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Invasive to Non-Invasive: Exploring Genetic Landscape of All Cancerous Lesions & Guide to Treatment.
- Biopsy and BMA 2018

About Conference

In cancer patients, Biopsies provide the histological explanation, of the disease and, currently, have revealed details of the genetic profile of the tumor enabling prediction of cancer progression and response to therapies. The role of CT-guided core biopsy has increased in the diagnosis of benign disease, cellular differentiation, and somatic mutation analysis. A fine-needle aspiration (FNA) biopsy is often used to take cell samples from organs or from lumps that are below the surface of the skin.

Being inherently unique, limited and non-renewable, after a limited number of analyses, small samples of tissue biopsies gets completely exhausted. A method has been introduced that enables fast and reproducible conversion of a small amount of tissue (approximating the quantity obtained by a biopsy) into a single, permanent digital file representing the mass spectrometry-measurable proteome of the sample. The method combines pressure cycling technology (PCT) and SWATH mass spectrometry (MS), and the resulting proteome maps can be analyzed, re-analyzed, compared and mined in silicon to detect and quantify specific proteins across multiple samples.

Bone marrow, mainly involves two separate specimens, a cytologic and a histologic preparation. Cytologic preparation of bone marrow, allows better visualization of cell morphology, while histologic preparation, allows optimal evaluation of fibrosis, cellularity, or infiltrative disease. Bone marrow examination has been progressively useful in documenting metastatic connection of tumors. Sites like the posterior iliac crest, anterior iliac crest, the manubrium of the sternum and in some rare cases vertebral body can be used for the aspiration purpose.

Real-time monitoring of cancer therapies in individual patients can be achieved by the analysis of blood samples for circulating tumor cells (CTCs) or cell-free circulating tumor DNA (ctDNA). Elevated concentrations of ctDNA fragments are found in plasma and serum of cancer patients. The proportion of ctDNA to the entire blood free DNA differs in step with the location of cancer (low in Central system tumors), stage of cancer (higher in advanced cancers), type of cancers and detection ways. For detecting Circulating Tumor Cells, it can be enriched using various technologies like Cell Search system, CTC-Chip, MACS (Magnetic Activated Cell Sorting System), Adna Test and MagSweeper. Researchers on combined analyses of CTCs and single DNA show a stimulating relationship between ctDNA and CTCs in blood and Disseminated tumor cells (DTCs) in bone marrow of cancer patients. Mutations, methylation, DNA integrity, microsatellite alterations, and infectious agent DNA may be detected in ctDNA, present in the blood of patients with tumors. Liquid Biopsy may be used for a range of clinical and analysis applications, together with response assessment in cuticular protein receptor (EGFR)-mutated NSCLC patients receiving EGFR amino acid enzyme substance medical care.

Market Analysis

Importance & Scope

Increasing incidence of cancer, need for minimally invasive medical procedures, and increased spending for effective treatments are the major factors driving the global biopsy market. Statistics published on cancer shows that the global incidence of cancer in 2012 was 14.1 million which may reach to 23.6 million by 2030. The increasing number of cancer patients is set to increase the demand for biopsy procedures. Moreover, future projections indicate, even more, increase in prevalence, ensuring the lucrative industry growth in the coming years.

Market research analysts have estimated that the global biopsy devices market will keep on growing at a CAGR of more than 6% by 2020. Biopsy device Market Report predicts that the global biopsy market may reach $2,399 million by 2022, registering a CAGR of 5.5% during the period 2016-2022. According to the research report, the growing Non-Invasive Bone Marrow Aspiration Needle market is likely to boost the global market substantially over the forthcoming years.

Bone Marrow Aspiration Needle Market will grow at CAGR of 7% by 2022. Revenue from the global bone marrow transplant market is estimated to expand at a constant CAGR of 3.9% over forecast period 2015–2021 and is expected to be valued at the US $10.3 Billion by the end of 2021.


Why Toronto, Canada?

Toronto is the leading tourism destination in Canada, attracting more than 25 million Canadian, American and international visitors annually. It is the provincial capital of Ontario and the fourth most populous city in North America after New York City, Mexico City, and Los Angeles. Toronto is the center of the Greater Toronto Area (GTA) which is the most populous metropolitan area in Canada. A global city, Toronto is an international center of finance, business, arts, and culture, and is recognized as one of the most cosmopolitan and multicultural cities in the world. Toronto is home to 20 public hospitals, including: Mount Sinai Hospital, St. Michael's Hospital, the Hospital for Sick Children, Toronto Western Hospital, North York General Hospital, Toronto General Hospital, St. Joseph's Health Centre, Rouge Valley Health System, The Scarborough Hospital, Sunnybrook Health Sciences Centre, Centre for Addiction and Mental Health (CAMH), and Princess Margaret Cancer Centre, as well as the University of Toronto Faculty of Medicine. The Ontario Institute for Cancer Research (OICR) and Princess Margaret Cancer Centre are the most popular Institute for Cancer Research in Canada. The Ontario Institute for Cancer Research (OICR) is a not-for-profit organization based in Toronto, Ontario, Canada that focuses on the early diagnosis, detection, prevention and treatment of cancer.


