Clinical Applications
Clinical Applications: Cancer is a major public health problem. Worldwide, more than 6 million people die from cancer each year and more than 10 million new cases are detected; 85% of cancers arise in epithelial tissue. In developed countries, cancer is the second leading cause of death. Currently, the clinical classification of cancer and its precursors is based on phenotypic markers, such as nuclear to cytoplasmic ratio and extent of invasion, which are then used to select therapy. In the last decade, enormous progress has been made to understand the molecular events that accompany carcinogenesis. The identification of unique molecular markers of cancer and the associated processes they modulate has led to the development of new molecular cancer therapies that affect these processes, such as chemoprevention, chemo-radiation, gene therapy, and immunotherapeutics. Moving toward a molecular characterization of cancer would have important clinical benefits, including (1) earlier cancer detection based on molecular characterization, (2) the ability to predict the risk of precancerous lesion progression, (3) real time margin detection in the operating room, (4) the ability to rationally select molecular therapy and (5) to monitor response to a therapy in real time at a molecular level. While molecular markers can be visualized in vitro using complex immunohistochemical staining protocols, there is an important need to image the molecular features of cancer in vivo. Imaging the molecular features of cancer requires molecular-specific contrast agents which can safely be used in vivo as well as cost-effective imaging systems to rapidly and non-invasively image the distribution of these agents in vivo. Radiographic imaging modalities such as CT scan and MRI, although useful for delineating the deep extent of advanced carcinomas, are not sufficiently sensitive to detect small, intraepithelial lesions. Optical imaging is a relatively new modality which enables real time, high resolution imaging of epithelial tissue. Optical imaging systems have become inexpensive, robust and portable because of advances in computing, fiber optics and semiconductor technology. Optical imaging systems are ideally suited for early detection of intraepithelial disease and to assess tumor margins and response to therapy. The goal of our lab is to integrate advances in functional genomics of cancer with the development of optical spectroscopy and imaging systems and molecular specific contrast agents. We develop molecular-specific, optically active contrast agents that can be applied topically. At the same time, we develop inexpensive, rugged and portable imaging systems to monitor the three-dimensional profile of the targeted biomarkers as well as morphologic, architectural and functional biomarkers such as nuclear to cytoplasmic ratio, chromatin texture and redox state. We focus on cancers of the cervix, oral cavity and the lung, which represent more than 20% of both tumor incidence and mortality worldwide
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