Let’s talk tumor bank basics.
A tumor bank is a place to store tumor tissue, generally to be used for research purposes. Tumor or cancer tissue can be stored in two basic ways.
It can be stored after the cells have been killed by placing them in formalin and then preserved in wax. This is the way most tissues are stored, by putting these wax blocks in drawers in cabinets in pathology departments after some of the tissue has undergone routine pathologic analysis. Every time a piece of tumor is removed from a patient in the United States, the College of American Pathology dictates the manner in which it is studied and reported. This is always on this dead and “fixed” tissue and allows the testing to give standard information used to diagnose and manage cancers.
A second way to save tissue is in living form. This method allows actual testing of tumors against specific chemotherapies and other substances. It offers a way to validate whether the proposed therapy will work.
Unfortunately, saving living tissues and storing them in tissue banks is done very infrequently. The reason for this is that it is more expensive to save living cancerous tissue and, until recent years, it has been very difficult to save tumor tissue and then do research on it. In more recent times, some tumor tissue in a few places is saved in living form and then sold to pharmaceutical companies or used for research purposes by academic scientists.
Since doctors in nearly all hospitals have rarely, if ever, gotten the appropriate consents to allow for research, the tumor tissue held in pathology departments just sits there in case a question ever arises. The rise of tumor banks has coincided with the increasing needs of researchers for study of human tumor tissues.
In recent years a new industry has risen up around saving tumor tissue, especially living tissue, and then either using it for academic research or selling it to pharmaceutical companies to give them the tissues they need for research purposes. With these tissues researchers can learn much about drug effects on tumor tissues. This, in turn, has led to the expansion of tissue banks to save tissue in living form. This way of storing tumor tissue is definitely more expensive, but pharmaceutical companies have deep pockets and have been willing to pay for it.
Until now, almost never has tumor tissue been saved for the benefit of the individual patient. The expense of saving living tumor tissue is one big reason. Another is that only in very recent years has it become known that each individual patient’s tumor is unique, carrying specific genetic, immunologic, and other molecular characteristics, very different from other cancers that even carry the same name.
The time has come for individual research on a specific patient’s tumor tissue. This requires a new model in which the patient has to step up to the plate and pay for saving his or her own tissue and then for subsequent research on it. Not every cancer patient needs to do this. Some cancers have only a minimal chance of causing the patient’s death. In these cases, no tissue needs to be stored.
However, in other cases, each doctor and patient should carefully consider whether it is in the patient’s best interests to save a portion of that individual’s tumor tissue and to get tests done on it not available in other ways. This can lead to validation of therapies by ruling some in and some out, the hope of decreased toxicities from therapies and, importantly, more effective therapies that offer the hope of longer survival and perhaps, a cure.
The door to truly personalized medicine is opened by saving the individual cancer patient’s tumor tissues. Welcome in.