At the start of Bowel Cancer Awareness Month, we have heard the positive news that bowel cancer patients may soon be able to avoid chemotherapy by having a simple blood test to detect traces of cancer cells following surgery.

A major trial involving around 1,600 bowel cancer patients opened at The Royal Marsden NHS Foundation Trust last week. The study called TRACC (tracking mutations in cell free DNA to predict relapse in early colorectal cancer) is looking into whether a blood test can reliably show if surgery has removed all of the tumour. If successful, it could mean thousands of patients are spared toxic chemotherapy and the associated side effects.

Treatment for bowel cancer often involves surgery to remove the tumour followed by chemotherapy to kill any cells left behind and reduce the risk of the cancer returning. However, doctors say around 50 per cent of bowel cancer patients are cured by surgery alone which means many are currently undergoing chemotherapy unnecessarily.

Chemotherapy for bowel cancer can cause debilitating life-long side effects. This can make it difficult for them to return to work or carry out their usual activities of daily living.

How does the blood test work?

The study will evaluate the use of circulating tumour DNA to guide treatments decisions after surgery in patients with early stage colorectal cancer.

A sample of blood is taken for a liquid biopsy which is examined to check for microscopic traces of cancer in the blood, called circulating tumour DNA. These tiny cell fragments cannot be detected on a scan. If they are not present in the blood, this is considered a good indicator that the patient has been cured by surgery. In these patients, treatment can be de-escalated which means they can be given chemotherapy in tablet form with fewer side effects, or no chemotherapy at all.

The trial uses a test created by US company Guardant Health. The liquid biopsies are packaged and sent to their labs in California for testing with the results coming back in around two weeks.

Dr Naureen Starling at the Royal Marsden Hospital is the principal investigator on the trial and she is hopeful about the results.

“The hope is that this specialised technology could spare many patients unnecessary chemotherapy. That’s good for the patient, it’s good for the health service, it’s good for cost savings within the NHS. That would be a win-win,” she says (BBC).

The trial will examine any difference in survival rates after three years between those patients whose treatment was guided by the blood test results and those who had post-operative chemotherapy as currently recommended.

Hopes for the future

Similar trials are also underway in the UK for patients with lung and breast cancer so the possible impact of this technology across cancer care generally is huge.

Dr Starling says the potential benefits are not just in relation to the detection of residual disease but also for early diagnosis.

At JMW Solicitors, we have represented many clients with bowel cancer where their diagnosis and treatment has been delayed. We are therefore well aware of the importance of early diagnosis and treatment and how devastating the consequences can be when this does not happen. We also understand how gruelling chemotherapy can be for many cancer patients.

Any new technology which makes treatment options for cancer patients less debilitating and reduces the pressure on an already stretched NHS can only be a good thing.

We await the outcome of the trial with interest.