The holy trinity of cancer care: biochemistry, microbiology and pathology Premium

Explore how biochemistry, microbiology, and pathology collaborate in cancer care for early detection, personalized treatment, and survival monitoring.

Cancer originates at the genetic micro-molecular level within a cell — resulting in a cascade of subtle biochemical and cellular abnormalities that escape internal patrol — and eventually manifests as a detectable disease. Onco-biochemistry involves quantifying tumour markers, enzymes, hormones and metabolites in blood and body fluids for diagnosis, prognosis and monitoring treatment response or resistance. Clinical biochemists monitor the chemical signature of cancer and the body’s systemic response to treatment. They determine the baseline biochemical parameters in a cancer patient and any reversal of these chemical signals as a result of cancer treatment.

Tumour markers such as prostate specific antigen (PSA), cancer antigen‑125 (CA‑125) and carcinoembryonic antigen (CEA) can flag prostate, ovarian and colon cancers even before symptoms appear. Enzyme tests such as lactate dehydrogenase (LDH) and Beta2M give an idea of the overall cancer burden. Protein electrophoresis, a test that separates blood proteins, can reveal a distinct “M‑spike” that helps diagnose multiple myeloma. Subsequently, the down-trending of these values reveals whether treatment is working, before a radiological scan can capture the changes.

Advanced biochemical techniques such as serum-free light chain assays allow the treating oncologist to detect even tiny amounts of remaining cancer cells that could trigger a relapse. Measuring therapeutic drug levels in blood allows precise and safe dosing. Baseline and periodic liver function tests and kidney function blood tests reveal the trend of systemic response. Clinical biochemists are the first to spot cancer related life-threatening complications such as tumour lysis syndrome and hypercalcemia of malignancy. In the high-risk environment of a bone marrow transplant, biochemistry provides the “dashboard” for recovery by monitoring rejection and electrolyte homeostasis.

How oncopathology works | Photo Credit: Special Arrangement

Microbiologists play a significant role in the management of cancer patients. Approximately 20% of cancers are caused by microbes: viruses and bacteria. Viruses including the human papillomavirus, hepatitis B virus, hepatitis C virus, Epstein-Barr virus, Kaposi’s sarcoma-associated herpesvirus andHuman T-lymphotropic Virus-1 all cause cancer. Bacteria such as Helicobacter pylori are associated with stomach cancer. Early detection of these microbes and treatment of the infection caused may help in prevention.

Additionally, cancer treatment weakens the immunity of patients and renders them susceptible to life-threatening opportunistic infections. Microbiologists use advanced detection techniques such as BACTALERT 3D/240 (blood microbe culture system), MALDI TOF (matrix‑assisted laser desorption ionisation time‑of‑flight) for rapid and accurate detection of the culprit microbes and to identify the specific antimicrobial agents (drugs) needed to treat the infection. Early detection, therefore, supports rational antibiotic use, de-escalation of antibiotic therapy and antibiotic stewardship. Cumulatively, these advanced microbiological diagnostic techniques prevent the emergence of antimicrobial resistant microbes and impact countless lives.