Helen White, Professor Ian Tomlinson, Claire Coughlan and Dr David Church: Can genetic discoveries revolutionise bowel cancer care?

In this episode, we explore findings from a groundbreaking study
recently published in Nature which revealed potential targets for
bowel cancer prevention and treatment. The study provides the
most detailed understanding yet of bowel cancer’s genetic makeup.
The research, which used data from the 100,000 Genomes Project
identified over 250 genes that play a crucial role in the
condition, driver genes and potential drug targets. Our guests
discuss the potential impact of these findings on patient
outcomes, screening for bowel cancer, and future prevention
strategies.


Helen White, Participant Panel Vice-Chair for Cancer at
Genomics England is joined by Professor Ian Tomlinson, Professor
of Cancer Genetics at the University of Oxford, Claire Coughlan,
Clinical Lead for Bowel Cancer UK and consultant nurse in
colorectal cancer, and Dr David Church, a clinical scientist
fellow and a medical doctor specialising in oncology at Oxford
University.


"The people that were kind enough to donate samples to the
100,000 Genomes Project, they did so knowing that they almost
certainly wouldn’t benefit personally from their donation from
their gift and that any benefits would be some way down the line
and hopefully benefit others which is what we’re seeking to
realise now. But, you know, it’s not a given when we treat people
in the clinic so we’re very, very grateful to those individuals."


You can read more about the study in our colorectal cancer blog
and our study findings news story.


You can download the transcript or read it below.


Helen: Welcome to Behind the Genes.


Ian: One of the great hopes is that some of these new genes that
we’ve found could be useful in preventing cancer and it doesn’t
necessarily matter that they’re rare, even if they’re only 1% of
cancers, by using those and changing those in the normal
individual before they have had cancer then we may be able to
reduce that risk. So, there are lots of potential new targets for
prevention that are coming through. 


My name is Helen White and I’m the Participant Panel Vice-Chair
for Cancer at Genomics England. Today I’m delighted to be joined
by Professor Ian Tomlinson, Professor of Cancer Genetics at the
University of Oxford, Claire Coughlan, Clinical Lead for Bowel
Cancer UK and consultant nurse in colorectal cancer, and Dr David
Church, a clinical scientist fellow and a medical doctor
specialising in oncology at Oxford University.  


Today we will be discussing a pioneering colorectal cancer study
which using data from the 100,000 Genomes Project has uncovered
new insights that could transform diagnosis and treatment for
patients with bowel cancer. If you enjoyed today’s episode we
would love your support, please like, share and rate us on
wherever you listen to your podcast. 


Thank you for joining me today. We’re going to be discussing the
findings from a landmark study that has been published in nature.
This study used data generously donated by people with bowel
cancer who took part in the 100,000 Genomes Project giving us the
most detailed look yet at the genetic makeup of colorectal cancer
better known as bowel cancer. But before we get into that let’s
start by hearing from my guests. Could each of you please
introduce yourselves. 


Ian: I’m Ian Tomlinson, I work at the University of Oxford and
most of my work is research into bowel cancer, it’s genetic
causes, the genes that are involved in actually causing the
cancer to grow which may be different from genetic causes and
also the use of that data to help patients whether guiding future
treatments or potentially helping to prevent bowel cancer which
would obviously be our optimum strategy to have the biggest
impact on the disease and its incidents.  


Claire: So, I’m Claire Coughlan, I’m the clinical lead for Bowel
Cancer UK and my remit at the charity is to ensure that
everything we do is clinically relevant and that we’re providing
services that meet the needs of those affected by bowel cancer
and the educational needs of those health professionals that work
with people affected by bowel cancer. I’m also a nurse consultant
in colorectal cancer at Lewisham and Greenwich NHS Trust and I
lead an urgent referral service there and also work with patients
with late effects of bowel cancer. 


David: I’m David Church, I’m a medical oncologist and Cancer
Research UK advanced clinician scientist at the University of
Oxford. I treat bowel cancer clinically and do research on bowel
cancer and womb cancer including a lot of research using samples
and data from Genomics England data service we’re discussing
today of course. 


Helen: Great, thank you. Now let’s turn to Claire to learn more
about bowel cancer. Claire, can you share with us how common it
is, how treatable it is and if there are any trends in terms of
which groups of people are affected? 


