Bowel Cancer Awareness Month: how Sydney is tackling the disease

The gut of the matter

Microbiologist Dr Erin Shanahan believes science is on the brink of a new way of thinking about bowel cancer and its relationship with what we eat.

Her work with the University’s School of Life and Environmental Sciences and the Charles Perkins Centre could help pave the way for new treatment and prevention strategies for the second biggest cancer killer in Australia (after lung cancer).

Dr Shanahan’s research focuses on the gut microbiome (the ecosystem of micro-organisms that lives in the intestinal tract) and how it can contribute to the development of bowel cancer.

“The microbes in the gut respond differently depending on what you eat,” she says. “We think that if you’re eating less beneficial foods, the gut microbiome can start to produce products that can damage the lining of the intestine or affect the cells that line the intestine, and that can start to drive those cells down the pathway towards cancer.”

She is interested in discovering more about how diet can promote gut health. It is well established that a high-fibre diet can help prevent cancer and that too much red meat can be a risk factor, but Dr Shanahan wants to uncover more detail.

“It’s about really understanding those interactions, so we can give people much more targeted advice,” she says. “We’d like to get to a point where we can give people individualised nutritional advice that suits their gut microbiota and makes their gut as healthy as possible.”

She is growing gut bacteria in cultures in the lab and feeding them different food components to see how they respond. She will also feed different diets to mice, to observe the impact on their gut bacteria and overall gut health.

Her work is supported by a $15 million bequest that funds the University’s à Beckett Fellowship program for early- and mid-career researchers working on bowel cancer or bowel health. When benefactor Elwin à Beckett died in 2013, she left the bulk of her estate to the University to fund research in memory of her brother, Martin, who died of bowel cancer in 1986.

For Dr Shanahan, the à Beckett fellowship was a chance not only to develop her research, but to help tackle a disease that has had a huge impact on her family. “Three of my grandparents died from bowel cancer,” she says. “I’m passionate about this work both scientifically and personally.”

Tech transformation

Technology is driving a revolution in clinical care, says Professor Mark Molloy, the Lawrence Penn Chair of Bowel Cancer Research.

Professor Molloy, a biochemist based at the Kolling Institute at Royal North Shore Hospital, is an expert in molecular analysis, which can improve understanding of tumour biology and help clinicians make decisions about treatment.

Using mass spectrometers – sophisticated weighing devices that allow researchers to determine the molecular make-up of various substances – Professor Molloy and his team can analyse the molecular features of proteins and metabolites in individual tumours, in order to tailor treatment pathways according to the needs of each patient. "When combined with genomic analysis, this gives us a more complete molecular picture of bowel cancer and polyps, which is essential to better understand prevention and treatment strategies," Professor Molloy says.

Mass spectrometers could also be used to monitor medication levels in a patient’s system, allowing clinicians to deliver a dose precisely calibrated to suit the individual. “By applying molecular analysis techniques to blood samples, the oncologist could potentially adjust the medication levels up or down in a more precise and personalised way,” says Professor Molloy.

He aims to find ways of integrating molecular analysis into everyday patient care. Within the next five years, he says, clinical teams working with bowel cancer patients could include a molecular scientist.

“Currently these multidisciplinary teams discuss imaging, surgery, approaches to chemotherapy and so on,” he says. “I’d like to see clinicians also asking how molecular analysis could help add to the fuller picture.”

The Lawrence Penn Chair of Bowel Cancer Research is named after one of Australia’s oldest bowel cancer survivors and funded by $6.4 million in funding from Bowel Cancer Australia, plus an additional $4 million in support from the University. The newly established role will drive crucial research as well as raise awareness about the disease.

After bowel cancer: surviving and thriving

Dr Claudia Rutherford still gets emotional when she talks about her friend and mentor, Professor Donna Lamping, who died of bowel cancer at the age of 58 in 2011.

Professor Lamping, an expert in health psychology and quality of life assessment at the London School of Hygiene and Tropical Medicine, had been Dr Rutherford’s PhD supervisor when she was working in the UK. “I spent a lot of time with her when she was going through chemo and she still made time to review my thesis chapters and to give feedback,” says Dr Rutherford, now a health psychology researcher at the University of Sydney.

When bowel cancer is detected early, patients have a good chance of survival. But, says Dr Rutherford, there is more to thriving after cancer than simply staying alive.

“People are living longer as bowel cancer survivors. My research is focused on making sure we maintain the best quality of life,” she says. “Bowel cancer affects patients in various ways, and there are symptoms and side effects that can last into the long term.”

Along with physical symptoms, such as constipation, diarrhoea or bloating, survivors may experience anxiety, depression and body-image issues.

Like Dr Shanahan, Dr Rutherford is an à Beckett Fellow. During her fellowship, she will work with clinicians, from nurses and radiotherapists to surgeons and medical oncologists, to design a program that uses patient reports about their illness and treatment to improve their experience from diagnosis through to life after cancer.