Biopsy Market Segmentation, By Procedural Type

•           Needle biopsy         

•           Surgical biopsy

Needle Biopsy:

Needle biopsy market will grow at a CAGR of 5.2 % till 2023 for sure. Europe Clinical Reference Laboratory Market is projected to expand at a CAGR of 5.4% which may reach the US $ 1, 14,128.8 million by 2027. In 2016, Europe Clinical Reference Laboratory Market, Western Europe accounted for the largest market share.

Key players in the market are:

•           Boston Scientific Corporation

•           Cook Medical

•           CareFusion Corporation

•           Hologic Inc.

•           Cardinal Health Inc.

•           Medax

•           C. R. Bard Inc.

•           Möller Medical GmbH

•           Becton

•           Dickinson and Company

•           Hakko co. ltd.

•           Kompass

•           Argon Medical Devices Inc.

Vacuum-assisted needle biopsy has been estimated to be the fastest growing segment. According to the market study, the biopsy needle-based guns segments will have more influence in the biopsy devices throughout the forecast period and by 2020, will account for more than 41% of the total market share.

Surgical Biopsy:

The surgical biopsy segment market value was $436.4 Million in 2015 and shared more than 56% of the total market and thus had more influence in the industry during 2015. The global breast biopsy market can smoothly reach $728.8 Million by 2020, at a CAGR of 10.8%.

The breast biopsy guidance market has been categorized as mammography, ultrasound, MRI, and others (PET and thermography). Owing to the increasing demand for minimally invasive and non-radiation breast biopsy among patients and surgeons, the ultrasound is estimated to be the fastest growing segment.

On the basis of region, the breast biopsy market is segmented into North Europe, Asia-Pacific, America, and the Rest of the World. North America accounted for the largest share of the breast biopsy market in 2015, followed by Europe. Asia-Pacific is expected to reach a higher rate of growth during the forecast period. The growth of the breast biopsy market in Asia-Pacific is mainly centered on India and China.

Major players operating in the market are:

•           C.R. Bard

•           Becton

•           Dickinson

•           Devicor Medical Products Inc. (U.S.)

•           Company (U.S.)

•           Inc. (U.S.)

•           Hologic Inc. (U.S.)

Biopsy Market Segmentation, By Product Type

•           Biopsy guidance systems

•           Biopsy needles

•           Biopsy needle-based guns

•           Biopsy forceps

According to an estimate, vacuum assisted needle biopsy is going to be the fastest growing segment. The biopsy needle-based guns segments will have the highest influence in the biopsy devices throughout the predicted period and will hold more than 41% of the total market share by 2020.

Biopsy Device Market, By Region

North America contributed the global share by 55% in 2015 and thus was the largest regional industry in the field of biopsy devices, followed by Europe and Asia Pacific. U.S. In 2015, Biopsy devices market size has a value close to USD 1 billion, which was over 80% of the industries in North America. This was due to the increased awareness regarding cancer diagnosis, and continued funding activities for effective diagnostics procedures. Europe biopsy devices market share may see moderate growth, with Germany being responsible for over 28% sales in 2015. China and India biopsy devices market may enter the maximum growth rate of 11.8% from 2016 to 2024 and is eyed upon as the most beneficial market for investment.


Biopsy Device Market

During the forecast period, CT-guided biopsy segment is expected to grow at the highest CAGR of 6.3%. The lung biopsy is expected to be the fastest growing application segment, entering a CAGR of 7.0%.The robotic guidance system segment is estimated to enter the highest CAGR of 7.0%.The Asia-Pacific region may become the fastest growing market, with a CAGR of 7.2%.

The key companies in the market are:

•              Leica Biosystems

•              Medtronic

•              C.R. Bard Inc.

•              Boston Scientific Corporation

•              Hologic Inc.

•              Becton

•              and Company

•              Ethicon EndoSurgery Inc.

•              Mauna Kea Technologies

•              Fujifilm Medical Systems

•              Veran Medical Technologies

•              MDxHealth

•              Cook Medical Inc.

•              Dickinson

•              Argon Medical Devices Inc.

•              Intact Medical Corp.


Bone Marrow Market Analysis

In 2014, autologous bone marrow transplant segment accounted for the major proportion of the market volume. During the forecast period; it is predicted to remain the leading segment in terms of volume. By disease indication, the leukemia segment is expected to have more influence over the market, having a share of 26.5% of the overall market revenue by the end of 2021. During the forecast period, Revenue contribution from the thalassemia segment may grow at the highest CAGR of 8.9%.

