Unilabs: Closing the Care Gap

With World Cancer Day around the corner, at Unilabs, we proudly reaffirm our commitment to revolutionise cancer diagnostics. Positioned as the sole entity covering the full diagnostics spectrum – including imaging, pathology, genetics, and lab IVD – we go beyond diagnosis, aiming to empower individuals to lead healthier lives to the fullest. Let’s explore how.

Consider the case of Mrs. Y, a 52-year-old seeking medical attention due to a troubling sensation in her breasts. This seemingly routine concern set in motion a profound diagnostic journey that starts with a medical prescription and showcases the collaborative efforts of our diverse medical specialties.

The journey begins with imaging services—a mammogram and ultrasound examinations—that uncover a solid nodule in Mrs. Y's breast, prompting a deeper investigation: a biopsy is performed. Here, a dedicated pathologist examines tissue samples, leading to the diagnosis of breast cancer.

To determine the extent of the cancer, both locally and as metastasis, advanced imaging techniques such as magnetic resonance, computerised scanners, and PET scans come into play. Additionally, in vitro diagnostics (IVD) analysis, such as hemogram, contributes crucial insights that guide the next steps.

As the journey progresses, molecular biology steps into the limelight. Genetic analysis assesses the tumour’s mutation and expression of specific hormone receptors. These genetic insights become the cornerstone for personalising Mrs. Y's treatment plan, offering a beacon of hope for improved chances of remission.

Lab IVD plays a critical role in monitoring treatment effects on liver or kidney function and assessing the risk of anaemia, ensuring comprehensive care beyond the initial diagnosis.

As Mrs. Y progresses through her journey, lab IVD and imaging continue to monitor remission status through the follow-up of specific tumour markers in blood or tissue imaging.

As you can see, all our specialties play a key role in cancer diagnostics and treatment. Now, let’s deep dive into the role of each of these specialties through interviews with some of our key scientists.

Radiology – Dr Thomas Lindahl:

• How does radiology contribute to cancer detection?

The field of radiology holds a crucial role in the early detection and management of cancer, significantly influencing patient outcomes. Situated at the intersection of medical expertise and advanced imaging technology, radiology has revolutionised our approach to cancer diagnosis and treatment.

The primary contribution of radiology in cancer care is early detection. Techniques such as mammography have proven indispensable in identifying breast cancer at its early stages, allowing for treatment when the disease is most manageable. Similarly, low-dose computed tomography (CT) scans have been instrumental in identifying lung cancer in its early stages, especially in high-risk individuals.

However, radiology is not limited to cancer detection alone. Advanced imaging methods, including Magnetic Resonance Imaging (MRI), Computer Tomography (CT), and Positron Emission Tomography (PET) scans, offer detailed images of cancerous tissues. This precision is crucial for treatment planning, assisting surgeons and oncologists in determining the tumour's size, location, and spread. 

Radiology extends its role into the treatment phase. Techniques like image-guided radiation therapy (IGRT) leverage imaging technologies to deliver precise radiation doses to cancerous cells while minimising harm to healthy tissues. This level of precision is particularly vital when treating cancers in sensitive areas, such as the brain.

Monitoring the effectiveness of cancer treatments is another essential aspect of radiology. Regular imaging checks play a key role in evaluating how well a tumour responds to chemotherapy, radiation, or other treatments, facilitating timely adjustments to therapy plans.

Beyond its clinical applications, radiology plays a crucial role in cancer research. Advanced imaging techniques empower researchers to study cancer behavior and progression, contributing valuable insights to the development of new therapies and drugs. 

• Could you share the latest breakthroughs in radiology for cancer detection and give us a glimpse of upcoming innovations?

As of 2023, radiology has witnessed several groundbreaking advancements in cancer detection, highlighting the dynamic interplay between technology and healthcare.

One of the most notable breakthroughs is the development of AI-enhanced imaging. Artificial Intelligence (AI) algorithms, trained on vast datasets of medical images, have become adept at identifying subtle signs of cancer that might elude even experienced radiologists. For instance, AI-driven mammography has shown promise in detecting early-stage breast cancer with greater accuracy than traditional methods. At Unilabs, we take particular pride in the leadership of Dr Kristina Lång, one of our Breast Radiologists, in this field. Read about the exciting first results from Dr Lång's MASAI trial here: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00298-X/fulltext 

Another significant advancement is in molecular imaging. Techniques like PET-MRI, which combines Positron Emission Tomography and Magnetic Resonance Imaging, offer highly detailed views of cancer's metabolic and molecular activity, alongside its anatomical structure. This dual perspective enhances the precision of diagnoses and aids in tailoring personalised treatment plans.

Looking towards the future, the horizon of radiology in cancer detection is exciting. One emerging innovation is the development of 'radiogenomics' – linking imaging features with genetic data. This approach could lead to the identification of genetic markers associated with various cancers, paving the way for highly personalised medicine and targeted therapies.

