Thanks to a pan-European health consortium, however, a new concept that uses photonics to help doctors spot bowel cancer could soon prevent up to half of these deaths and save €9 billion in reduced healthcare costs.
While there are currently no tools that can look inside the colon at the cellular level in real-time to give an immediate diagnosis, a European research team based across Denmark, Germany, the UK, Ireland and Austria is creating a new optical imaging platform that uses harmless light beams to spot the tell-tale signs of colon cancer at an incredibly early stage.
This new optical imaging technique can assist clinicians to avoid unnecessary invasive biopsy by instead peering into the tissue in much greater detail than ever before.
Fitted to an endoscope, the optical imaging system can give clinicians the power to zoom in on areas of the intestine they identified for inspection. Building up rich 3D images, the new device uses light to make a more detailed examination at incredible speeds.
First, using conventional white light in a camera, then using more advanced photonics and optical imaging, a doctor can look at the microscopic and molecular levels – switching across the different modalities to look deeper and analyse the tissue further.
To increase the spatial resolution, penetration depth, and molecular sensitivity, the team have combined several methods, namely optical coherence tomography (OCT), multi-photon microscopy, and Raman spectroscopy. Scientists are already applying these modalities as stand-alone methods in several different applications; for example, OCT is routinely used in ophthalmology for scanning and diagnosing retinal diseases.
The number two cause of cancer deaths in Europe, colorectal cancer (CRC), which kills a staggering 160,000 people every year across Europe. A lack of specific, early diagnostic tools and education means just over one-tenth of the population receive adequate screening.
Diagnosing bowel cancer can be a tricky procedure for clinicians: when examining polyps – clusters of cells that form along the ridges of the colon that could go on to develop cancer – doctors can sometimes miss a precancerous growth. According to a 2017 study, nearly 1 in 5 (17.2%) colorectal polyps were missed during colonoscopies.
"Our imaging procedure starts with conventional white light to identify a suspicious area a clinician would like to inspect further. Next, we can zoom into the depth of the lesion using first OCT, then multi-photon microscopy for metabolic information, and finally Raman spectroscopy for molecular information (almost a molecular fingerprint of cancerous cells) to assess the suspected lesion,” explained project coordinator Peter Andersen.
“Cancerous cells have a higher metabolism than the adjacent, non-cancerous cells, implying higher blood flow and vessel growth surrounding suspected lesions. Once zoomed in on a lesion at the cellular length scale, we can measure blood flow, metabolism and molecular-specific information to identify cancerous lesions at cellular resolution. Our technology is, for the first time in colon inspections, an all-in-one device and, most importantly, label-free, meaning we do not have to inject a patient with dyes or biomarkers to flag up something suspicious.”
Called PROSCOPE, the consortium has set itself ambitious targets to save up to half of the 160,000 lives lost annually in Europe to CRC.
“Currently, only 14% of the EU population participates in screening programmes due to inconvenient tools and insufficient education or awareness. With early intervention, we could do so much more, save more lives and reduce healthcare costs; PROSCOPE is a crucial step in this journey to tackling this disease," said Andersen.
The project is being coordinated out of the Danmarks Tekniske Universitet in Denmark and includes a mix of technical partners from: Austria - Medizinische Universitaet Wien; United Kingdom - The University Court Of The University Of St Andrews, M-Squared Lasers Limited; Germany - Albert-Ludwigs-Universitaet Freiburg, Grintech Gmbh, Ovesco Endoscopy Ag, Universitaetsklinikum Freiburg, Din Deutsches Institut Fuer Normung E.V.; Ireland - Q4 PR.