Based on regional segmentation, the market in Europe is supposed to continue the lead in the global market due to growing number of bone marrow transplant centers and expansion of bone marrow registry. Latin America market, due to increased density of bone marrow transplant centers, revenue is anticipated to grow at healthy CAGR of 6.0%. Bone Marrow Aspiration Needle Market is expected to grow at CAGR of 7% by 2022. It is likely to promote the global market significantly in the forthcoming years.

Top players in bone marrow transplantation market are:

•           Merck Millipore Corporation,

•           Sanofi-Aventis LLC,

•           AllCells LLC

•           Lonza Group Ltd.

•           STEMCELL Technologies

•           American Type Culture Collection (ATCC) Inc.

Top players in bone marrow needle market are:

•           Argon Medical Devices

•           STERYLAB

•           Tsunami Medical

•           Egemen International

•           SOMATEX Medical Technologies

•           Biomedical

•           Biopsybell

•           Tenko International Group

•           Zamar Biopsy

•           Depuy Synthes

•           Jorgensen Laboratories


Bone Marrow Biopsy Needle Industry scope on the basis of region:

•           United States

•           European Union

•           Japan

•           China

•           India

•           Southeast Asia


Market Growth of Liquid Biopsy

Major complications associated with typical tumor biopsies for a variety of various cancers include infections, colonic perforation, peritonitis, and collapsed respiratory organ, inflammation of the pancreas, sepsis, and haematoma. Moreover, within the current scenario, a diagnostic test prices between USD 2000 to as high as USD 10,000. The increase in prices due to further treatment needed owing to the complications could drive this value up fourfold.

The rising incidence of cancer, pros of liquid Biopsy test over solid tumor diagnostic test, advancements in the technology, handiness of funding and growing awareness regarding biopsy through government initiatives and the conferences, are driving the expansion of the market. Some within the business predict the market’s worth may balloon to anyplace from $20 billion to over $100 billion. The liquid biopsy market is anticipated to reach USD 1.66 Billion by 2021 from USD 0.58 Billion in 2016, growing at a CAGR of 23.4% during this period.


Target Audience

•           Biotechnology Companies

•           Government and Public Laboratories

•           Liquid Biopsy Product Manufacturers and Distributors

•           Reference Laboratories

•           Research Institutes

•           Contract Research Organizations

•           Research and Consulting Companies

•           Pharmaceutical Companies

•           Hospitals and Diagnostics Centers


A glance at Market of Advertising and Marketing

Multiple gene analysis using NGS technology expected to witness higher demand in this market over the forecast period. Some of the key players like Adaptive Biotechnologies, Biocept, Guardant Health, NeoGenomics Laboratories, Personal Genome Diagnostics, Qiagen, RainDance Technologies, Cynvenio, and Trovagene, have commercialized tests for CTC, ctDNA, and exosomes and are directly involved in the liquid biopsy.

Commercialization is expected to take place that will consequently fuel significant growth in revenue between 2020 to 2030.The Global Liquid Biopsy Market to expand at a CAGR of 20.31% during the period 2017-2021.CTCs and ctDNA hold immense potential for breakthrough developments in cancer care and in reducing cancer-related mortality.

Tracks and Sessions

Oncology & Molecular Pathology

Oncology depends on diagnostic tools like biopsy or removal of bits of the tumor tissue and examination. A team of oncologists who specialize in different areas of oncology monitors and provides treatment to the cancer patient. This approach is helpful because cancer treatment frequently involves a combination of surgery, chemotherapy, and radiation therapy. The oncologist is also responsible for symptomatic or palliative care in patients with terminal malignancies. Radiation oncology covers the integration of radiation therapy into multimodal treatment approaches. Japan is having the largest share in total Asia Pacific cancer drug market due to the high prevalence of cancer in the Japanese population. Lung cancer is the major cause of death in the Japanese population. The total healthcare expenditure of Japan was $495 billion in 2013. Global cancer drugs market by therapeutic modalities is segmented into, chemotherapy, Targeted therapy, Immunotherapy, Hormonal therapy and others. Global Oncology Market is expected to reach a value of $111.9 billion by 2020, registering a CAGR of 7.1% during the forecast period 2014 to 2020.


