For the Love of Health

Finding a Cure for Colon Cancer with Dr. Bruce Boman

• ChristianaCare • Season 1 • Episode 27

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0:00 | 11:13

Colorectal cancer is the second most deadly cancer worldwide, equally affecting both men and women. According to the American Cancer Society, when colorectal cancer is caught early, 91% of patients survive five years or longer... however, that percentage drops significantly if the cancer has already spread to distant parts of the body before it's found. 

In this episode of For the Love of Health, Dr. Bruce Boman, medical director of Cancer Genetics and Stem Cell Biology at ChristianaCare provides invaluable perspectives on his team's research focused on finding a cure for colon cancer.

Whether you're a medical professional, a patient, or simply someone interested in the advancements in cancer treatment, this episode is a fascinating listen.

Renowned for his work in colorectal cancer, and a cancer survivor himself since 2000, Bruce M. Boman, M.D., Ph.D., is an attending physician and director for Cancer Genetics and Stem Cell Biology for ChristianaCare's Helen F. Graham Cancer Center & Research Institute. He also represents the Graham Cancer Center as a scientist with the Center for Translational Cancer Research.

With forward-thinking collaboration, the Cawley Center for Translational Cancer Research at ChristianaCare's Helen F. Graham Cancer Center & Research Institute links physicians and scientific researchers under the same roof. Working side by side, together they identify needs of individual patients at the bedside, explore solutions in the lab and translate those results directly into treatment plans as unique as the individuals who will benefit from them.

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Speaker 1

If we don't cure colon cancer from surgery, then it's really an uphill battle.

Speaker 2

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3

Hello everyone, I'm Megan McGerman.

Speaker 2

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3

Colorectal cancer is the second most deadly cancer worldwide, equally affecting both men and women. According to the American Cancer Society, when colorectal cancer is caught early, 91% of patients survive five years or longer. However, that percentage drops significantly if the cancer has already spread to distant parts of the body before it's found.

Speaker 2

Research being done here at ChristianaCare could change the lives of colon cancer patients. Dr Bruce Bowman, medical Director of Cancer Genetics and Stem Cell Biology at ChristianaCare, has dedicated his career to understanding colon cancer and he's here with us today to discuss his research. Bruce, thank you so much for being here with us today.

Speaker 1

Thank you, pleasure to be here.

Speaker 3

We mentioned that colon cancer is the second deadliest cancer worldwide. What is causing that? How did that happen?

Speaker 1

Because if we don't cure colon cancer from surgery then it's really an uphill battle. We have very few treatments that are curative for advanced colon cancer.

Speaker 2

Obviously, there have been plenty of studies about colon cancer over the years, but you've made some pretty significant breakthroughs in your time here with Christiana Care. Can you give us a little bit about what you've discovered on that time?

Speaker 1

So what we study is the stem cell origin of colorectal cancer. So most cancers are developed and they grow because of the small cell population of stem cells within the cancer itself. So these malignant stem cells, they drive the growth of the cancer. So we've been studying the stem cells within colon cancer and trying to understand why these stem cells differ from the normal stem cells that are essential for our health and our bodies. So the key is is if you can target the stem cells through treatments, then theoretically you can cure the patient. If you can't target the stem cells, then you're not going to cure the patient, assuming that the patient has cancer that's already spread.

Speaker 3

For someone who maybe has never heard of how stem cells work. How would you explain that?

Speaker 1

Like trying to get rid of the dandelions in your lawn. So if you want to get rid of the dandelions in your lawn, you can keep cutting the tops of the dandelions off, but they keep coming back. So if you want to get rid of the dandelions, you got to get rid of the root of the dandelion. So the cancer stem cells are the root of the problem. So if you want to cure the cancer patient with metastatic cancer, you've got to kill the cancer stem cells, because that's what's driving the tumor growth.

Speaker 2

You've been doing this research for decades. At this point, what have you seen change? What is going on in the landscape that is causing some of what you're seeing these days?

Speaker 1

The real shocking news in the last decade or so is that cancers are occurring in younger people, so I'm talking about people under age 50. So there's a big surge in colorectal cancer in individuals under age 50. Now when we see patients who are younger and they have cancer, we think they've inherited a gene mutation from one of their parents. But we found that this is not the case in these early onset colorectal cancer patients, because we screen these patients for germline mutations quote, unquote germline mutations to see if they might have inherited a predisposing genetic mutation that they got from one of their parents. But we find that there is not any more of these germline mutations in these younger people than we've seen previously. So something else is going on.

Speaker 3

Does your research show what might be causing the increase in colon cancer among young people?

Speaker 1

The current theories hold that it's probably a lifestyle factor. The current theories hold that it's probably a lifestyle factor, and so what we're studying is maybe what lifestyle factor might affect the lining of the colon so that when these cells get gene mutations then the cells are not lost. In our normal epithelium, in our normal lining of our colon, there's a mechanism called tissue renewal where the tissue is turning over all the time. It takes about five days for our tissue to turn over, and so the cells, except for the stem cells the stem cells stay, but they produce new cells, and these new cells are continually turning over, and so if there are any new mutations in any of these cells, the cells are lost that have the mutations, because the cells get extruded into the feces of the colon. There's some lifestyle factor we think Maybe it's allowing these cells that have mutations to take permanence within the colon itself, and so if the cells with the mutation take permanence, then that could trigger the development of colon cancer. So that's what we work on.

