A little more than five years ago, Stanford brought together its surgeons and scientists, its researchers and radiologists, with the opening of the Stanford Cancer Center. Patients found themselves in a more comfortable environment where they could go for both diagnosis and treatment. Doctors found a place of collaboration that brought together 270 members to better understand and treat cancer.
Three years later, the National Cancer Institute designated Stanford's Cancer Center as a National Cancer Institute Cancer Center—a designation, the institute noted, "characterized by scientific excellence and the capability to integrate a diversity of research approaches to focus on the problem of cancer."
Today, Stanford Cancer Center physicians and scientists continue to be at the forefront of cancer research, working for better diagnosis, treatments and understanding of this class of diseases. Here are three promising approaches.
MOLECULAR IMAGING
Radiology professor Sanjiv Sam Gambhir describes them as spies. In academic papers they might be called molecular probes or tracers, but Gambhir, director of Stanford's molecular imaging program, enjoys the espionage analogy.
Much of medical imaging is anatomical—a chest X-ray, a CT scan—showing a map of density, but not providing any information on cells. "Molecular imaging asks a different question," Gambhir explains. "If disease occurs at the cellular level, where either genes that are mutated started to become expressed, or other errors occur in your cells, how do we image disease at this level?"
That's where his spies come in.
"We can't quite see what's going on inside every cell from the outside world," he says, "but I could send in little molecular spies and those spies are not recognized by your body so your body lets them freely travel around, and those spies then do a house-to-house search, literally going from one cell to another to another, and when they encounter a problem, they send a signal back to us."
It's the merging of molecular and cell biology. The spies are molecules altered by Gambhir's lab to be able to activate some kind of signaling device—light, sound or radiation—and each designed for a specific purpose, such as detecting a certain cell.
Molecular imaging is helping change the way cancer cells are detected and diagnosed, as well as providing information as to how a particular cancer responds to a given treatment. In June, the Canary Foundation, the School of Medicine and the department of radiology pledged $20 million for the Canary Center at Stanford for Early Detection, which Gambhir will lead.
PROTEIN TARGETS
For several decades, researchers have worked on identifying and categorizing mutations that occur in normal cells and result in the transformation to cancer. "We've categorized many of these mutations," says Amato Giaccia, professor of radiation oncology, "but with no real way to exploit it."
By exploiting genetic differences between tumors and normal tissues, Giaccia and many of his colleagues hope to refine the specificity of chemotherapy, targeting toxicity just to the cancer cells.
For example, by inhibiting a protein called connective tissue growth factor, which leads to the growth of pancreatic cancer, Giaccia and his team were able to slow or prevent tumor growth in mice. And in the lab of liver cancer surgeon Samuel So, research showed that blocking a protein labeled CDC25B—which is overproduced in primary liver cancer—decreased tumor growth in cell cultures and mice.
"Many different tumors are amenable to this approach," Giaccia says. "It represents a very significant advance in thinking about the next generation of cancer chemotherapies."
DNA MICROARRAYS
"Most of our diagnostic methods today involve a pretty barbaric thing—cutting people open," associate professor of dermatology Howard Chang says. For many cancers, getting a biopsy to examine the cancer cells is invasive, sometimes involving significant surgery. It can damage tissue, cause unnecessary pain and require recovery time. But what if we were able to gain the same information from a noninvasive test?
With the DNA microarray (whose pioneers include biochemistry professor Patrick Brown) revolutionizing molecular biology, researchers like Chang are now able to analyze tens of thousands of genes at a time. The genes are printed onto a small gene chip, where gene expression and patterns can be monitored simultaneously, to understand the design and behavior they dictate in cells.
Chang describes the theme of his research as trying to understand how large groups of genes work together. Two years ago, he and his colleagues published a study on how images from CT scans and other radiology scans could be linked with DNA microarrays, connecting the gene activity to the image patterns to provide information on the genetic makeup of a tumor.
By understanding the genetic activities of the cancer cells, doctors would be better able to understand the disease in a patient, in terms of both diagnosis and prognosis, as well as have a guide for which drugs might be most useful. Matching gene expressions with outcomes of cancer has the promise of leading to new tests and treatments.