•           Surgical Oncology

•           Clinical Oncology

•           Cytopathology

•           Dermatopathology

•           Histopathology


Cancer Diagnostics

The complete evaluation of a patient usually requires a thorough history and physical examination along with diagnostic testing. There is no single imaging test that can accurately diagnose cancer. MRI is a diagnostic procedure that uses a combination of radio frequencies, large magnet, and a computer to produce detailed images of structures and organs within the body. A lymphangiogram is an imaging study that can detect cancer cells or abnormalities in the lymphatic system and structures. It involves a dye being injected into the lymph system. Additionally, genomic DNA alterations, circulating viral DNA or RNA, various mutations such as p16, KRAS, and/or APC either in blood, serum or circulating cancer cells in blood samples have been evaluated to allow the early diagnosis of cancer patients. In addition to liquid biopsy, there are several other novels and promising non-invasive diagnostics being developed for the diagnosis and prognosis of cancer. NCI researchers showed that an image-guided biopsy for the detection of prostate cancer did a better job of identifying men with the high-risk disease than standard biopsy, while also reducing the detection of low-risk disease that may not need treatment. In recent years, the Food and Drug Administration (FDA) has approved tests called companion diagnostics to help identify candidates for certain treatments.


•           Diagnostic Imaging

•           Endoscopic Exams

•           Nuclear Medicine Scans

•           Genetic Tests

•           Laboratory Tests


Biopsy: Scans & Tests

Most diagnostic biopsies are small, nondescript bits of tissue, so the gross description is useful for identification of the origin of the tissue. In some cases, a small tissue sample can be removed with a needle while others may surgically remove a suspicious nodule or lump. Mostly, when the lump is likely to be filled with fluid, a fine needle aspiration is preferred. For internal organs, this is achieved with the help of imaging techniques such as Magnetic Resonance Imaging (MRI), ultrasound, or computed tomography scans. Imaging tests may be performed to determine if a nodule is benign (non-cancerous) or malignant (cancerous).if the disease is at an advanced stage or if the organ is difficult to access, such as the prostate gland Multiple biopsies may be needed. If cancer is found, the tissue sample can be used to determine the type of tumor and extent to which it has spread through the tissue. Information acquired from a single biopsy provides a spatially and temporally limited snap-shot of a tumor and might fail to reflect its heterogeneity.


•           Mass Spectrometry in Tissue Biopsy

•           Image-Guided Biopsy for the Detection of Prostate Cancer

•           Needle Biopsy

•           Surgical Biopsy

•           Endoscopic Biopsy

•           Optical Biopsy


Breast Cancer and Biopsy

The Image Guided Automated Robot (IGAR) can be used for doing a biopsy of a suspicious lesion; if clinically appropriate it can be followed by ablation of biopsy site margins. IGAR works in combination with a magnetic resonance imaging (MRI) scanner which helps doctors to see the potentially harmful mass in the breast. IGAR has removed most of the “manual” aspects of the procedure and reduced user-dependence and training level required. In the lumpectomy, BioZorb marker device identifies the location of the tumor in a fixed, 3D manner from where it was removed, helping the radiation oncologists more reliably determine where to aim the radiation in follow-up treatments. Most commonly used biopsies on the breast area Core-needle biopsy and surgical biopsy. The doctor may choose to conduct a fine-needle aspiration (FNA) if the lump is easily accessible or if the doctor suspects that it may be a fluid-filled cystic lump. If a woman has a family history of breast cancer then probably she is with ‘high-risk factors‘, in such cases she can be biopsied with BI-RADS category 3 mammograms. Overall, when a biopsy is requested, the rate of breast cancer diagnosis is about 30%.


•           Fine Needle Aspiration Biopsy

•           Excisional Biopsy

•           Incisional Biopsy

•           Sentinel Lymph Node Mapping and Biopsy

•           Open Biopsy


Advances in Liquid Biopsy

In the non-invasive method for detecting genetic alterations in tumors, analysis of cell-free tumor DNA (cfDNA) in plasma plays important role in improving cancer diagnosis, monitoring, and drug development. Cancer is associated with mutated genes, and analysis of tumor-linked genetic alterations is increasingly used for diagnostic, prognostic and treatment purposes. Liquid biopsies have the ability to pair tests on circulating tumor cells with genomic tests thus it became more clinically useful in recent years. The researchers are looking into whether clusters of Circulating Tumor Cells(CTCs) are correlated with other disease markers measured via blood test, like prostate-specific antigen (PSA) and Chromogranin A (CgA), to determine if they’re linked with more aggressive cancer. This ctDNA test for blood cancer provides a much more comprehensive picture of how a patient is responding to their treatment. It allows real-time evaluation of metastasis and helps in the monitoring of the actual treatment response. Whether liquid biopsies will be cost-effective is unknown. Guardant’s test costs $5,400 (U.S.); some insurers cover it for certain types of patients.