Claire: Of course, bowel cancer is a relatively common cancer,
there are about 46,000 people each year in the UK diagnosed with
bowel cancer so that is quite a large number. The thing that
really drives us forward in bowel cancer is that the earlier
stage you’re diagnosed at the greater chance of survival. So, the
figures for that are quite stark, we stage bowel cancer through
stage one to 4 with one being the earliest stage and 4 being the
most advanced.  


If you are diagnosed with bowel cancer at stage one you have a 9
in 10 chance of being alive and well 5 years after your diagnosis
of bowel cancer. And if you’re diagnosed at the other end of the
spectrum at stage 4 that drops to a 1 in 10 and should people
survive after a diagnosis of stage 4, which more people than
before do they will have had a lot of treatment for their bowel
cancer so the burden of the treatment will also be with them
after that. So, it’s really important that we diagnose at the
earliest possible stage which is why studies such as the one
we’re going to talk about today are so important.  


We have noticed that there has been a slight increase in being
diagnosed at a younger age. That said the latest statistic is
2,600 people were diagnosed under the age 50 in the UK last year
so it’s still a disease of older people, you still have a greater
chance of getting bowel cancer as you get older but it’s really,
really important that we’re aware that you can still get bowel
cancer as a younger person.  


Probably one of the most exciting things that has happened for
bowel cancer of recent years is our bowel cancer screening
programme and the age for that now has been brought down to 50,
we’re not quite there all over the country, but in the UK that is
the aim that everyone will be screened for bowel cancer at the
age of 50. So, yes it’s a common disease and staging an early
detection is vital.


Helen: That’s lovely Claire, thank you very much for that. David,
turning to you could you please explain to us how bowel cancer
typically develops?


David: Yes, so we know compared with many cancer types quite a
lot about how bowel cancer develops because the bowel is
accessible to collect samples by a technique called endoscopy
which is putting a camera into the bowel from which you can
sample tumours or lumps. And so from genetic research done in the
last 10 years we know that, or we’ve known for many years
actually, for much longer, that cancer is a genetic disease, it’s
a disease caused by alterations in genes and particularly genes
that control whether the cells in our bowel grow normally and die
normally as they should do.


And collectively when there are alterations in genes that
regulate those processes you can have a cell or collection of
cells which are able to grow without restraint and don’t die when
they should do which are some of the hallmarks of a cancer and
they also require the ability to spread elsewhere in the body
which is what kills people with cancer including bowel cancer. We
know from research done in the last 10 to 15 years that some of
the alterations in genes that can cause bowel cancer in
combination occur very early in our life, even in the first and
second decade of life, but don’t cause cancer.


The earliest detectable abnormality is typically a polyp which is
a tumour, a lump within the bowel which is detectable and if
removed is almost certainly cured by removal alone but if it’s
not detected then as that grows and acquires more alterations in
genes then it can become a cancer and cancers develop the ability
to invade the bowel wall, to spread to what we call lymph nodes
or glands nearby and also to spread further afield, most commonly
to the liver or to the lungs.  


And for most people whom bowel cancer has spread to the liver or
to the lungs or elsewhere unfortunately we’re not able to cure
their disease which as Claire has said is why there is such an
importance in detecting cancers and pre-cancers as we call them
so that the tumours are not actually cancerous but come before
bowel cancer as early as possible. 


Helen: Thank you David. Moving on to the study, Ian perhaps you
can take this, in the study that you carried out my understanding
is that the whole genome sequencing was used to investigate the
genetic changes that lead to the development and growth of bowel
cancer. And for this participants with bowel cancer in the
100,000 Genomes Project donated both a blood sample and a tumour
sample while those with rare conditions only provided a blood
sample, can you explain why that is? 


Ian: As you said the study really looked at 2 quite separate arms
albeit with a little bit of overlap as we’ll see. So, one very
important aim was to look at individuals, both children and
adults, who had medical problems or other conditions that were
unexplained but which had some features that suggested that they
weren’t necessarily inherited but there may be some variation in
their genes that had caused them, and roughly half of the
programme was dedicated to that.  


Within that there was a small number of people who had a strong
family history of bowel cancer or who had large numbers of polyps
in the bowel and they were analysed in a separate part of the
project from what we’re mostly discussing. Within the cancer arm
there was a collection really throughout England of patients who
had most of the common types of cancer and a few with less common
cancers.  


And because when we’re looking at genetic and related changes in
cancers we need to make sure that those changes have actually
occurred in the cancer as it started growing from its earliest
stages with a small number of cells in the body that were
slightly abnormal and then progressing. We need to look at what
genetic variation the patient has in all the cells of their body.
We don’t want to look at patients and say that looks an
interesting change, we may be able to use that if it’s present in
all of the normal cells in that patient’s system.  


