World CCA Day: Tackling Cholangiocarcinoma
People who have PSC live with a higher risk of developing bile duct cancer (also known as cholangiocarcinoma, or CCA). Although the risk of developing it is low, the worry it causes is huge.
CCA is difficult to detect because it mimics PSC and we do not yet have the tools to detect it early, and we don’t know which PSC patients are at highest risk of developing it. This is important, because if it is picked up early before symptoms appear, treatments have the best chance of success.
How is PSC Support addressing cholangiocarcinoma?
PSC Support is tackling CCA in four ways:
- Supporting one of the largest ever clinical trials in PSC, the Asp PSC Study, to see if aspirin can help prevent cancers and other complications of PSC.
- Helping to develop new treatment options such as liver transplantation for people with PSC who get CCA. Transplant is currently only available in the UK for some patients meeting strict criteria;
- Supporting the commercialisation of promising tests (developed by academic researchers) to detect CCA early from the lab to clinics; and
- Funding a range of research projects aimed at early detection, identifying the most at-risk patients, and understanding how the cancer begins;.
Key Research
Below is a summary of the key research areas being funded by donations to PSC Support:
1. Developing Simple, Non-Invasive Blood Tests
One of the most significant goals is to use simple blood tests that can catch cancer early when it is most treatable.
- International Collaboration for a Global Test: Professor Jesús Bañales and Dr Pedro Rodrigues are leading a global study involving over 800 samples to develop a practical, cost-effective blood test.
- Machine Learning Insights: Dr Ghada Nouairia is using advanced machine learning to identify unique molecular ‘signatures’ in the blood. Her work has found specific combinations of molecules that may help predict which patients are at a higher risk of developing cancer in the future.
- Detecting Genetic "Noise": Dr Rodrigo Motta is studying DNA methylation, which can be thought of as disruptive noise around our genetic code, to spot early signs of cancer in blood and bile. His team is using new technology that can gain extensive insights from very small biological samples.
2. Identifying Markers of the Transition to Cancer
Understanding exactly when and how healthy bile duct cells start becoming cancerous is a key focus because findings could lead to possible treatments or even prevent cancers.
- The COX2 Discovery: Dr Edward Jarman has successfully identified a protein called COX2 as a marker for the transition from PSC to cancer. This ‘appreciable leap forward’ is significant because the changes seen in his lab models match what is actually happening in patients.
- Genetic Changes in Cells: Dr James Sun is using "organoids" (3D lab-grown bile ducts) to identify genetic changes in bile duct cells that lead to cancer. This could eventually lead to genetic tests that tell patients exactly how high their personal risk is.
3. Improving and Validating Diagnostic Methods
Even when new tests are discovered, they must be proven to work in the real world compared to existing methods.
- The DOUBLE Study: Professor Christoph Schramm and Dr Jan Philipp Weltzsch are conducting a study to compare traditional tests with emerging methods (like those from Dr Bañales' work). Their goal is to identify the most accurate combination of tests to ensure patients get a definitive diagnosis as early as possible while avoiding unnecessary invasive procedures.
By investing in a diverse range of research projects, PSC Support is working to unlock the breakthroughs needed to detect associated cancers early and with certainty
Hey - what about curing PSC?
This article highlights our CCA work to help raise awareness on World CCA Day. However, we have a laser-sharp focus on supporting and funding research towards treatments to slow or stop PSC progressing, and even reverse damage to the liver caused by PSC. See our other research studies.