•           Tumor-Educated Platelets(TEPs)

•           Circulating Tumor DNA(ctDNA)

•           Liquid Biopsy in Neurovascular Inflammation

•           Urine Tests for Early Spotting of Bladder Cancer Instead of Cystoscopy

•           Sensitivity of Liquid Biopsy


Liquid Biopsy: Emerging Biomarkers

Metastatic cancer cells release DNA fragments into the bloodstream. Currently, blood-based cancer testing involves the assessment of biomarkers, most commonly cell-free DNA, circulating tumor cells (CTCs) or exosomes. Many studies have proved that the amount of circulating tumor DNA is correlated with progression of the cancer process and furthermore the capture of ctDNA scales across many types of cancer. Cell-free RNA (cfRNA) fragments, methylated ctDNA also acts as the prognostic and predictive markers of cancer that are at an earlier stage of development. Certain tumor-associated miRNAs were expressed by cancer-related regions, exhibiting DNA amplification, deletion or translocation during tumor growth. Currently, several methods have emerged to examine circulating miRNA levels including microarrays, RT-qPCR and NGS. Massive parallel sequencing (MPS) is current and promising technology for miRNA biomarker discovery.


•           Circulating RNAs (miRNA, lncRNAs, and mRNAs) & Proteins and Peptides as emerging Biomarkers

•           Circulating Tumor Cells (CTCs)

•           Cell-Free DNA (cfDNA)

•           Cell-free DNA Clinical Applications

•           Integrity of Cell-free DNA


Cancer Biomarkers

Cancer biomarkers, particularly those associated with genetic mutations or epigenetic alterations offer a quantitative way to determine when individuals are predisposed to particular types of cancers. Genetics, proteomics, genomics, many non-invasive imaging techniques and other technologies are used in the measurement of several biomarkers. DNA (germline or somatic), RNA, proteins, peptides, hormones, metabolites, and even biological processes such as apoptosis, angiogenesis or proliferation can act as cancer biomarkers. Biomarkers can be detected in the circulation (serum, whole blood, or plasma) or in secretions (urine, stools, sputum or nipple discharge) or in other human biological fluids thus easily assessed noninvasively and serially, or can be tissue-derived. Cancer cells release many proteins and other macromolecules into the extracellular fluid through secretion that can also serve as biomarkers. Some of these products can end up in the bloodstream and hence serve as potential serum biomarkers. Enhanced cell proliferation is important hallmarks of cancer, which is easy to identify using a number of biochemical, histological, and flow cytometric analysis. Current image-based tests such as CT and MRI for monitoring tumor status are highly costly thus biomarkers have the potential of providing significant cost reduction in patient care.


•           Predictive and Prognostic Biomarkers

•           Genetic Biomarkers

•           Clinical Biomarkers

•           Imaging Biomarkers

•           Molecular Biomarkers

•           Colorectal Cancer Biomarkers


Liquid Biopsy: Technological Innovations

Imaging tests (e.g., X-rays, CT, MRI, PET scans, mammography or ultrasound) can identify masses, but they cannot find microscopic metastases nor characterize a solid tumor’s cellular composition. One of the biggest technical challenges to overcome in the analysis of cfDNA is the issue of low-frequency mutant alleles since ctDNA levels which vary greatly among patients and can reach as low as 0.01% of the total cfDNA in patients with early-stage disease. Somatic mutation profiling can be performed by quantitative or digital PCR. Digital PCR can be used to detect, ctDNA in greater than 75 percent of patients with advanced cancers and in 48–73 percent of patients with localized tumors. Using PARE (Personalized Analysis of Rearranged Ends) proves helpful in detection of specific structural chromosomal rearrangements. Using Whole-exome sequencing analysis of all protein-coding genes; copy number alterations can be done. The comprehensive RNA analyses to establish landscapes of cell-free RNA transcriptomes either by microarrays or by RNA sequencing (RNA-Seq) is relatively novel. These technologies are promising as they can provide insights into the temporal dynamics of plasma mRNA.


•           Gene-Amplification and Sequencing Technologies

•           Amplification Refractory Mutation System (ARMS-PCR)

•           BEAMing Digital PCR (Beads, Emulsions, Amplification and Magnetics)

•           Application of Carbon Nanotube (CNT) Semiconductors in Liquid Biopsy

•           Next-Generation Sequencing (NGS)


Cancer Cell Biology

The abnormalities in cancer cells usually result from mutations in protein-encoding genes that regulate cell division. Tumor cell starts its growth in tumor microenvironment which includes blood cell, fibroblasts, immune cells, lymphocytes etc. Symptoms of different cancers are depending upon the location of the tumor. More problems arise If cells don't repair damage to their genes properly. New gene faults, or mutations, can make the cancer cells grow faster, spread to other parts of the body, or become resistant to treatment. The p53 gene—named for the molecular mass of its protein product—may be the most important gene in human cancer. It turns out the cancer cells instruct fibroblasts to secrete exosomes - a tiny fluid-filled sac that in this case contain special genetic material that makes them look like viruses. Mutations in the p53 Gene allows cancer cells to survive and proliferate despite DNA damage.


