Dr Girish Patel

"Each day I meet patients with cancer, for me the cancer stem cell hypothesis is a beacon of hope…I need to make the cancer stem cell hypothesis benefit my patients"

Who are you?

I am the lead investigator for the Skin Cancer Stem Cell Research Programme as well as an Honorary Senior Lecturer at the European Cancer Stem Cell Research Institute. I am also a practicing Dermatologist working in West Wales for Hywel Dda University Health Board, looking after patients with skin diseases including those with skin cancer.

How did you become the Lead Investigator of the Skin Cancer Stem Cell Research Programme?

The short answer is by default because there isn't anyone else. Although as a dermatologist and the person who identified two skin cancer stem cell populations it is hard to imagine who else! I'm not too bothered with the title, it fits but it is not that important to me. What is important is that I can continue to investigate and answer relevant scientific and clinical questions.  What I do know is that at this moment, I am in the right place to make the most progress. 

What is the cancer stem cell theory and how can having the knowledge of this help produce a cure?

The cancer stem cell theory proposes that cancer stem cells have the capacity to drive tumour growth, by their exclusive ability to proliferate long-term, give rise to progeny that undergo differentiation, as well as maintain its own population (a process called self-renewal). However, they may also have other properties that as yet we are unaware of. Indeed the central tenet of the cancer stem cell theory promises cure for cancer patients if cancer stem cells are efficiently killed. 

The presence of cancer stem cells can be determined by showing that a small sub-population of cancer cells can recreate cancer growth, while at the same time, demonstrating that the remaining cancer cells are unable to perpetuate cancer growth.  To date 16 human cancers have been determined to show cancer stem cell driven growth, including the three common skin cancers – two of which we identified!

How common is skin cancer and what do you think is the best way to educate people of the risks?

In spite of the pledge by government the 1992 Health of the Nation white paper to halt the year-on-year increase in skin cancer incidence by 2004, over the last decade the number of the three common skin cancers (basal cell carcinoma, squamous cell carcinoma and malignant melanoma), which account for 99% of all skin cancers, increased by 34-55%. This can be compared to a rise in all cancers of 3% in men and 6% in women. Last year in the UK there were over 100,000 operations for skin cancer, leaving suffers with disfiguring scars and the fear of cancer recurrence.

At current estimates, 1 in 5 individuals will develop skin cancer in their lifetime and this is set to rise in line with the continued increasing incidence, resulting in a continuous drain on clinical resources, costing the National Health Service an estimated £190M in 2012.

I personally think individuals should be warned of what to look out for, so that skin cancer treatment is prompt when it has the best outcome.

Human skin cancer stem cell research, because samples are abundantly accessible, provides an important gateway into exploring and understanding cancer stem cell biology and developing new treatments. 

Could you tell me about the different research projects that your team are currently undertaking?

Each person in my group is working on skin cancer stem cells trying to develop new ways to prevent, detect, predict outcome and develop of non-surgical treatments. Each project also has an aspiration to make breakthrough that can also be applied to all cancers.  Projects include: 'whether the CD200 glycoprotein is an effective target for basal cell carcinoma', 'the risk of squamous cell carcinoma in patients after organ transplantation' and 'the mechanisms of smoothened antagonist drug resistance in basal cell carcinoma'.

How do you see your research being applied to the bigger picture?

For me cancer stem cell treatments cannot come quick enough, I guess that has something to do with being a doctor seeing cancer patients every day. Although my research endeavours are still in their infancy, we already have a number of projects directly trying to apply cancer stem cell research for patient benefit.

What does your job involve today?

Today, I have been writing a grant seeking funds for a project to develop a new cancer treatment and also tidying up a research paper before submission. After our coffee and enjoyable a chat about our research, I am going to catch up with each team member to check on their individual projects. I love seeing and looking after patients, but it is equally gratifying talking to the team and sharing in their excitement over new discoveries. It's a cool day – really!

What do you enjoy most about being a researcher and is there anything you dislike?

Research serves the creative side of my personality and there is nothing more satisfying than experiments that work and grappling new data. What I also love is the team spirit and the energy from everyone working towards a common aim. When I get researcher visitors from other institutes they are definitely envious. Dislikes, the most fun I had was as a post-doc - I miss being at the bench and now must be satisfied knowing that I have created the opportunities for others.  I think we have something special here and I am proud to be a part of it. 

(Interviewer: Jasmine Gore, final year Biosciences undergraduate student)