These advancements and future innovations underscore radiology's vital role in evolving cancer care. By integrating cutting-edge technology and novel research, radiology is set to offer more precise, early, and individualised cancer detection. As technology advances, radiology's role in oncology will continue to grow, offering hope for more effective cancer management in the future.

Pathology – Dr Ali Bayoumi:

• What role does pathology play in enhancing cancer diagnostics?

Pathology is at the forefront of cancer diagnostics, playing a crucial role in identifying and characterising cancerous tissues. No matter how high the index of clinical suspicion, the diagnosis of cancer is neither conclusively established nor safely assumed in the absence of a tissue diagnosis. With very few exceptions, definite therapy for cancer should not be undertaken in the absence of a tissue diagnosis. 

Through different pathological techniques, pathologists can determine the nature, extent, aggressiveness, and specific characteristics of a tumour. This information is vital for accurate diagnosis, prognosis, and treatment planning. Pathology also helps to identify specific biomarkers and genetic mutations that guide targeted therapies, allowing for more personalised and effective treatment strategies. Additionally, pathology is vital in surgical margins assessment, monitoring residual disease and recurrence surveillance to ensure complete tumour removal, prevent recurrence, inform the need for additional surgery, guide further treatment decisions, and help detect cancer recurrence early. 

Hence, we can see that pathology is indispensable for accurate cancer diagnosis, risk assessment, treatment guidance, and monitoring. Its continuous advancements are revolutionising cancer care, leading to better patient outcomes and personalised treatment strategies in collaboration with other healthcare professionals to provide comprehensive cancer care.

• Could you highlight recent advancements in pathology shaping the future of cancer detection, and share what's on the horizon?

Recent advancements in pathology have significantly contributed to the future of cancer detection. Digital pathology, for instance, has revolutionised the field by enabling the digitisation of the microscopic process with the production of high-quality images and streamlining the workflow. This not only enhances collaboration among pathologists but also facilitates the application of artificial intelligence (AI) algorithms for more accurate and efficient diagnosis. Molecular pathology techniques like immunohistochemistry and next-generation sequencing have seen notable progress, providing valuable insights into tumour genetics and potential treatment targets, allowing less invasive and more frequent monitoring of cancer progression.

Looking at the horizon, we can recognise that the ongoing AI algorithms, integration of big data, and machine learning will help pathologists in analysing vast amounts of data to identify patterns and trends that may not be apparent through traditional methods. Additionally, personalised medicine will become even more precise, tailored to the unique genetic profile of each patient.

Unilabs is uniquely positioned at the forefront of this revolution. Our highly skilled pathologists utilise the latest technologies like digital pathology and AI supported by advanced molecular testing capabilities to ensure that our patients receive the most accurate and timely diagnoses.

Finally, quoting Fitzgerald, R.C et al.'s recent publication in Nature Medicine have concluded that “The future, advances in sensors, contrast agents, molecular methods, and artificial intelligence will help detect cancer-specific signals in real-time and reduce the burden of cancer on society.”

• How does Unilabs leverage pathology for a more comprehensive approach to cancer care?

Cancer is a complex disease that involves multidisciplinary diagnostic approaches. Our Scientific Business Units of Pathology, Lab IVD, Radiology, and Genetics are working together to provide comprehensive cancer care solutions during the entire patient journey through screening, early detection, diagnosis, therapy decision, and follow-up. Additionally, our multidisciplinary expert team works together to create and maintain evidence-based cancer patients’ pathways.

At Unilabs, we are committed to providing comprehensive cancer care by leveraging the latest advancements in pathology. Our digitised histopathology platforms ensure efficient processes and faster turnaround times for diagnoses. Integrating digital pathology at Unilabs facilitates remote consultations and collaboration among pathologists, ensuring a multidisciplinary approach to complex cases. In addition to traditional pathology services, Unilabs actively explores emerging technologies such as AI and molecular diagnostics to enhance the accuracy and speed of cancer diagnoses. Furthermore, Unilabs invests in continuous education and training for our pathologists.

Genetics – Dr Purificação Tavares:

• How does genetics contribute to personalised cancer diagnostics?

Genetics individual profiling, through DNA sequencing or other genomics studies, provides specific information at different levels. It plays a fundamental role in personal risk, prevention, detection, diagnosis, and selecting the best treatment therapies for cancer. 

Personalised medicine uses two types of genomic analysis. The first is germline, which identifies inherited genes predisposing people to certain types of cancer. The second is somatic, pinpointing DNA mutations and other alterations in a patient’s tumour cells. Both analyses can reveal the mutations driving a particular cancer and whether targeted treatment or immunotherapy might be the most effective.

Some genetic mutations, such as those in the BRCA1 and BRCA2 genes associated with breast and ovarian cancers, increase the risk of developing specific types of cancer. Studying individual predisposition allows us to identify those at high risk and plan routine prevention exams for early detection. 

Moreover, we can extend this study to other family members at risk, significantly reducing familial cancer cases. This preventive approach is crucial, especially for common cancers like lung and colon.