•           Cell Death Resistance

•           Carcinogenesis

•           Mutagenesis

•           Sustaining Proliferative Signaling

•           Tumor Suppressor Genes


Cancer Genetics & Epigenetics

Only a small number of the approximately 35,000 genes in the human genome have been associated with cancer. In genetic testing, a simple blood test may be used to get a more precise estimate of cancer risk. In some cases, genetic testing can be done on stored tissue samples from deceased relatives. In recent years, scientists have discovered a number of mutations that can contribute to a person’s risk of developing certain cancers, ovarian, including breast, colorectal, and prostate cancer, as well as some other, less common cancer types. The malfunctioning genes are broadly classified into three groups, proto-oncogenes, tumor suppressors and DNA repair genes. Characteristic errors of DNA replication known as microsatellite instability (MSI) are the hallmark of colorectal tumors in HNPCC. People who carry hereditary mutations do not necessarily get cancer, but their risk of developing the disease at some point during their lifetime is higher than average. The most common type of inherited breast cancer is hereditary breast and ovarian cancer syndrome (HBOC). HBOC is caused by mutations in the BRCA1 and BRCA2 genes. Researchers are hoping to identify specific epigenetic profiles of various types and subtypes of cancer with the goal of using these profiles as tools to diagnose individuals more specifically and accurately. Epigenetic control of the proto-onco regions and the tumor suppressor sequences by conformational changes in histones play a role in the formation and progression of cancer. Pharmaceuticals that reverse epigenetic changes might have a role in a variety of cancers.


•           Epigenetics & p53, Protein

•           Genetic Cancer Syndromes

•           Cancer Predisposition

•           Genome Instability

•           Gene Faults Involved in Hereditary Cancers

•           Mechanisms and Pathways of Oncogenesis


Cancer: Drugs & Treatments

An approach to cancer care is Precision medicine that allows doctors to select treatments that have most probably to help patients based on a genetic understanding of their disease. Many of the newer drugs, called targeted drugs, damage cancer cells by blocking genes or proteins found in the cancer cells. These treatments work specifically on the cancer cells, thus they cause different side effects and usually damage less number of healthy cells. Molecularly targeted therapy, the treatment consists of drugs designed at the molecular level of the cell to specifically attack and kill only the cancer cells of a specific type of cancer. Most people have had to go with a combination of treatments, such as surgery with chemotherapy or radiation therapy. There are several major classes of anticancer drugs; these include antimetabolites, alkylating agents, natural products, and hormones. Certain anticancer drugs can find the difference between normal tissue cells and cancer cells, the rate at which cancer cells proliferate plays a role in the apparent selectivity of agents. As researchers have learned more about what makes cancer cells different from normal cells, they have developed Monoclonal antibodies mAbs to exploit these differences.


•           Anti-Cancer Therapy Efficacy

•           Clinical Trials

•           Angiogenesis and Angiogenesis Inhibitors to Treat Cancer

•           Antimetabolites

•           Precision Medicine

•           Oncolytic Viruses as a New Class of Therapeutic Agents

Protein Kinase (CDK) & Cancer Therapy

Cyclin-dependent kinases (CDKs) which belong to the family of serine/threonine, controls the cell cycle transcription and progression. They are also regulating the mRNA processing, the nerve cells differentiation and homeostasis of glucose. Cellular proliferation which is being driven by CDKs and the cyclin partners gets decontrolled in cancer; therefore, cancer acts as a proliferative disorder which targets the cell cycle. So it seems to be a good strategy for new targeted anticancer agents. CDKs activity is related to specific cyclin co-factors and at least 12 separate genetic loci are known to code for the CDKs. Hence, cyclins are considered to be the gears that are changed to aid the transition between cycle phases. Based on whether they control cell cycle progression, CDKs are generally classified into two major groups which include CDK1 to CDK6 or regulate gene transcription by RNAPII that includes CDK 7, CDK8, CDK9 and CDK19. In cancer, increases in level of CDKs are observed. Inhibition of CDKs represents a good strategy for cancer drug development as well as therapy.

Cancer Statistics

In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. Over the past 3 decades, the 5-year relative survival rate for all cancers combined has increased 20 percentage points among whites and 24 percentage points among blacks. Progress has been most rapid for hematopoietic and lymphoid malignancies due to improvements in treatment protocols, including the discovery of targeted therapies. The overall cancer death rate rose during most of the 20th century, largely driven by rapid increases in lung cancer deaths among men as a consequence of the tobacco epidemic, but has declined by about 1.5% per year since the early 1990s.Cancer incidence and death rates vary considerably among racial and ethnic groups, with rates generally highest among blacks and lowest among Asian/Pacific Islanders (APIs).Cancer is the second most common cause of death among children aged 1 to 14 years in the United States, surpassed only by accidents. In 2018, an estimated 15,270 children (birth to 14 years) will be diagnosed with cancer (excluding benign/borderline malignant brain tumors) and 1,490 will die from the disease.


