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Cancer Research at the Christie Hospital

Introduction

Hi, my name is Shreya, a Master's student at the University of Manchester. My Master’s is in cancer research, an extremely topical and fast paced field. After completing three years of medicine, I decided to take a year out, known as 'intercalating', to explore research.

The knowledge of how innovative and pioneering the current projects are, coupled with the fact that I had a previous interest in the clinical side of cancer, solidified that this was the field for me. After this year I’ll return to finishing my medical degree, now with the perspective of working as a researcher. The invaluable skills I’ve learnt and will continue to develop this year should only help me become a better doctor in the future.

In Depth...

My research is focused on colorectal cancer, one of the most common cancers in the UK. The project I’m doing specifically involves patients that have had advanced colorectal cancer, which has unfortunately spread to the lining of the abdomen. This type of cancer is difficult to treat and involves intricate surgery that lasts for around 8-10 hours. Patients after this surgery have kindly donated their tumours in order for our team to analyse them. We are looking at the DNA of the starting tumour and the DNA of the tumours that have spread, in order for us to see how closely related the two tumours are. This project has many elements to it and involves a large team, I’m working closely with surgeons, pathologists and lab researchers who are using state of the art techniques and facilities to get the most accurate results. My main role will be to analyse the raw results, which should start to become available within the next month. At the moment I am mainly delegating and in charge of organising, as there are many people involved, it can often be difficult, but I’m enjoying the communication aspect. Performing a DNA profile of the starting tumour (primary) is common practice in hospitals, as it helps doctors come up with a treatment plan tailored to the tumour type. A profile of the tumour that has spread (secondary) is not routinely done, therefore the profile of the primary is also used to treat the secondary. This project aims to see if there are any differences in DNA between the two, and whether the secondary site should also be analysed for establishing treatment plans. A lot of information can be gained by looking at the DNA of tumours, and more information is needed to help manage this advanced disease, which currently has a poor prognosis.

My project is a good mix of lab work and clinical; often projects are one or the other. This means I get the opportunity to explore both kinds of research. I am also exposed to many different environments, for example, I have sat down with pathologists and looked at tumour samples under the microscope, as well as having the opportunity to be in the genomics lab and understand the process of DNA profiling. Being able to have these experiences is one of the reasons why I took a year out of medicine. Despite having previous reservations about doing a Master’s (mainly due to adding an extra year to my already long 5 year degree!) I’m happy with the work I’m doing, and I have been enjoying experiencing the world of research.

Going Further…

1.  For more information on DNA and genes: https://www.genomicseducation.hee.nhs.uk/genetics101/what-is-dna/

2.  I am based at the world-renowned Christie Hospital which is pioneering in cancer research, for more information on the research they do have a look at their website: https://www.christie.nhs.uk/professionals/research/

3.  For general information about cancer, check out the Cancer Research UK website: https://www.cancerresearchuk.org/?gclid=EAIaIQobChMImcevrJDr3wIVCbDtCh2byAaqEAAYASAAEgII7vD_BwE&gclsrc=aw.ds#/

4.  For more information about applying for medicine at Manchester: https://www.manchester.ac.uk/study/undergraduate/courses/2019/01428/mbchb-medicine/

5.  For information about the Masters in oncology (cancer): https://www.manchester.ac.uk/study/masters/courses/list/08422/mres-oncology/

 

What links: cigarettes, psoriasis and John Snow?

Intro

My name is Alex Trafford and I am a second year Epidemiology PhD student in the Division of Pharmacy and Optometry. I have quite a diverse academic background for somebody in my field, being unsure of which subjects I enjoyed most at school and splitting my A-levels between the sciences and humanities. I eventually decided to pursue an undergraduate degree in geography, with two years at Lancaster University and one year abroad at the University of North Carolina. In my final undergraduate year I took part in a module looking at health geographies - during this time I came across the field of epidemiology, which combined aspects of science and humanities, and decided that this was the direction I wanted to go in. In order to learn more about the field, I completed a master’s degree in Demography and Health at the London School of Hygiene and Tropical Medicine in 2017.

In late 2017, I received funding from the Global Psoriasis Atlas and started my PhD in Epidemiology at Manchester. My project here involves using huge datasets to understand how having psoriasis might make somebody more or less likely to get cancer.  

In Depth


Although epidemiology is not a field that is as well-known as others, like maths or chemistry, its results are often very well publicised and can shape how many people live their lives. The first epidemiological study was conducted in London by John Snow (not the one from Game of Thrones), who used a map of cases of ill health and interviews with local people to identify a contaminated water pump that was spreading cholera. Since this first study, epidemiology has been developed and used in a lot of different ways to improve health – from proving that smoking can be extremely bad for your health to recognising the role of mosquitos in the spread of yellow fever. Though more traditional methods are still used to quantify disease and its distribution - for example, in recent Ebola outbreaks - epidemiology has also evolved to use big data and more complex techniques, such as machine learning. 

In my research, I will be using big data to understand how having psoriasis may influence the risk of developing cancer. Although psoriasis presents as a condition of the skin, it involves chronic, systemic inflammation and this has been linked to an increased risk of cancer in other conditions, such as inflammatory bowel disease. However, attributing an altered risk of developing cancer to the inflammation involved in psoriasis is challenging due to the presence of other lifestyle behaviours, such as smoking. As it has been demonstrated that smoking is more common in people with psoriasis, it is challenging to say whether people with psoriasis develop cancer more often because of their psoriasis or because they are more likely to smoke – this is a concept known as confounding in epidemiology.

To try to understand whether people with psoriasis do develop cancer more, and whether it’s likely to be a result of their psoriasis or other lifestyle behaviours, I am analysing health data recorded by GPs and Hospitals in England. By following anonymous people with and without psoriasis through their health records, it is possible to compare the number of cancer diagnoses in each group. Having data for behaviours such as smoking then allows me to understand how these factors might be influencing any risk.

Gaining an understanding of whether people with psoriasis do develop cancer more, and what might be causing this, is vital for the current care of people with psoriasis and may also guide important future immunological research into the topic.


Going Further

To learn more about John Snow’s first epidemiological study - 

https://www.pastmedicalhistory.co.uk/john-snow-and-the-1854-cholera-outbreak/

To learn more about epidemiology –

https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/1-what-epidemiology

To learn more about psoriasis –

https://www.psoriasis-association.org.uk/

Population health at the University of Manchester –

https://www.research.manchester.ac.uk/portal/en/facultiesandschools/division-of-population-health-health-services-research--primary-care(19db7129-c98b-4029-a819-8c5ffe20e845).html