We want to make sure the change is specific to the cancer itself
and therefore we have to sequence both a sample probably taken
from blood and a sample taken from the actual cancer. And in a
way we subtract out the changes in the blood to identify the
changes that have actually occurred in the cancer itself. 


Helen: That’s a very helpful explanation. Does this research show
that there is a role for whole genome sequencing in clinical
care? 


Ian: I think my own view is it is all a question of cost. I think
the advantages it provides it can assess multiple types of
genetic change at once. It is relatively consistent across each
cancer’s genome between cancers, even between centres mean that
it is the method of choice. There are undoubtedly developments
that will happen in the future, maybe being able to sequence
longer stretches of DNA in one go that will help the
analysis.  


And some of the computational methods are likely to develop to
identify some of the slightly difficult to identify genetic
changes but it ought to be the standard of choice. There are
issues and potential difficulties in collecting the high-quality
samples that have been needed from pathology laboratory and that
will be difficult going forward with current budges and there are
lots of challenges but ultimately it in some form has to be the
method of choice. What wasn’t done is to look at other molecule
tests or essays, looking at RNA wasn’t really done on a big scale
as well as DNA and other changes to DNA apart from the genetic
changes were not looked at.  


So, there are certainly ways it could be improved if you had
limitless money but I think the project, 100,000 Genomes has
shown the whole genomes are. They have a lot of advantages and
ultimately probably will be adopted by the NHS and similar
organisations. 


Helen: David, could you now tell us about the findings of this
pioneering study and what impact these findings might have on
people with bowel cancer in the future? 


David: So, this is the largest study to date to analyse the
entire genome of bowel cancer by some margin and the fact that
we’ve done whole genome sequencing and in so many people it has
really given us an unprecedented ability to identify the genetic
alterations that drive bowel cancer. And within bowel cancer
we’ve known for some time it is not a homogeneous entity that
bowel cancer is not all created equal, that there are sub-groups
of bowel cancer and we have been able to refine those over
previous efforts. And I guess if you were to ask what the biggest
take home for me from the study is it’s just the complexity of
the disease.  


So, as we’ve mentioned we know that cancer is a genetic disease,
that it’s driven by genetic alterations, alterations in genes
which regulate the growth of cells or the death of cells or the
spread of cells. And we’ve known for many years that there is a
modest number of genes which are commonly malfunctioning in bowel
cancer and they would be in the tens to dozens really. But with
this work we’ve hugely extended our understanding of the genes
that drive bowel cancer and in fact we’ve discovered nearly 250
genes which are altered in bowel cancer and appear to drive the
growth of the cancer.  


Now we know that not all of those will be validated and by that I
mean that there are associations that we find at the moment, not
all of which will be biologically relevant but interpreted in the
data we know a large number that are previously undiscovered are
or we can be fairly confident of that. And one of the take homes
from that is that many of these are only altered in a small
fraction of bowel cancers.  


So, rather than being perhaps half of bowel cancers or a third of
bowel cancers there are a good number of genes, a very
substantial number of genes, which are altered in say 3 to even
1% of bowel cancers. And if we think about how we go about
targeting those and perhaps we’ll come onto treatment later that
poses really challenges for how we work and we would think about
treating patients with bowel cancer who have those particular
alterations in their cancers. 


Helen: Thank you David, yes we’ll come onto treatment shortly,
but I think Claire has a question for you.  


Claire: Yes, thank you. For me as somebody who works in this
every day this is such an exciting and interesting study,
particularly in light of what we said earlier about early
detection and how critically important that is for improving
outcomes in people with bowel cancer. So, in your view do you
think this research could help shape future screening programmes
or prevention strategies? 


David: That’s a great question, I suppose in terms of screening
at the moment the majority of screening is done in the UK at
least by testing for blood in the stool which is relatively
non-specific so I’m not sure that that would be directly impacted
by this research. But one area of early cancer detection that is
perhaps more relevant is quite a lot of work including from
Oxford actually in recent years looking at blood tests. So,
testing blood samples for early detection of cancer whereby you
can test for genetic alterations, fragments of DNA that have
alterations from the bowel cancer or any cancer that circulates
in the blood and that tends to rely on a small number of common
alterations.  


And with this data I could see that we might be able to refine
those tests and in so doing improve our early detection of cancer
but that would need quite some work before we could actually say
look that had real potential I think. And in terms of prevention
there are, I think Ian may want to come in on this, one or 2
sub-groups which you might think that you could try to prevent
but of course that needs a lot of extra work really.  


