When it comes to cancer, early detection can be the difference between life and death.
Many people, however, don’t find out they have cancer until they experience symptoms, and by then it’s all the harder to beat.
It’s an unfortunate chronology that Lehigh University Professor Yaling Liu hopes to reverse with the development of a low-cost, easy-to-use cancer test that eventually could be sold over the counter for at-home use. Imagine something like a pregnancy test — except it would screen blood for circulating tumor cells, the telltale sign of some of the deadliest diseases, including lung, cervical, breast and colon cancers.
“It’s portable, and it’s cheap,” Liu said of his invention, which, to the naked eye, looks like a simple glass slide. He calls it a “lab on a chip,” hinting at the complicated science the inconspicuous device is able to perform.
“It’s hugely interesting from an engineering standpoint,” said Dr. Robert A. Smith, vice president for cancer screening for the American Cancer Society in Atlanta. “To me, this kind of [research and development] is fascinating. It’s literally a chip that acts as a laboratory.”
Currently, cancer diagnosis is labor-intensive, expensive and, for the patient, highly intrusive. Indeed, Smith describes it as “medieval.”
“We scrape the cervix with a wooden spatula. We compress the breast between two plates. We insert a tube into the rectum,” he said. “When will be the day when we can look back at this and shake our heads?”
Liu, a professor of mechanical and bioengineering, turned his attention to cancer diagnostics several years ago, after attending a conference hosted by the National Cancer Institute in Bethesda, Md. He then applied to the National Institute of Biomedical Imaging and Bioengineering, a division of NCI, for a research grant, and was awarded $250,000 over three years. (His collaborators at the University of Pennsylvania got $200,000 to fabricate the necessary materials.)
A Chinese immigrant who looks younger than his 36 years, Yaling has assembled a research team in his Bethlehem lab that includes graduate students as well as Parkland High School freshman Roy Ghosh, who is 14. Last year, when Ghosh was still in middle school, he learned about Liu’s project at the Lehigh Valley Science Festival at Coca-Cola Park and was so inspired he asked for an internship at Liu’s lab.
The lab on a chip works like a change-sorter that separates not nickels and dimes, but circulating tumor cells from normal blood cells. Basically, as the blood runs from one end of the chip to the other, it flows over a series of ripples covered in microscopic pillars that snag passing tumor cells.
The presence of tumor cells in a blood sample is not necessarily proof of malignant cancer. However, according to Liu, it does suggest an increased likelihood of a growth somewhere in the body.
“It gives you a certain confidence that you should go get another test,” he said.
And that’s where things get complicated. Despite his enthusiasm for Liu’s engineering feats, which he considers novel, Smith has grown somewhat skeptical after seeing many other proposed cancer tests come and go, including some that also targeted circulating tumor cells.
The problem is that a positive test — one detecting an elevated number of tumor cells — could raise more questions than it answers, starting with what kind of cancer it is. Without that key piece of information, a patient wouldn’t know what kind of additional testing to seek: A mammogram? A colonoscopy? Perhaps magnetic resonance imaging?
Moreover, the body produces many tumor cells that never turn into cancer. And some tumors aren’t malignant, or they’re so slow-growing as to pose little threat in a patient’s expected lifetime. So a positive test could lead to a lot of unnecessary heartache, scaring people into getting tests and treatments they really don’t need.
“The idea that this could be a home test, that would be something we would be very discouraging of at this early stage,” Smith said.
“This is pretty exciting and interesting technology,” he continued. “But it’s a long way toward routine use. … It faces the challenge of showing that it outperforms anything we are doing today, which has typically gone through” rigorous trials.
The time between the development of new health technology and its deployment is often years, and even decades. Take the example of mammography used to detect breast cancer: Doctors first tried it in the late 1960s but didn’t accumulate persuasive findings until the late 1970s. Additional studies took several more years. And by the time hospitals bought their own mammography equipment, the 1980s were almost over and two decades had elapsed.
Lehigh University recently filed for a patent for the lab on a chip. Now, Liu said, he hopes to find a partner, perhaps a medical device company, that will acquire rights to the technology and bring it to market.
Dr. Lee Riley, chairman of oncology for St. Luke’s University Health Network, said he could imagine using the lab on a chip to detect the recurrence of cancer that was in remission — a possibility Smith suggested as well.
“Obviously there will be a lot of work,” he said. “But it’s a neat concept. …If we are going to improve the outcome of cancer, we’re going to have to come up with a better screening program. A simple blood test would be so much easier.”
He added, “I think it’s really cool something like this is happening in our own backyard.”
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