Hrev_master Healthcare in Low-resource Settings 2024; volume 12(s2):12831 Innovations in cancer diagnosis and treatment: prospects and challenges Katarzyna Wisniewska,1 Ervin Marku,2 Martina Vidova Ugurbas,3 Ilona Hartmane,4 Malika Shukurova5 1Faculty of Health Sciences, Radom Higher School, Radom, Poland; 2Faculty of Technical Medical Sciences, Tirana Medical University, Tirana, Albania; 3Department of Plastic, Reconstructive and Aesthetic Surgery, Pavol Jozef Šafárik University in Kosice, Kosice, Slovakia; 4Department of Dermatology and Venereology, Riga Stradins University, Riga, Latvia; 5Department of Development of Children’s Cancer Registry, Scientific Practical Medical Center for Pediatric Hematology, Oncology and Clinical Immunology, Tashkent, Uzbekistan Abstract The research relevance of cancer diagnostics and treatment is determined by its widespread occurrence and the lack of adequate modern diagnostic methods. The study aims to characterise new diagnostic methods, namely screenings in detecting cancer at early stages of development. To achieve this goal, the bibliosemantic and bibliographic methods were used. Cancer is the leading cause of morbidity and mortality after cardiovascular diseases and injuries in many countries around the world. Various diagnostic and treatment methods are used to combat this problem, including computed tomography, magnetic resonance imaging and positron emission tomography. In addition, modern diagnostic methods such as polymerase chain reaction, mass spectrometry and genom- ic sequencing play an important role in determining the types of cancer cells and their sensitivity to treatment. These advanced methods can be used to diagnose cancer more accurately and effi- ciently and choose the most appropriate treatment strategies for each patient. The practical significance of this topic is to ensure appropriate care for patients with cancer: providing high-quality, efficient, fast and minimally invasive diagnostics using the latest methods, as well as implementing a screening system. Introduction Cancer remains one of the most common and dangerous med- ical problems in the world today. The speed of diagnosis, the suc- cess of treatment, and the prognosis of the disease leave much to be desired. For this reason, new approaches and innovations in the field of cancer diagnostics are constantly being sought.1 According to Siegel et al.,2 the number of cancer cases is expected to increase every year. For example, in the United States, despite technological advances in medicine, 609,820 cancer deaths were recorded. The topic presented is extremely relevant and needs to be studied in connection with the rapid spread of cancer incidence of various origins and locations. The problem occurs in several cancers that remain without visible early symptoms for a long time, or such symptoms are often missed and diagnosed at later stages. Another reason is the diversity and heterogeneity of tumours, and most importantly, the lack of a perfect screening sys- tem for early cancer diagnosis. For instance, Merkuri et al.3 addressed the imperfection of cervical cancer diagnosis in Albania. This pathology is the second most common among women aged 14-44, and screenings have been established at the state level for primary examinations. However, complicated cases of the disease have become increasingly common around the world. Dimitrova et al.4 state that many countries, such as Albania, Macedonia, and Bosnia and Herzegovina, already have decent standards of early cancer detection. However, despite significant progress, such screenings remain imperfect and require further improvement, as complicated forms of cancer are overlooked due to the lack of diagnostic accuracy. Xhemalaj et al.5 point out that the prevalence of cancer among the population of Albania, includ- ing even the capital Tirana, is quite high, which endangers the healthcare system. Moreover, in Albania, malignant tumours cause 13 to 18% of deaths. The author notes that lung cancer is the first among morbidity and mortality, and this number is more than 15%. Given the widespread prevalence of cancer, it is important to introduce not only new diagnostic methods but also therapeutic ones. To put the results in perspective, it would be more instruc- tive to compare the lung cancer rates and treatments in Albania Correspondence: Katarzyna Wisniewska, Faculty of Health Sciences, Radom Higher School, Radom, Poland. E-mail: wisniewska.kater@gmail.com Key words: cancer, disease detection, tumour, benignity, screening. Contributions: KW and EM, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing – original draft, review and editing; MVU, conceptualization, investigation, methodolo- gy, validation, and writing – original draft, review and