Truthfully, I just made up that title. There is really no discipline known as “cancer tissue management science” or “biospecimen management science”. At SpeCicare, our team is investigating this space because we believe that living tissue is better for most clinical applications. We call this area of study “Live Tissue Science”.
There has been quite a lot of research into the collection, handling, and preservation of tumor specimens. And there is a knowledgeable research community in this arena. But, unfortunately, this knowledge has remained limited to a segment of the research community and, in fact, never been transferred to the clinical oncology community. As a surgeon who has spent his entire life in the clinical cancer community and has only late in life become aware of these facts, I can say with confidence that almost all of us who take care of individual cancer patients really have no clue about how best to handle tumor tissue.
How in the world can I make such a radical statement?
Well, because the global clinical cancer community handles tumor tissues the way 28 year old Ferdinand Blum figured out how to do it in 1893.
Cancer tumors are still being handled in 2024 as they were in 1893!
What? That was not a typo. 1893. Blum found that a solution made of formaldehyde hardens the tissue and makes it easy to cut and then stain with dyes and look at it under the microscope. Ask any first year medical student who gets his/her fingers exposed to the cadavers about the hardening of the skin of the fingers if you get a hole in your gloves as you are doing your dissection. Yet, tissue is still placed in formalin, although we now know that doing so causes major changes in the molecules within the tumor.
Since 4% formalin solutions allow tumor tissue to be cut, placed on slides, and then stained with hematoxylin and eosin, the diagnosis of cancer can be made by visual inspection of the tumor. This property has fostered the specialization of physicians to look at the changes in the tissue, defined as the pathology of the tissue, and thereby the profession of the pathologist. In fact, this specific discipline is now called anatomic pathology.
Cancer patients of 2024 can freeze their tumor tissue for better results.
But times have now changed and much more information can be extracted from the tumor tissue than just by looking at the tissue under a microscope. Essentially all these additional methods of study of the tumor tissue are better served by freezing the tumor tissue, rather than putting it in the formalin that, not only kills it, but also chemically alters it during these tumor tissue death throes.
This is not a scientific article, just a perspective that makes a sweeping statement about the deficiencies of our current methods of tumor tissue handling and preservation.
At SpeciCare we have embarked on a journey of investigation of tumor tissue management and we are currently comparing tissue fixation by formalin (FFPE or formalin fixation paraffin embedment) with cryopreservation (freezing the tissue slowly to keep it alive). So far, we have confirmed that the research community is right. Formalin fixation of tumor tissue induces many changes. We are working to introduce cryopreservation into the work flow of the pathology community. At present, we recommend this and can enable this for the individual cancer patient. Further, our overall mission is to make freezing of a portion of the tissue, in addition to the usual formalin fixation of another tissue portion, a daily occurrence for all patients. We need to make sure that the tests of the tissue beyond the initial microscopic exam give the answers that are most aligned with what is real and true.
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