But I think we have some clues of the biology of bowel cancer and
particularly some of the sub-groups where you might think well
this drug would work better in terms of preventing that sub-group
or that sub-group but that will need to be the subject of future
study. 


Helen: Ian, did you want to come in on that at all? 


Ian: So, at the moment prevention is a fairly new way of helping
to reduce the number of people with bowel cancer at the level of
the whole population which is what we have in the UK above a
certain age group as we heard from Claire earlier. The methods
used, again as we heard, are screening for occult blood in the
stool and then colonoscopy to identify either hopefully early
cancers or polyps and remove those. But when we think about the
methods that we use for preventing other diseases then normally
where they’re successful using a more easily delivered and I have
to say less expensive method.  


So, high blood pressure is treated to reduce the risk of
cardiovascular disease and there are other diseases where those
what you might call molecularly-based prevented strategies are
coming in. We really lack that for bowel cancer in particular, it
does happen for some other cancers, but one of the great hopes is
that some of these new genes that we’ve found could be useful in
preventing cancer. And it doesn’t necessarily matter that they’re
rare, even if there are only 1% of cancers, by using those and
changing those in a normal individual before they have had cancer
then we may be able to reduce that risk.  


So, there are lots of potential new targets for prevention that
are coming through and as David said it is going to take a lot of
work to work out which of those are deliverable and who will
benefit. But we have quite a lot of opportunities in that space
and although that may not be us that takes that forward, it may
be, but it may not be. We think it is a lot of material for those
interested in chemo prevention using drugs of cancer that they
can work on and with luck deliver some new ways of preventing
cancer that may be simply popping a pill every morning to take
your risk right down to as close as zero as we can. 


Helen: Thank you Ian. David, I think you had something to add
here. 


David: Thanks Helen. One area of prevention that we’re really
interested in Oxford and many others are is using the genetic
alterations that we find in bowel cancers and other cancers as
targets for vaccination. Now we know that gene alterations will
cause abnormal proteins which while they might drive the cancer,
make it grow or not die, can also be recognised by the immune
system so the abnormal proteins can be recognised by the immune
system as being foreign and as foreign they can be targeted by
the immune system so the immune system will try and kill the
cells carrying those alterations. And we know for some sub-sets
of bowel cancers those alterations can be relatively predictable
actually, they occur in quite a sizeable fraction of some
sub-groups of bowel cancers.  


And one area that we’re particularly interested in at the moment
and actively pursuing is using those targets where you need some
additional work to demonstrate when they are particularly
recognisable by the immune system. But to use these genetic
alterations is potential targets for vaccination with the
intention ultimately of preventing bowel cancer in at risk
individuals or ideally in the full-term time the whole
population. And we’ve received some funding from Cancer Research
UK to pursue this line of research and we have a group working on
this in Oxford and as I say many others do elsewhere. 


Helen: Thank you David, yes I have a vested interest in this
because my understanding is this work is aimed primarily at
people with a genetic condition called lynch syndrome which
predisposes the people who have inherited this gene change
alteration to bowel cancer, womb cancer and other cancer. And I
had womb cancer, as I think David you know, a few years back and
discovered it was due to lynch syndrome and so it’s really
exciting that you’re now looking at vaccinating preventing
because yes I take aspirin every day, I have my colonoscopy every
2 years which have some effect on preventing these cancers but
it’s not 100% guaranteed. And I don’t suppose it ever will be but
having the vaccination in that armoury would be fantastic I think
for future generations, it’s very exciting and we look forward to
hearing more about it.  


Thank you Ian and David. I mean we’ve heard a lot there about
preventing bowel cancer but I think moving back now to potential
treatments, you know, we’ve heard from David how this study has
shown a number of actionable findings but what are the next steps
towards treatment? How can these findings be turned into real
actions that will benefit those people diagnosed with bowel
cancer in the future? Ian, perhaps you would like to pick up on
this to start. 


Ian: That step is one, you know, in which I’m not personally an
expert but a lot of the newer treatments are based on the finding
of so called driving mutations which are simply genetic changes
that occur as the cancer grows and contribute to that growth and
ultimately if it’s not treated to the spread and dissemination of
a cancer. And the fact that we have reported 250 which need
validation but of which a large proportion are likely to be true
drivers means that anyone of those can be a potential new
target.  