•           Estimated New Cancer Cases

•           Mortality, Survival Rates and Trends for Individual Cancer Sites

•           Risk Factors

•           Cancer Type in the Current Year

•           Lifetime Probability of Developing & Dying from Cancer


Bone Marrow Analysis

It contains cells that produce white red blood cells, blood cells, and platelets. Marrow Aspiration can detect cancers of bone marrow or blood, such as leukemia or lymphoma. It can be used to determine if cancer has spread to the bones. Bone marrow, mainly involves two separate specimens, a cytologic and a histologic preparation. Obtained by aspiration, cytologic preparation of bone marrow, allows better visualization of cell morphology, while histologic preparation, allows optimal evaluation of fibrosis, cellularity, or infiltrative disease. Bone marrow examination has been progressively useful in documenting metastatic connection of tumors. Sites like the posterior iliac crest, anterior iliac crest, the manubrium of the sternum and in some rare cases vertebral body can be used for the aspiration purpose.


•           Bone Marrow Biopsy

•           Bone Scan and Imaging

•           Iliac Marrow Biopsy Sites

•           Multiple Myeloma

•           Bone Marrow Stem Cell Extraction


Cancer Stem Cells

Many new anti-cancer therapies are assessed on the basis of their capability to shrink tumors, but if the therapies fail to kill the cancer stem cells, the tumor soon grows back (often with a more resistance against the previously used therapy).It has also been suggested that cancer stem cells are more resistant to chemo and radiotherapy than other cells in a tumor. As cancer stem cells form a small proportion of the tumor, this leads to a problem in selecting drugs that act specifically on the stem cells. Current anti-cancer therapies are primarily based on trying to inhibit cancer cell growth, causing cancer cells to die, or a combination of both. Till date, novel antibodies have been created those target antigens on both CSCs and the bulk differentiated tumor cells, which are derived from the CSCs. A new study from researchers observed that the same stem cells and differentiated cells were found in cells with different genetic mutations in these tumors, with stem cells fueling tumor growth in each case. This could mean that targeting these cancer stem cells may help inhibit tumor growth.


•           Identification and Targeting of Cancer Stem Cells

•           Gastric Cancer Stem Cells

•           Tumorigenicity

•           Cancer Stem Cell Markers

•           Stem Cell Mutation


Stem Cell Transplantation

According to researchers stem cells are naturally attracted to proteins released by tumors. So these cells serve as biological delivery vehicles to cancer tissue, releasing therapeutic payloads directly at the site of malignancy. A stem cell transplant aims to try and cure some types of blood cancer such as leukemia, lymphoma, and myeloma. It is also known as peripheral blood stem cell transplant. Stem cells can be used in mini transplants which are also known as reduced intensity conditioning (RIC) transplants. There are clinical trials showing the role of the stem cells in the regeneration of myocardial tissue following myocardial infarction. Researchers are programming human bone marrow stem cells to identify the unique physical properties of cancerous tissue. According to a current report on stem cell research, it’s growing twice as fast as the world average research. Over the last 25 years, there has been an exponential growth in journal articles on stem cells. The market is expected to reach USD 145.8 Million by 2021, growing at a CAGR of 11.0% during the forecast period.


•           Autologous & Allogeneic Transplantation

•           Stem Cell Differentiation & Cancer

•           Umbilical Cord Blood Transplant

•           Parent-Child Transplant and Haplotype Mismatched Transplant

•           Syngeneic Stem Cell Transplant


Radiology: Nuclear Medicine & Imaging

Radiation oncology covers the integration of radiation therapy into multimodal treatment approaches. A variety of imaging techniques such as X-ray radiography, ultrasound, computed tomography (CT), nuclear medicine including positron emission tomography (PET), and magnetic resonance imaging (MRI) are used to diagnose cancer in its early stages. Interventional radiology is the performance of (usually minimally invasive) medical procedures with the guidance of imaging technologies. They can sometimes help predict whether a tumor is likely to be cancer. This can help health care providers decide if a biopsy is needed. Molecular imaging enables scientists to understand the molecular pathways inside organisms in a non-invasive manner. Nuclear medicine uses small amounts of radioactive material called radiotracers (typically injected into the bloodstream, inhaled or swallowed) to diagnose and determine the severity of or treat a variety of diseases.


