Written by Whitney L.J. Howell

It’s an unfortunate, but all-too-common, story – a patient receives a clean bill of health from a physician but returns with advanced, untreatable cancer mere months later. If only doctors had been able to identify the malignant cells earlier.

Now, thanks to Adam Wax, Ph.D., Theodore Kennedy Professor of Biomedical Engineering, that’s a possibility. Using light channeled through a fiber-optic probe, researchers are able to pinpoint the cells most likely to become cancerous before they even reach that point. Doing so can open the door to treating and eradicating cancers more effectively.

“We’ve needed new detection methods for cancer because the ones we have aren’t great,” he said. “We generally only find them when they’ve impinged on other systems.”

Catching nascent cancers depends on measuring the nucleus size of suspect cells. Healthy nuclei measure around 8 microns, just barely over a millionth of a meter. But pre-cancerous ones increase to between 10-to-15 microns. A technology known as angle-resolved low-coherence interferometry (a/LCI), an optical-imaging technology that shines dim light onto tissue through a fiber-optic probe, is the only tool currently available that can identify such small changes.

And, it’s a/LCI that provided the foundation of Wax’s company, Oncoscope. This venture, founded in 2006, is dedicated to treating intestinal cancers and identifying early cases of Barrett’s Esophagus, a condition where intestinal tissue replaces esophageal tissue, putting patients are increased risk for the rare cancer esophageal adenocarcinoma. Each time the probe presses against tissue, light scatters back. Within milliseconds, the probe measures the angle of the light’s reflection to determine the nucleus size, and any over-sized cells are removed for biopsy.

“We can see the fundamental changes that lead to cancerous cells before there’s a painful, bleeding mass and before they’re visible on the surface of the tissues,” Wax said. “We see it before there’s a lesion – before the cancer is even cancer.”

Used in the clinic, the probe allows clinicians to scan larger tissue areas in less time and minimizes unnecessary biopsies, he said. Limiting biopsies is particularly important because patients with Barrett’s Esophagus traditionally undergo repeated and frequent biopsies.

However, Oncoscope wouldn’t have existed, and the probe wouldn’t have been brought to market without the support of a Duke-Coulter Translational Partnership Grant, he said. This initiative aims to support and speed-up the development of bioengineering research endeavors that can address vital, unmet clinical needs. The funds also bolster improvements in commercial development and clinical practice.

Ultimately, success means sticking with the investigations, Wax said.

“It comes down to perseverance, and it’s not an easy thing to do,” he said. “You really have to have a passion for your research and a belief that you’re headed in the right direction to keep things moving along.”