Genetic analysis information is also valuable in predicting an individual's response to cancer treatments, tailoring the most effective choice among available therapies. This is key in avoiding ineffective drugs and their secondary effects, saving crucial time. 

Importantly, appointments with our Medical Geneticists are available to explain the results of genetic testing and their implications. They integrate all this information in terms of value for the patients and their families. 

• Could you discuss breakthroughs in genetic research improving cancer detection and any exciting developments on the horizon?

Several recent breakthroughs in genetic research have significantly contributed to improving cancer detection and the development of more efficient therapies. Here are some examples:

One notable advancement is the liquid biopsy. These tests analyse circulating tumour DNA or cancer-related molecules in the blood, offering a non-invasive and real-time approach to monitor cancer progression, treatment responses, and the development of drug resistance.

CRISPR technology enables precise gene editing, allowing researchers to modify the genes responsible for a particular patient's cancer. This opens the door to the development of targeted therapies and personalised treatments.

Other genetic and molecular biomarkers show promise in early cancer detection, a crucial stage for more effective treatments. Once validated, these biomarkers may find practical applications in clinical practice.

Personalised cancer vaccines represent a significant stride towards specific treatments tailored to each tumour’s unique genetic alterations in a patient. This advancement is poised to revolutionise precision medicine for cancer patients and is expected to be integrated into clinical practice in the near future.

Anticipated areas of substantial expansion in the coming years include gene editing, epigenetics, structural biology for protein design, and medicinal chemistry.

• What is Unilabs' approach to using genetic insights for tailoring cancer care?

Unilabs performs various genetics tests to identify specific mutations or biomarkers associated with different cancers. These tests include next-generation sequencing (NGS), polymerase chain reaction (PCR), fluorescence in situ hybridisation (FISH), microarray analysis, among others. By analysing tumour samples or body fluids, these tests help determine the genetic profile of a patient's cancer, including its specific mutations or variants.

Next-generation sequencing (NGS) technologies are commonly used for DNA analysis. NGS allows for the simultaneous sequencing of multiple genes, providing a comprehensive view of genetic alterations in the tumour and their clinical significance. Variants found are classified using knowledge accumulated over many years of experience, databases, and literature.

Genetics plays a crucial role in monitoring disease progression and the response to treatment.

Unilabs also uses powerful bioinformatics tools and AI expertise to detect and interpret genetic variants for biomarkers that are crucial for treatment choices and decisions.

As an innovation company, Unilabs is a robust partner in several clinical trials, providing genetic testing services to identify eligible patients for specific new therapies and treatments, and other programmes. This has a clear impact on the evolution of cancer treatments.

Furthermore, our Medical Geneticists can assist cancer patients in integrating information into the multidisciplinary care required for cancer.

Lab IVD – Dr Dany Mercan:

• What role does In Vitro Diagnostics (IVD) play in the accurate follow up of cancer treatment?

Laboratory IVD contributes in three major ways through either immunoassays or clinical chemistry tests. The first role is to monitor the tumour and indirectly the effect of treatments on it. This is done by measuring molecules named tumour markers. Most tumour markers are proteins that are normally present in very low quantities but that are overexpressed by tumour tissues and pass into the blood where their concentration rises. For some endocrine tumours, the marker may be a hormone or a neurotransmitter that is produced in an excessive and deregulated way. The impact of the treatment on the tumoural mass may be indirectly followed by monitoring the tumour marker. The same measurement may also be done post-treatment to detect a possible relapse. Tumour markers do not perform well for diagnostics because they may lack specificity but are quite useful once a tumour is found and is clearly the cause of their elevation in blood. 

The second role is to monitor the patient who may have secondary effects from the treatments, particularly chemotherapy. Complete blood count, liver enzymes, and renal tests are the most frequently used IVD measurements to detect side effects and adjust the therapy to minimise them. 

The third role is to adjust the treatment through therapeutic drug monitoring to adapt the dosage and reach an optimal blood concentration window. The idea is to kill tumour cells while minimising damage to the patient’s organs.

• Could you share the major advancements in Lab IVD shaping the future of cancer treatment and any upcoming developments?

Lab IVD is broadening the therapeutic monitoring portfolio towards biological drugs like clonal or 'humanised' antibodies targeted at tumours. This expansion involves measuring a greater number of drugs with enhanced precision and specificity. Furthermore, monitoring various points in time, from administration to elimination, enables a detailed assessment of how efficiently drugs are absorbed, distributed in the body, and ultimately eliminated. This comprehensive approach not only evaluates the effectiveness of the treatment but also assesses the potential risk of side effects. It contributes to the adjustment and personalisation of anti-tumoural treatment by providing more accurate and nuanced insights into drug dynamics within the body.

Drug monitoring involves complex and highly technological methods that may unfortunately have a slower turnaround than classical laboratory tests. However, a quicker response would allow a better adjustment of therapeutic regimen; therefore, there is still room for future improvements in the IVD field.

Stay tuned for in-depth conversations that delve into the heart of medical innovation and care at Unilabs.