Speaker 1

The main gene that we've worked on and I've been working on this most of my lifetime in my research is the adenomatous polyposis coli gene, the APC gene.

Speaker 1

We know that mutation of this gene drives the growth of about 90% of all colon cancers. Now the main thing that we think is happening is it's probably related to a vitamin A deficiency. So a lot of the epidemiologic studies show that there's a common occurrence of vitamin A deficiency not only in the United States but worldwide, including well-developed countries. So we know in our research that there's two pathways that are operational in the colon. One is the vitamin A pathway, which is also called the retinoid signaling pathway, and then there's this Wnt signaling pathway that's activated to shut that Wnt pathway down. If that vitamin A pathway doesn't get operational, isn't functioning because of a deficiency. Maybe that's why these mutant cells are gaining permanence. So we study the link between these two pathways and we've published papers earlier this year that show that this link exists. We've identified the gene, the protein that links the two pathways and that's what we're trying to develop therapeutics towards.

Speaker 2

You've talked about these multiple pathways, these two pathways that you're dealing with in the process of treating it here. How did you discover them? How did you come to isolate these two different paths?

Speaker 1

The groundwork for these two pathways is done in the laboratory. So we have cancer cell lines, we grow these cells with media and bottles or flasks and we can test these different drugs in the laboratory, test these different drugs in the laboratory, and so it's in vitro studies that we test the ability of these drugs to decrease the proliferation and growth of these cells. In the laboratory we can actually isolate these cancer stem cells and we can test the drugs on these cancer stem cells in the laboratory. But the laboratory is a foreign environment. It's a first step to see if there might be a clue that there's activity there.

Speaker 3

And what makes you optimistic that a few years from now, this could be in human studies as well?

Speaker 1

This is a combination of drugs that have not been tried before. Most of the current drug trials focus on current paradigms, existing paradigms, where they take drugs that are already in the clinic and they combine them in different ways or not. This is a new combination that's not been tested. We've studied the pathways pretty extensively in the laboratory, so we have a pretty good idea of how they function and how they might be targeted. Because of this tissue renewal. There's two pathways, and if you're just trying to target one pathway, it's not going to work. You got to target two pathways and we know that pretty much for sure, and so that's what we're working on is trying to target these two different pathways that we know are linked. So we think that there's great hope that that might work.

Speaker 2

You've mentioned several times at this point the importance of screening and early detection. What's your message to the community there as far as getting that word out about how important that is? What would you tell people?

Speaker 1

Prevention is the ultimate cure. So if we can prevent colon cancer, I mean that's the cure, that's the real cure. If we can detect colon cancer early enough, at an early stage, where we can remove it surgically and remove all the cancer cells, it's another form of cure. It's a community thing, it's word of mouth. We go to some of these church functions and we encourage people to get screened. We have a lot of publicity out there to get screened. We know there's legislation out there that pays for the screening and it's people getting motivated through different ways to actually get out there and get screened. I'm basically a cancer survivor and I'm not a colon cancer survivor, but I know that it was because of screening that I'm still alive today. I mean, I had my cancer 25 years ago and it was because of the screening program that I'm alive today.

Speaker 1

So I'm an advocate, I'm an advocate not only for patients, but I'm an advocate for people getting the screen. I'm an advocate for gene testing so that people can determine if they're genetically predisposed to develop cancer. So it's a lot of the advocacy effort that works as well. You know patients, they have community and if you are a cancer survivor you have a little bit of credibility to say you know this actually works. Screening is a cure. Screening really is a cure.

Speaker 2

And what is the current guideline, especially if the colon cancer rates are increasing for younger people? What is the guideline at this point for recommended starting to get screened for colon cancer?

Speaker 1

Yeah, most of the societies and the federal guidelines have decreased the screening age to 45. If you have a family history then you need to see a genetic counselor because if we find that you have a predisposition factor then we will actually start screening much earlier. And so you know, we tell patients early age of onset. If you have any bleeding rectal bleeding, if you're losing weight there are a number of tests that we would recommend to see if they might have a gene mutation and family history I mean family history is so important and we recommend to physicians they need to take family histories and patients we get the word out there if they have cancer in their family they need to talk to their doctors and get referred if their doctor thinks there might be something going on.

Speaker 3

Bruce, thank you so much for your time.

Speaker 1

Okay, thank you.

Speaker 3

We'll have more information on colon cancer research, treatment and screenings being done here at ChristianaCare in the show notes for today's episode.

Speaker 2

And don't forget to subscribe to, for the Love of Health, on Apple Podcasts or Spotify, and follow Christiana Kerr on social media.

Speaker 3

We'll be back in two weeks with another great conversation.

Speaker 2

Until then, thanks again for joining us for.

Speaker 3

The Love of.

Speaker 2

Health.

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Megan McGuriman

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