most robust. A good companion to that is the IV gene test, which measures methylated circulating tumor cells, which not only measures the level of circulating tumor cells, but more importantly, the methylated circulating tumor cells. And this is going to be a different number than the circulating tumor cell count we get from the bicep test. And of course, measuring circulating tumor cell levels does not replace standard labs that we would get, including kidney function, liver function, immune system function, vitamin levels, hormone levels, etc.. I hope you found this information today to be helpful. I feel that this can and should be a vital part of cancer monitoring and diagnosis today. In Episode six, we're going to dive deeper into the details of integrative oncology, including additional tests and diagnostic tools we can use to help us. Thank you again for spending your time with me today. Hope you have a great rest of your day and I look forward to next time.
Speaker1:
Thank you for listening to the Cancer Secrets podcast. If you were encouraged by this show, please share it with a loved one or friend. Help support the show by leaving us a rating and review on iTunes. The more reviews, the more friends like you can find the show. Finally, to learn more, visit us online at Doctor Stay Google.com. The Cancer Secrets Podcast. Changing the Cancer Paradigm.
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