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Research solves pancreatic cancer mystery

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A NEW technique to study tissue samples in 3D has revealed that pancreatic cancers can start and grow in two distinct ways, solving a decades-old mystery of how tumours form.

The new method could help researchers to get more information from tissue biopsies and may lead to improved treatments for pancreatic cancers. The technique was developed by scientists at the Francis Crick Institute, and their results are published in Nature. The work was supported by the European Research Council and core funding from the MRC (one of the Crick’s founding partners).

The pancreas is a crucial organ that sits behind our stomach and plays a key role in digestion. It relies on a network of ducts linking it to other digestive organs, and the most common pancreatic cancers are found in the ducts. However, until now it has only been possible to see 2D slices of these ductal cancers, which contained an unexplained variety of abnormal shapes.

“To investigate the origins of pancreatic cancer, we spent six years developing a new method to analyse cancer biopsies in three dimensions,” explains Dr Hendrik Messal from the Francis Crick Institute, co-lead author of the research paper. “This technique revealed that cancers develop in the duct walls and either grow inwards or outwards depending on the size of the duct. This explains the mysterious shape differences that we’ve been seeing in 2D slices for decades.”

By analysing developing cancers in 3D, the team defined two distinct types of cancer formation: ‘endophytic’ tumours which grow inwards and ‘exophytic’ tumours which grow outwards. To find out what makes cancer cells grow in a particular way, they analysed detailed 3D images and worked with biophysicists at the Crick who created sophisticated computer models.

“We made a simulation of the ducts, describing individual cell geometry to understand tissue shape,” explains biophysicist Dr Silvanus Alt, co-lead author of the paper. “The model and experimental results both confirmed that cancer grew outwards when the diameter of the duct was less than approximately 20 micrometres, around a fiftieth of a millimetre.”

The work was made possible by an interdisciplinary collaboration between two research groups at the Crick, led by Dr Axel Behrens and Dr Guillaume Salbreux. Axel’s group works on stem cells and pancreatic cancer, while Guillaume focuses on using physics to understand biological processes.

“I think we first started discussing this when we bumped into each other in the bike shed,” says Axel. “It’s amazing what can come out of a chance encounter, we now have a patented technique to see the three-dimensional shapes of cancers and a biophysical understanding of the emergence of tumours. Now that we know pancreatic cancer can develop in these two different ways, we can start looking at whether one is likely to be more aggressive or spread in a different way. Many years from now, this could lead to improved diagnostic or treatment options.”

The team also applied the technique to other organs and found that cancers in the airways of the lungs and ducts in the liver behave in the same way. This shows that the mechanism the teams discovered is not specific to the pancreas and also applies to other cancers.

“Both the data and our models indicate that the two different mechanisms of tumour growth are purely down to the innate physics of the system,” explains Dr Guillaume Salbreux. “Like most cancers, ductal pancreatic cancer starts with a single defective cell that starts dividing. We found that very quickly, when there are only a few cells, the tumour has already started to grow either inwards or outwards depending on duct diameter. Defining this fundamental process will help us to better understand how cancer grows in many places across the body.”

Dr Mariana Delfino-Machin, Programme Manager for Cancer at the MRC, said: “Pancreatic cancer remains a very difficult disease to treat but understanding that it can grow in different ways will inform the development of more accurate treatments in the future.

“These findings came about thanks to researchers working in very different fields coming together to successfully tackle the same problem.”

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Health

Ambulance delays as heart attack victims left waiting one hour 57 minutes

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FREEDOM of Information requests reveal the worst ambulance delays out of 22 local authorities in Wales.

Postcode lottery revealed with patients in some areas waiting over double the amount of time for life-threatening calls

The average wait time for amber calls, which includes heart attack and stroke victims was 1 hour 57 minutes. In Swansea, it was 2 hours 33 minutes.

Shocking figures have unveiled the local areas in Wales with the longest ambulance delays, revealing a stark “postcode lottery” for response times to life-threatening calls.

Figures were provided by local authority giving a more local breakdown of the usual Health Board data.

Potential heart attack and stroke victims in the worst-hit areas are now waiting an average of one hour and 57 minutes for paramedics to arrive.

