If you got a fever, take paracetamol.
If you are in pain, take an analgesic.
If you get a burn from hot water in the kitchen, apply bacitracin.
Today, we almost have a one-point medication solution, probably for every common disease.
Talking about human diseases in April reminds us of the deadly oral cancer. The historical timeline on oral cancer dates back to Edwin Smith and Eber’s Egyptian papyri descriptions of cancers around 3000 – 1600 BC.
Sushruta Samhita, a Sanskrit medical encyclopedic text from around 1000 BC, described different head and neck cancers.
Standing amid an era of DNA and experiencing the advent of high-throughput technologies, we still have questions to answer.
Questions!
Why don’t we have a single drug to treat oral cancer?
Why don’t we have a single biomarker panel for early detection?
Perhaps you can add more to this list!
April is Oral Cancer Awareness Month. It is an annual observation that underscores that early detection of oral cancer can decrease morbidity and increase long-term survival. (Ref: American Dental Association, ADA)
This April, let us dig into a perspective a bit differently.
Understanding two vital aspects of oral cancer genetics might give us fruitful answers to the above questions – genetic heterogeneity & epigenetics
Q1. Why don’t we have a single drug to treat oral cancer?
The most probable answer lies in understanding the concept of genetic heterogeneity.
Genetic heterogeneity refers to genetic differences among cells or individuals of the same species, including differences in DNA sequence, gene expression, or gene function.
In the context of cancer, genetic heterogeneity refers to genetic variations within a tumour or among different tumours from the same type of cancer or amongst patients with same cancer.
Oral cancer is a heterogeneous disease. It means oral cancer can have different genetic and molecular characteristics depending on a particular individual. It also depends on the specific subtype of cancer.
The primary reason that makes it unlikely that a single drug can treat all cases of oral cancer is genetic heterogeneity.
Is there a solution?
Yes! The solution is a personalized medicine approach. It will target the specific genetic and molecular alterations driving the growth and spread of an individual’s cancer. It is likely to be more effective than a one-size-fits-all approach. This approach may involve a combination of drugs that target multiple pathways and molecular targets involved in the development and progression of cancer.
How can we achieve the solution?
It is only through an evidence-based clinical practice approach.
Q 2: Why don’t we have a single biomarker panel for the early detection of oral cancer?
Biomarker assays need to be highly sensitive and specific. They should have low false positive and false negative rates.
Three pertinent challenges exist:
- One of the main challenges in developing a biomarker panel for oral cancer detection is that oral cancer is a complex disease with multiple genetic and environmental factors contributing to its development and progression.
2. Clinical challenges in developing biomarker panels for oral cancer detection:
a) Biomarker panels should be tested in large and diverse patient cohorts. It is to ensure their effectiveness in detecting early-stage oral cancer, which is critical for improving patient outcomes.
b) To incorporate biomarker panels into routine clinical practice, significant regulatory and reimbursement hurdles are to be overcome.
3. A lack of standardization in biomarker development and validation exists.
Is there a solution?
The probable solution would be to understand the epigenetic changes of oral cancer.
Epigenetics refers to changes in gene expression or cellular function that do not involve alterations in the DNA sequence itself. It involves modifications in the regulatory part of a gene called “junk DNA”.
Epigenetic modifications include DNA methylation, histone modifications, and non-coding RNA molecules.
Dysregulation of these epigenetic modifications can result in abnormal gene expression patterns, leading to the development and progression of cancer.
Here are some ways in which understanding epigenetics can help in biomarker development:
- Early detection of oral cancer
- Diagnostic and prognostic biomarkers
- Monitoring treatment response
- Predicting treatment response
- Drug development
Epigenetic biomarkers have the potential to improve cancer care. They can help in early detection, guiding treatment decisions, and facilitating personalized treatment approaches.
Overall, a better understanding of oral cancer genetics can help to overcome the challenges of developing a biomarker panel for oral cancer detection by providing insights into the molecular and genetic changes that drive the disease. Using advanced genomic technologies like next sequencing, microarrays, and mass spectrometry can lead to the development of personalized medicine approaches to oral cancer detection and treatment, improving patient outcomes and reducing the burden of the disease.
Education is not the filling of a pail, but the lighting of a fire -William Butler Yeats.