The criteria to be used for which of those mutations to pursue,
which of those driver genes to chase up are quite complicated
normally, depend on many things such as the interest of research
groups and small and larger drug companies. And the similarity of
those genes to other genes that have evolved and the processes
that they make to go slightly wrong in the cancer.  


So, there is also the issue that because these are uncommon,
everybody talks a lot about personalised medicine or precision
medicine, this would be truly precision or personalised medicine
because a genetic change that was driving the cancer in only 1%
of patients is obviously not a huge number of patients although
bowel cancer is a common cancer so it’s not a tiny number either.
But it would mean investment at that level to benefit let’s say 1
to 2% potentially of all patients with bowel cancer but I think
that’s a nettle we have to grasp. And I think our results are
showing that most of the really common drug changes either have
not yet been successfully targeted in treatment or are too
difficult to target.  


So, we’re going to have to start looking at these less common
genetic drivers and design strategies, inhibitors, you know,
again that can be delivered to patients relatively
straightforwardly in order to see whether they benefit the
patients concerned. But there is this problem of getting enough
patients enrolled in clinical trials where a change is only
present in a relatively small proportion of all the patients with
that cancer type.  


Helen: Thank you Ian. Presumably if there is a relatively small
number of patients the people who are looking at running these
trials might be looking at perhaps international trials, would
that be one way to go? 


Ian: So, I think David can speak with more personal knowledge but
there are international trial networks and there are
collaborations along these lines already under way. I would hope
that those could be made use of even more than they are already.
There is, you know, a financial consideration for those
developing new anticancer treatments which are, you know, high
risk work and also the costs of setting up trials and enrolling
people is not a trivial thing. So, I think those are hurdles that
can be overcome but it would need a concerted effort to do that.
Patients will play a major role in that and patient organisations
as well as 100,00 Genomes and other similar projects. 


Helen: Yes, thank you, David I don’t know if you want to come in
on that. 


David: Yes, the challenge of testing therapies in small groups is
a very real one and there is lots of interest at the moment in
exploring alternatives to conventional clinical trials. And as we
use more electronic patient records and we have pharmacy records
so there is the potential to get those data from routine clinical
practice and there is lots of investments and attention on that
at the moment so called real world data which is always an
interesting term as if patients in clinical trials aren’t in the
real world which of course they are.  


But it’s perhaps a little more cost effective sometimes in
clinical trials, of course it does pose its own challenges in how
you disentangle true treatment effect from other factors because
there are many factors impacting on how long people with cancer
live. But there is a lot of investment and effort going into that
at the moment and it will be interesting to see how that develops
over the coming years. 


Helen: Turning to you Claire based on your experience how well do
you think people with bowel cancer understand how genomes can
help with their care and what support is currently available to
them in this area? 


Claire: I think the answer, as it is so often is, it’s dependent
on individuals and not just one individual. So, I think some
patients are very motivated to know as much about this as
possible and to understand and to know what the next steps may be
in their own treatment that may be helped by this. Others don’t
want to have the same knowledge and want to be guided very much
by their medical teams but I think oncologists obviously are at
the forefront of this and we see at the charity … we have
services at the charity that supports patients and we see lots of
queries into our ask the nurse service where people have been
given variable information about I suppose personalised medicine
as Ian alluded to and how their very specific bowel cancer may be
treated, so I think it varies from patient to
patient.  


There is support available so we have the ask the nurse service I
alluded to. We have a brilliant patient forum actually and
everybody in clinical practice will have seen this, patients
often become more expert than anybody and they share advice and
they’re moderated forums that are a very safe place for people to
ask questions where there is a moderator to ensure that it is
made really clear that circumstances are individual.  


And the same with the ask the nurse service because you don’t
have all the clinical information so it is about empowering
people, so there is support available. I think the other thing
that is really important is equipping specialist nurses with the
knowledge that they need to support their patients. This is a
really exciting area of evolution for bowel cancer particularly I
think in all cancers at the moment but for bowel cancer I think
things have changed fairly rapidly in recent years and specialist
nurses really need support in knowing that they have up-to-date
information to give their patients.  


So, that’s another challenge for us and any specialist nurses
that might be listening to this podcast we have online education
on genomics for specialist nurses. Just while we’re talking about
that and you mentioned lynch syndrome earlier, so there has been
a lynch syndrome project as I’m sure you’re aware where we’re
trying to get testing for lynch syndrome brought into local
hospitals.  


