Molecular markers

Created: 19.08.2019

The indication of when medicine can be used is sometimes based on the molecular characteristics of the tumor. This is expected to happen increasingly in the future as new cancer drugs become available. The extent to which a molecular test has been carried out and its result is therefore important information that can be compared with the medicine and other treatment the patient has received.

Where do we get molecular test data from?

The central source for information on molecular methods comes from the reporting of pathology reports. When the pathology laboratory has analysed the tissue piece, a response report is sent back to the clinic with information about the findings on the specimen. The Cancer Registry of Norway receives a copy of the response report (paper or as xml). This is reviewed by coders who structure the information according to given rules and register this in the Cancer Registry's database. Among other things, we register morphology (tissue type), as well as which molecular tests (e.g. EGFR or PD-L1) have been done and what was the result of the test.

In most cases, this is only done at the time of diagnosis, but sometimes a molecular analysis of pieces of tissue obtained at a later stage in the course of the disease (e.g. when spreading to other organs) is performed.

The second source of molecular information is from clinical messages. Some markers tested for in blood and not on tissue are only reported on clinical messages. These are forms that cover different parts of the patient pathway and are completed by the clinician in a web portal (KREMT).

Some cancers have specially developed forms, while others are registered on a generic form. Therefore, the amount of information we have on treatment is somewhat different for the different types of cancer. Types of cancer for which there are quality registries have specific reporting forms that cover the various parts of the treatment pathway, such as assessment, surgical treatment, radiotherapy, drug therapy and follow-up.

Other cancers are reported on general forms for solid and non-solid tumors. In some cases, the information here may be from tests done on blood, and Thus only available via the clinical notification form.

What molecular data do we collect?

For cancers with quality registries , the starting point is that we want to register all tests that are relevant to the treatment.

We do this in close cooperation with the professional councils for each quality register. Here, representatives from different regions and academic communities sit and ensure the relevance of what is registered. New markers used in connection with new drugs that come into use are discussed in the professional council. They advise the Cancer Registry of Norway on when and how (level of detail on test type and result) markers should be registered.

Overview of molecular markers in use

Various methods are used for molecular characterization, including immunohistochemistry, fluorescent in situ hybridization (FISH), and molecular genetic analyses such as allele specific PCR, multiplex fluorescent PCR, fragment analysis, DNA methylation and DNA sequencing.

The methods reveal different types of molecular changes, such as single gene mutations, translocation of one gene to another area of the genome, change in the amount of gene expression (RNA or a protein) for one or more genes combined.

The genes in which the changes are characterised may have very different functions, but common to them is that the change is important for the assessment of the patient's prognosis and treatment.

Today we record the following markers:

See ELVIS for details.