Identification of Biomarkers for Detection of Cancer of the Oral Cavity.

Early detection and management is an emerging paradigm to reduce cancer mortality by shifting the stage of diagnosis of most cancer types to an earlier stage  when they still might be curable  Despite the dramatic progress and development of successful therapies for cancer treatment over the past decades cancer remains the second leading cause of death globally accounting for almost one in six deaths Cancer mortality is exacerbated by late stage diagnosis especially in developing countries like India where more than two thirds of the cancer patients are already in an advanced and incurable stage at the time of diagnosis One major goal in cancer research is the detection of cancers before they metastasize to distant sites or develop drug resistance. Even when metastasis has initiated but is not yet evident radiologically cancers can be cured in up to 50 percent of cases with systemic therapies such as cytotoxic drugs and immunotherapy. Therefore earlier detection is critical for increasing the rates of survival and at significantly lower costs of treatment.

A liquid biopsy LB test primarily relies on measuring one or more circulating analytes shed by the tumour cells in the blood. These analytes include cell-free nucleic acids cfDNA or cfRNA protein biomarkers .  and other biomolecules such as glycosaminoglycans . Such tests could be supplemented with other specialized medical imaging tests such as lose dose CT or PET CT to increase the sensitivity and specificity of cancer detection at an earlier stage.

Many studies since 2016 have shown the utility of protein biomarkers evaluation of somatic mutations to identify the circulating cfDNA from tumour cells ctDNA differential fragmentation and methylation profiles of ctDNA, and presence of cancer-specific RNA species in the blood - with or without conventional radiological imaging techniques - to detect cancers before the emergence of distant metastases. Encouraged by these landmark studies, we seek to evaluate, coherently and comprehensively, many of these different next generation approaches for identification of cancer biomarkers and development of a non-invasive test for detection of oral cavity cancers (OCC and other oral potentially malignant disorders (OPMDs) to be introduced to the Indian population.