Bone Oncology - our research explained

Work in our team is focussed on understanding how cancer cells spread from the original (primary) site (for instance the breast) to the skeleton. This is very common in patients who suffer from the late stages of breast and prostate cancer, two of the major cancer types in UK women and men. Although the majority of people survive their cancers as a result of early diagnosis and modern treatment, every year around 12,000 UK women die from breast cancer and 11,000 men die from prostate cancer. In most of these patients the cancer will have spread to many sites within the body (a process called metastasis after the Greek words meta, "next", and stasis, "placement"), including the skeleton.

Tumour in bone cropped

Damage caused by a tumour growing in bone

What happens when cancer spreads to the skeleton?

When new tumours start to grow in bone they cause a number of changes that result in the bone being weakened, this can ultimately result in painful nerve compressions and even cause the bone to fracture. Patients often experience symptoms like back pain as the first indication that the cancer has spread throughout the body. Although we have many ways we can treat these symptoms, once the cancer spreads it is in most cases incurable. Unfortunately there are no treatments available that can prevent cancer cells from spreading, partly because we do not understand exactly how and when this happens.

What do we need to know?
In order to develop new and effective treatments for cancer we need to find out how cancer cells spread around the body, in particular what it is that makes them decide to settle in a new site and develop a new colony. We also need to understand how cancer cells interact with the cells around them to build a new blood supply and how they avoid being detected and destroyed by the immune system.

Why can cancer come back after many years?
We know that both breast and prostate cancer may return in a more deadly form many years after the apparently successful treatment of the primary tumour. This is because a small number of cancer cells avoid being killed by chemotherapy and radiotherapy as they are in a particular state called “dormancy”. This means that the cells are not growing and dividing and therefore are not sensitive to many of the treatments that are developed to kill fast growing cancer cells. It is believed that these dormant tumour cells are hiding in particular sites in the bone marrow. In most cases these dormant cells do not ever wake up and start to grow into new tumours. However, in a small proportion of cases (less than 2 out of 10 breast cancer patients), the dormant tumour cells receive signals to start to grow. We do not yet know how this happens and it is impossible to study these dormant cells in the bone of patients.

What we do
We aim to find the answer to the following questions:

1) Why do breast and prostate cancer colonise bone?
2) Where do cancer cells go in bone when they first arrive?
3) How can cancer cells stay dormant for so long?
4) What are the signals that trigger dormant cancer cells in bone to start growing again?
5) How do cancer cells change their surroundings once they start to grow?

In addition we are working to identify new ways of treating breast cancer spread to the skeleton, in particular how we can make sure cancer cells remain dormant (and never grow to be a problem).