So, there was some funding via NHS England so that the testing be
done at time of diagnosis, so a pre-test and then a final test if
that’s appropriate, for everybody diagnosed with bowel cancer to
see if they have lynch syndrome. And in some trusts that has been
done and in others it hasn’t yet and the funding hasn’t quite
followed in the way that we need it to enable that to happen.
It’s vitally important, we think there are about 175,000 people
in the UK with lynch syndrome and we only know about 5% of them.
And this is a gene change that is an inherited gene change so we
can do what we call cascade testing where we test family members
and we can then employ preventative strategies to prevent people
from developing bowel cancer.  


So, it’s a really important project, so I think as well as
supporting patients with the information around the changes that
are happening in this area we also need to ensure that we support
the workforce and have investment there to enable the support of
all the changes and the genomic landscape. 


Helen: Absolutely Claire and so much resonates there with what
you’ve said. Having myself had cancer discovered that was due to
lynch syndrome, cascade testing offered to my family members so
valuable. It turns out I inherited my change from my mum who is
83, has never had cancer, so I think that’s a very good example
of, you know, it doesn’t necessarily mean that you will get
cancer but actually on that point that you made about empowering
patients I always have a right smile because there is my mum
going off to all her other medical appointments because at 83 she
sees quite a few people and she is always the one telling them
about lynch syndrome and educating them because most of them
haven’t heard of it, so yes it’s really, really
important.  


And that patient forum, you’re probably aware of Lynch Syndrome
UK, I don’t have any involvement in that other than being a
member but that is so valuable for people with a particular
condition to go somewhere where they can talk to or listen to
other people with a similar condition, really, really
valuable.  


Right, well I think circling back really to the 100,000 Genomes
Project I think you touched on this earlier David but reflecting
on what you and Ian have told us about your study what is it
about the 100,000 Genomes Project bowel cancer dataset that made
this work possible? 


David: There are a few things, one of which and not least of
which is the sheer size of the effort. So, to have whole genome
sequencing for more than 2,000 individuals is previously
unprecedented and we’ll be seeing more of this now as we scale up
our research efforts but at the inception of the project it was
very, very ambitious and to be able to deliver that is a huge
achievement. And the quality and breadth of the analysis is very
strong as well.  


And ultimately, you know, the former gives thanks to the people
that were kind enough to donate samples to the 100,000 Genomes
Project, they did so knowing that they almost certainly wouldn’t
benefit personally from their donation from their gift and that
any benefits would be some way down the line and hopefully
benefit others which is what we’re seeking to realise now. But,
you know, it’s not a given when we treat people in the clinic so
we’re very, very grateful to those individuals.  


And I think also to the scientists who worked incredibly hard
over the last 5 years to deliver this work actually. So, having
been part of the team and being lucky enough to be part of the
team along with Ian we’ve had hugely motivated individuals that
really have dedicated a large fraction of their working lives to
delivering this project which I think is a fantastic achievement
as well. 


Helen: Thank you, thank you to all those participants who at a
time when their lives probably were turned completely upside down
by a cancer diagnosis were offered the chance to join the 100,000
Genomes Project and said yes. As you say most of them will have
known that it won’t have helped them but by donating their data,
you know, it has allowed this work to happen and potentially it
could change lots of people’s lives in the future, so thank you
to them. 


Ian: Could I also just emphasise and agree with what David has
said, I won’t go through all the individuals by name, but if
anybody wants to read the published report of the work there are
several people on there, Alex Cornish is the first author, but
many colleagues from an institute of Cancer Research, The
University of Manchester, Birmingham, Leeds, other universities
in London that all contributed, but also colleagues in the NHS
and/or universities who recruited patients, collected samples,
processed them etc and of course the people who did the
preparation of the samples in genetics laboratories and actually
did the sequencing and basic analysis too.  


So, it is a truly huge effort across particularly all the cancer
types which is particularly a complex collection given the fact
the tumour is needed and a blood sample. It’s quite difficult in
a way to find a formal way of thanking them for all of this but
without them it wouldn’t have happened. 


Helen: On that note I think we’ll wrap up there. A huge thank you
to our guests, Professor Ian Tomlinson, Clare Coughlan and Dr
David Church for an enlightening discussion on the groundbreaking
study published in nature. This research is set to reshape our
understanding of colorectal cancer and pave the way for new
possibilities in treatment and patient care.  


If you would like to hear more like this please subscribe to
Behind the Genes on your favourite podcast app. Thank you for
listening. I have been your host, Helen White. This podcast was
edited by Bill Griffin at Ventoux Digital and produced by Naimah
Callachand.