News from the Netherlands
Tumor detection improves as the Netherlands is expected to see an increase in the number of cancer patients in the coming years
Researchers at the Netherlands Cancer Institute (NKI) have found that using PET/CT scanning technology, together with a new radioactive agent, Fluor-18-FAPI, allows harder-to-detect tumours to become more visible on scans. At the same time, it has been revealed that by 2032, 18 Dutch people will be diagnosed with cancer every hour.
Although many tumours are clearly visible on a standard CT or MRI scan, there are also a number of tumours that are considerably more difficult to detect.
The new FAPI PET/CT technology reveals tumours in a different way. As a result, those tumours that are considerably more difficult to detect, such as certain intestinal tumours, will be made more visible in the scans.
This improvement is possible because the new FAPI PET/CT scanning technology does not make malignant cells visible, but rather specific tumour stromal cells. This is the normal tissue that lies between the growing tumour cells and contributes to the tumour gaining firmness and being able to grow.
The technology is particularly suited to recognise tumours that do not grow into a clearly defined mass and tumours that are still very similar to normal cells both in appearance and behaviour.
"We were looking for a new type of scan that could detect tumours in a completely different way," says Wouter Vogel, an expert in Nuclear Medicine.
So that became the PET tracer Fluor-18-FAPI. The substance used for this purpose, Fluor-18-FAPI, does not bind to the tumour itself, but to tumour-activated fibroblasts in the surrounding tumour stroma.
This type of fibroblast does not occur in the rest of the body, so the FAPI substance will not bind to it. Therefore, thanks to these properties, the FAPI PET/CT technology can make the difference in discerning between normal and cancerous tissue.
Currently, the FAPI PET/CT technology is only used in scientific research on the improved detection of metastases from tumours in the intestine to the lymph nodes.
Researchers aim to soon be able to use the technology for other types of tumours that are difficult to recognise, for example, to detect unknown primary tumours or diffuse infiltrative growth tumours.
A similar technology was pioneered last year to better detect brain tumours. This technique uses another radioactive substance (FET) in combination with positron emission tomography/magnetic resonance imaging. The announcement of the improved tumour detection has been made in parallel with the results of a projection study on the increase of cancer patients in the near future.
The Netherlands is expected to have many more cancer patients in the coming years. The number of cancer diagnoses will increase by 156,000 per year until 2032.
Among people aged 15-59, the number of diagnoses is expected to remain fairly stable in the coming years. Putting this into perspective for the whole population, the number of cancer patients has increased considerably in recent years, from 56,000 in 1989 to 118,000 in 2019.
According to the IKNL, an average of 18 patients will be diagnosed with cancer every hour over the next ten years.
The increase is mainly due to 'double ageing', according to the researchers: there will be more older people in the coming years, who will in turn live longer than average. Cancer affects this group more often than others. Another cause is a lifestyle: smoking, alcohol consumption, obesity and low physical activity can lead to cancer.
The IKNL also states that the number of skin cancer diagnoses will increase due to excessive sun exposure and tanning beds.
In order to limit the number of cancer diagnoses in the future, the researchers advise more prevention. For example, less smoking will lead to fewer lung, throat, kidney and bladder cancers. The same goes for reducing excess weight.
In the Netherlands, lung cancer is the type of cancer that causes the highest mortality. About 10,000 people die each year from the disease, while it occurs in about 14,000 patients. Because doctors often discover it at a relatively late stage, the cancer is difficult to treat.
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