Early Cancer Diagnosis From Blood With Nuclear Magnetic Resonance Metabolomic Testing

A new type of diagnostic blood test, in patients with unexplained weight loss, fatigue and other symptoms not specific to a particular disease, has been shown to detect cancer accurately and distinguish patients with early and metastatic (advanced) cancer.

This is the first blood-based cancer test to determine whether a cancer is metastatic without prior knowledge of its organ of origin.

Early Cancer Diagnosis With a Different Blood Test

On 4 January 2022, Clinical Cancer Research published this study, in which researchers from the University of Oxford in England used nuclear magnetic resonance (NMR) metabolomics to analyze blood samples from 300 patients with symptoms not specific to a particular disease but potentially suggestive of cancer.

Metabolomics is the scientific study of chemical processes involving metabolites, small molecules, intermediates and products of cellular metabolism. These metabolites are small molecules such as sugars, nucleotides, amino acids and lipids. In metabolomics, small molecules in the metabolome are detected, quantified and identified using high-throughput technologies.

Conventional liquid / blood-based cancer tests look for genetic material released by tumors. In contrast, the NMR-based technique uses a magnetic field and radio waves to analyze blood metabolite levels as biomarkers for distinguishing different cancer states.

Study coauthor Dr. James Larkin said, "Cancer cells have unique metabolomic fingerprints because of their different metabolic processes. Metabolites produced by tumors can be used as biomarkers to detect cancer accurately; we are only now beginning to understand how."

NMR-based metabolomic analysis, among the 300 people recruited to the study, correctly detected solid (organ) tumors in 19 of the 20 cancer patients. It also identified metastatic disease in these patients with 94% accuracy.

The authors emphasize that the techniques will need to be tested in a larger patient group to validate the results and assess the test's usefulness in a broader clinical context.

However, the technique shows promise as a fast, inexpensive test to detect cancers early, before conventional imaging. It may also allow doctors to identify patients who could benefit from drugs designed to treat metastatic disease more quickly.

Rapid, Early Diagnosis With NMR for Patients Awaiting a Cancer Diagnosis

NMR metabolomic testing may be particularly helpful in diagnosing cancer in people with vague or nonspecific symptoms such as unexplained fatigue or weight loss, prolonged nausea or new atypical pain.

Current cancer referral pathways rely on organ-specific symptoms such as coughing up blood or blood in the urine, or clinically palpable abnormalities such as breast lumps. When symptoms are nonspecific, knowing which specialist to refer a patient to can be difficult. Patients may go back and forth between general practice and hospital many times before diagnosis.

In England, National Rapid Diagnostic Centres are being rolled out nationwide to speed cancer diagnosis and provide a referral pathway for patients who might otherwise be ineligible for urgent referral. However, diagnosing cancer without organ-specific symptoms to guide investigations can still be difficult.

Metabolomic tests could offer a quick, easy way to triage (direct) patients with more vague symptoms without having to pinpoint a specific site, allowing doctors to prioritize those needing more invasive investigations.

Dr. Fay Probert, lead investigator of the Oxford study, said: "This study describes a new way to identify cancer. The aim is to produce a cancer test that any doctor can request."

In conclusion, we think that metabolomic analysis of blood may enable accurate, timely and cost-effective referral of patients with suspected cancer and better prioritization based on the additional early information this test provides about their disease.