•           Brachytherapy

•           Stereotactic Radiosurgery

•           Image-Guided Radiation Therapy or IGRT used in Conjunction with Intensity-Modulated Radiation Therapy (IMRT)

•           Proton Therapy

•           Radioembolization


Metastasis Biology

Tumor metastases are responsible for approximately 90% of all cancer-related deaths. Although many patients can be cured, in the US and UK, cancer still causes 730,000 deaths every year, and it is second only to cardiovascular disease as a cause of death-metastasis is one of the hallmarks of cancer, distinguishing it from benign tumors. Most cancers can metastasize, although in varying degrees. Basal cell carcinoma for example rarely metastasizes. In Metastasis a complex series of steps takes place in which cancer cells migrate to other parts of the human body via the lymphatic system, therefore the bloodstream, or by direct extension. In Metastasis malignant cells break away from the primary tumor and attach to and degrade proteins that make up the surrounding extracellular matrix (ECM), which separates the tumor from adjoining tissues. Researchers examining the necessary conditions for cancer metastasis have found that one of the critical situations required is the growth of a new network of blood vessels, called tumor angiogenesis. It has been found that angiogenesis inhibits, therefore, can help in preventing the growth of metastases. Cancer cells affect the bones by interfering with osteoblasts and osteoclasts causing bone metastasis.


•           Common Sites of Metastasis

•           Metastasis Diagnosis

•           Bone metastasis

•           Molecular Analysis for Therapy Choice Metastatic lesion (NCI-MATCH)

•           Proteins involved in Metastasis


Pediatric Cancer: Leukemia

In children, a genetic condition, such as Down syndrome, sometimes increases the risk of cancer. Kids who have had chemotherapy or radiation treatment for cancer are more prone to get cancer again. Familial and genetic factors are identified in 5-15% of childhood cancer cases. In less than 5-10% of cases, there are known environmental exposures and exogenous factors, such as prenatal exposure to X-rays, tobacco, or certain medications.(childhood) leukemia (32%), brain tumors (18%), and lymphomas (11%) are the most common cancers in children. High-dose chemotherapy followed by a stem cell transplant can treat some types of childhood cancers. Newer types of treatment, such as targeted therapy drugs and immunotherapy, have also been proven in treating some childhood cancers. More than 80% of children with cancer now survive 5 years or more due to major treatment advances in recent decades. Overall, this is a huge increase since the mid-1970s, when the 5-year survival rate was about 58%.


•           Leukemia

•           Central Nervous System (CNS) Tumors

•           Molecular Pathogenesis of malignant Lymphomas

•           Bone Cancer: Osteosarcoma & Ewing Sarcoma

•           Neuroblastoma


Neurological Cancer

Generally, treatment for patients with brain cancer spinal cord includes surgery, radiation therapy, chemotherapy, and/or steroids to treat and prevent swelling. Brain cancer is caused by abnormal cell growth in the tissue of the brain. Astrocytomas are the most common type of brain tumor in children and anaplastic astrocytomas and glioblastomas make up about one-third of brain tumors in adults. Researchers have found that for the tumor's formation, it's-within the main tumor, a particular population of cells, called "glioma stem cells," are Response bits resistance to chemotherapy and radiotherapy, and has high recurrence rate following treatment. Doctors couldn’t see glioblastomas, until recently with the drug Gliolan or 5 ALA, which can turn the cancer cells pink has been approved by the FDA. especially in the brain; anti-seizure medication to treat and prevent seizures associated with intracranial pressure; placement of a shunt (to help drain excess fluid in the brain); lumbar puncture/spinal tap (to measure pressure in the spinal cord and brain); bone marrow transplantation; rehabilitation (to regain lost motor skills and muscle strength); and/or antibiotics (to treat and prevent infections).A new drug called CMP3a has been designed which is set to target NEK2 by selectively inhibiting its activity in glioma stem cells. It was able to hinder glioblastoma growth, as the scientists observed both in vitro and in vivo.


•           Astrocytoma

•           Oligodendrogliomas

•           Malignant Glimos

•           Pediatric Neuro Oncology

•           Glioblastoma Multiforme


Alternative Medicine & Cancer

Alternative medicine treatment can be used instead of standard medical treatments. One example is using a special diet to treat cancer instead of anticancer drugs that are prescribed by an oncologist. Some alternative Medicine therapies have undergone careful evaluation and have been found to be safe and effective. These therapies include a wide variety of botanicals and nutritional products, such as dietary supplements, herbal supplements, and vitamins. Some therapies may interfere with standard treatment or even be harmful. The herb St. John's wort, which some people use for depression, may cause certain anti-cancer drugs not to work as well as they should. By various accounts, from less than 10% to more than 60% of cancer patients have used Alternative Medicine.


•           Biological Treatments

•           Dietary Supplements and Herbal Remedies

•           Oxygen Therapy and Hyperbaric Chambers

•           Aromatherapy

•           Proteolytic Enzyme Therapy

•           Hydrazine Sulfate as a Treatment for Cancer.


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