The figures, uncovered by the Liberal Democrats through Freedom of Information requests, reveal how patients whose lives are in immediate danger are waiting twice as long in some rural areas than urban ones. In Anglesey, patients waited an average of 12 minutes and 22 seconds for category 1 calls compared to 6 minutes 31 seconds in Newport.

However, the figures for amber calls painted a much starker picture with an average arrival time of 1 hour 57 minutes in Wales, with the worst in Swansea, where the average wait was 2 hours 33 minutes.

Overall, 13 out of the 22 local authorities in Wales had an average wait of over 2 hours for amber calls.

The Welsh Liberal Democrats are calling for action on the social care crisis in order to free up hospital beds and stop ambulances waiting outside hospitals.

Welsh Liberal Democrat Leader Jane Dodds MS said:

“These figures are heart-breaking, but not necessarily shocking to anyone who has had to call on an ambulance in recent months.

“Far too many people are being left to wait too long in an emergency across every region of Wales. The length of amber calls, which includes stroke and heart attack victims in particularly concerning.

“None of this is the fault of our hardworking ambulance staff who are doing their utmost in extremely difficult conditions.

“We must see an end to the postcode lottery in emergency care, it shouldn’t matter where you live, you should be able to get timely medical attention when you need it most.

“Every day we hear more and more devastating stories of pensioners left stranded for hours, or families watching a loved one die before a paramedic could reach them.

“This cannot continue, the Welsh Labour Government must bring forward extra support to get ambulance services through winter as well as a long-term strategy to ensure people can get emergency care when they need it. That means addressing workforce shortages, fixing the social care crisis and ending the shortage of hospital beds, all of which are leaving patients in ambulances stuck outside A&E for hours.”

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Bereavement books to support children at Bronglais Hospital

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THANKS to donations, Hywel Dda Health Charities has purchased a collection of children’s books on bereavement for the Meurig oncology ward at Bronglais Hospital.

The books help families to support children when there has been a terminal cancer diagnosis.

Ellen Masters, Meurig Ward Administrator, said: “By having these books on the ward we are able to guide and support children and young people dealing with bad news and bereavement.

“Using stories and activities can be a really good way to discuss issues with a child who has been bereaved, helping them to explore feelings and emotions around loss.

“Parents also appreciate having something they can read to children which deals sensitively with the issues.”

Pictured with some of the books is Senior Ward Sister Alaw Ciornei.

Nicola Llewelyn, Head of Hywel Dda Health Charities, the official charity of Hywel Dda University Health Board, said: “The support of our local communities enables us to provide services over and above what the NHS can provide in the three counties of Hywel Dda and we are extremely grateful for every donation we receive.”

For more details about the charity and how you can help support local NHS patients and staff, go to www.hywelddahealthcharities.org.uk

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NHS Dental Treatment in Wales Still 55% Lower Than Pre-Pandemic Levels

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RESPONDING to figures released this week showing that the number of courses of NHS dental treatment are still 55.1% lower than the year prior to the pandemic, the Welsh Liberal Democrats have reiterated their calls for the use of dental hygienists and dental nurses to be increased to help clear backlogs.

Overall, there was a decrease of 35.5% (539,959 patients) in the total number of patients treated, and the percentage of the total population treated decreased by 17.0 percentage points. This is the largest decrease for both adults and children since the series began in the 24-month period ending March 2006.

The figures also show a worrying decline in the number of children treated decreased with a reduction of 33.6% (125,246 patients).

Welsh Liberal Democrat Leader Jane Dodds MS told The Ceredigion Herald: “The figures we see today are very concerning. An inability to access an NHS dentist continues to be one of the main concerns I hear from my constituents.

“Just over the course of this summer, the largest town in Powys lost two out of four of its dental practices and the picture is similar across much of Wales.

“Everyone understands the challenges faced by dentistry following the pandemic. However, there are actions the Welsh Government can take both in the here and now and in the longer term to help clear backlogs and get NHS dentistry back on track.

“When I’ve spoken to industry experts over the summer they have all said the same thing, increasing the number of dental nurses and dental hygienists, as well as broadening the work they are allowed to do will help clear backlogs.

“I will continue to press Labour to make these changes as soon as possible.”

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