Ulf Gyllensten's research projects on gynecological cancer
Research in our group focuses on identifying new molecular biomarkers that can be used to improve diagnostics for women seeking care for gynecological cancer, and to enable the development of a screening programme for these cancer forms.
Disease burden of gynecologic cancer
Epithelial ovarian cancer
Epithelial ovarian cancer (EOC) is the 8th most common cancer among women. Close to 90% of women with EOC survive past five years when the tumour is detected in stage I, but once the cancer reaches stages III or IV, treatment success drops to 25–30%. However, since an effective screening strategy is currently lacking, only 25–30% of EOC are diagnosed at an early stage. Thus, development of sensitive and specific screening strategy is urgently needed.
Endometrial cancer
Endometrial cancer (EC) is the second most frequent gynecologic malignancy. It is predominantly diagnosed in early stage due to symptoms such as post-menopause bleeding. Most cases are Type I, with low-grade, hormone receptor-positive endometrial tumours that generally have a good prognosis. Novel biomarkers are needed to improve identification and stratify patients on surgery and/or adjuvant chemotherapy.
Cervical cancer
Cervical cancer (CC) is the most common gynecologic cancer. It is caused by oncogenic forms of Human papilloma virus (HPV). Screening for HPV with co-testing using cytology is used in many countries. To increase sensitivity of screening, a second HPV test can be performed 4–6 months after the primary screening test, or HPV-positive women can be co-tested using protein biomarkers.
Identification of novel biomarkers for diagnosis and screening
We are focusing on plasma samples to improve diagnosis, and cervico-vaginal fluid (CVF) for detection of early-stage disease in screening. The work is divided into three main parts:
- Identification of novel biomarkers for EOC, EC and CC in blood and cervico-vaginal fluid (CVF) using next-generation high-precision plasma-proteomics.
- Development of a multi-omics test combining analyses of protein levels, tumour mutations and methylation pattern to improve diagnosis and enable population screening.
- Clinical validation the multi-omics test for preoperative diagnosis and screening.
Aiming for less surgery and reduced mortality
One of the main goals of our work is to reduce the use of diagnostic surgery in EOC. Close to 80% of women that undergo diagnostic surgery for ovarian tumours have benign conditions, and 13% of these develop complications from the surgery. A preoperative diagnostic test to distinguish those in need of surgery from those with benign conditions, could increase quality of life for women and reduce costs for the health-care system.
In addition, we hope that our findings will be able to reduce the mortality of EOC by identification of women with early-stage cancer. We also aim to expand the CC screening program to include biomarkers also for EOC and EC.
Sketch of the research aim, where body fluids such as urine and blood can be used to identify women at high risk of cervical, endometrial and ovarian cancer