Public Release: 

Singapore identifies mutations that may enable earlier diagnosis of colorectal cancer recurrence

The findings will be used to develop diagnostic kits for individual patients with colorectal cancer to detect future liver metastasis

SingHealth

Singapore, 18 March 2015- A multi-disciplinary team of doctors and scientists from Singapore has characterised the genetic changes associated with the spread of colorectal cancer to the liver. This finding is significant in helping to develop personalised diagnostic tests for patients with colorectal cancer based on the genetic changes present in each individual's colon tumour. The research team comprises representatives from National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH), Duke-NUS Graduate Medical School (Duke-NUS), A*STAR's Genome Institute of Singapore (GIS) and Cancer Science Institute Singapore (CSI Singapore) of the National University of Singapore (NUS). The findings were published online in Genome Biology.

Colorectal cancer is Singapore's most common cancer and incidence rates continue to rise. Most patients are initially diagnosed with an early stage disease. However, a proportion of these patients will develop a recurrence of the cancer (metastasis), typically in the liver, one to three years after their colon surgery. If identified early, the liver metastasis may be amenable to surgical removal, and cure may still be possible.

The Singapore team used leading edge DNA sequencing tools, some of which were developed in-house, including specialised laboratory techniques and computational methods developed at Duke-NUS and GIS to characterise genetic alterations associated with the spread of colorectal cancer to the liver.

Out of 750 genes measured, they found that every individual's cancer had a unique set of about 15 key genetic mutations. Whilst there was little overlap in the specific mutations present between 2 different patients, the large majority of the mutations found in each patient's colon tumour were identical to the mutations present in the same patient's liver metastasis. The team seeks to exploit this biological finding to develop new diagnostic tests in the search and identification of early spread of the cancer based on the genetic information found in the removed cancer from the colon surgery in the first instance.

Cancer survivors dread having their cancer recur. Even if this happens, we still have a chance to cure our colorectal cancer patients provided we diagnose it early. The research findings can have a significant impact on our patients' quality of life, and improve the precision of the treatment they receive," said co-author of the study, Assoc Prof Tang Choong Leong, Head, Department of Colorectal Surgery at SGH.

"Based on this study, we intend to customise a diagnostic test for each colorectal cancer individual. We will use the unique set of mutations present in that individual's cancer, as a barcode or thumbprint that we can exploit as innovative diagnostics to monitor for cancer recurrence and diagnose it early", explained Dr Iain Tan, co-lead author of the study who is a Consultant Medical Oncologist at NCCS and also a clinician scientist at GIS. The team has been awarded a grant from the National Medical Research Council (NMRC) to further develop this diagnostic test. Dr Tan cautioned that this R&D effort will take several years although he is optimistic that with this finding, further progress could be realised.

This study was performed in partnership with the POLARIS program, a strategic national program funded by A*STAR to translate local research findings towards "fit-for purpose" applications that improve the diagnosis and treatment of diseases in Singapore.

"POLARIS continues to seek opportunities to work with leading local researchers to enable the transition of their research findings from bench to bedside", explained Prof Patrick Tan from Duke-NUS who is a co-lead author of the study and the Program Director of POLARIS.

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For more information, please contact:

National Cancer Centre Singapore

Rachel Tan
Tel: +65 6236-9535
Email: rachel.tan.c.h@nccs.com.sg

Edwin Yong
Tel: +65 6236-9465
Email: edwin.yong.c.y@nccs.com.sg

Singapore General Hospital

Rachel Kelly
Tel: +65 6236-5168
Email: rachel.kelly@singhealth.com.sg

Genome Institute of Singapore

Winnie Serah Lim
Tel: +65 6808-8013
Email: limcp2@gis.a-star.edu.sg

About National Cancer Centre Singapore

National Cancer Centre Singapore (NCCS) provides a holistic and multidisciplinary approach to cancer treatment and patient care. We treat almost 70 per cent of the public sector oncology cases, and they are benefiting from the sub-specialisation of our clinical oncologists. NCCS is also accredited by the US-based Joint Commission International for its quality patient care and safety. To deliver among the best in cancer treatment and care, our clinicians work closely with our scientists who conduct robust cutting-edge clinical and translational research programmes which have been internationally recognised. NCCS strives to be a global leading cancer centre, and shares its expertise and knowledge by offering training to local and overseas medical professionals. http://www.nccs.com.sg

About Genome Institute of Singapore

The Genome Institute of Singapore (GIS) is an institute of the Agency for Science, Technology and Research (A*STAR). It has a global vision that seeks to use genomic sciences to improve public health and public prosperity. Established in 2001 as a centre for genomic discovery, the GIS will pursue the integration of technology, genetics and biology towards the goal of individualised medicine. The key research areas at the GIS include Systems Biology, Stem Cell & Developmental Biology, Cancer Biology & Pharmacology, Human Genetics, Infectious Diseases, Genomic Technologies, and Computational & Mathematical Biology. The genomics infrastructure at the GIS is utilised to train new scientific talent, to function as a bridge for academic and industrial research, and to explore scientific questions of high impact. http://www.gis.a-star.edu.sg

About Singapore General Hospital

Singapore General Hospital, a member of Singapore Health Services, is the public sector's flagship hospital. Established in 1821, SGH is Singapore's largest acute tertiary hospital with 1,600 beds and national referral centre offering a comprehensive range of 36 clinical specialties on its campus. Every year, about 1 million Singaporeans benefit from advanced medical care delivered by its 800 specialists. As an academic healthcare institution and the bedrock of medical education, SGH plays a key role in nurturing doctors, nurses and allied health professionals, and is committed to innovative translational and clinical research in her continual strive to provide the best care and outcomes to her patients. http://www.sgh.com.sg

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