editing; IH and MS, conceptualization, methodology, formal analysis, validation, and writing – original draft, review and editing. All the authors have read and approved the final version of the manuscript and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Ethics approval and consent to participate: not applicable. Funding: none. Acknowledgements: none. Received: 22 July 2024. Accepted: 22 August 2024. Early view: 22 August 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12(s2):12831 doi:10.4081/hls.2024.12831 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12(s2):12831] [page 95] Non -co mmerc ial us e o nly with those of other nations in the area or the world. Thus, Filaj et al.6 described the use of lasers in the treatment of cancer. This method is widely used to correct benign tumours – haemangiomas – and vascular anomalies. In addition, this method should be con- sidered as an innovative approach to tumours of other origins. Although a comparison with other treatment modalities would pro- vide a more comprehensive view of haemangioma management. Modern sources focus on the latest trends in cancer diagnos- tics. One of them is diagnostic markers based on RNA and DNA. Wang et al.7 believe that such methods are promising in addressing mRNA, non-coding RNA, circular RNA, and microRNA. The author notes that these types of RNA are the most sensitive in the diagnosis of cancer. Song et al.8 describe another promising method shortly: the determination of cell-free DNA in the patient’s plasma. It is believed that part of the tumour DNA enters the bloodstream and can be considered a biomarker of a particular tumour, and this fact may be useful in treatment in the future. However, at the same time, the collection and determination of this DNA can be inconvenient and inaccurate, so this method still needs to be developed. A similar study on the structure of DNA was highlighted by Dolatkhah et al.9 The scientists tested the effec- tiveness and reliability of DNA detection in the early diagnosis of colorectal cancer. However, colonoscopy has proven to be a more accurate and effective method, although it is not a new method. In turn, molecular screenings leave more questions than answers, which means that these areas are innovative and promising but still poorly understood. Additionally, it’s important to keep in mind that diverse populations and healthcare systems may respond different- ly to screening techniques. By offering a thorough and current examination of advancements in cancer detection and therapy, this study seeks to advance previous findings in the field. As opposed to earlier research, which frequently concentrated on particular cancer types or diagnostic techniques, this research adopts a more comprehensive strategy, looking at a wide range of cutting-edge technology and procedures across diverse cancer types. It offers a comprehensive picture of the state of oncology today by combin- ing, for the first time, a review of both diagnostic and therapy breakthroughs. The authors also highlight how these new technolo- gies should be integrated into the current healthcare systems, dis- cussing alternative answers and real-world implementation issues. Furthermore, the authors looked at how Artificial Intelligence (AI) and machine learning can improve cancer diagnosis and treatment planning. The study aims to describe the main aspects of the latest meth- ods of diagnosing cancer, which can be useful for the timely detec- tion of cancer pathology. Materials and Methods Bibliographic and bibliosemantic methods were used in the study of literature, which has significantly improved the quality and depth of the research. The approach to the use of scientometric databases such as Scopus, Web of Science, PubMed, and Google Scholar, as well as other archives, including Research Gate, demonstrates a broad analysis of the current professional literature on the problem under study. The choice of searching by title rather than by topic allowed us to accurately identify relevant research topics, which contributes to the accuracy and relevance of the information obtained. The absence of language restrictions makes it possible to cover a wide range of scientific literature and consid- er different points of view and approaches to the problem under study. A number of terms, concepts, phrases and keywords were used to search for scientific information: “cancer,” “oncology,” “pre-cancerous conditions,” “screening,” “diagnosis,” “treatment,” “therapy,” “examination,” “biopsy,” “cervical cancer,” “colorectal cancer,” “treatment effectiveness,” “tumour markers,” “biomark- ers,” “DNA analysis,” “RNA analysis,” “genetic engineering,” “gene mutations,” “gene expression,” “non-coding genes,” “gene alleles,” “lung cancer,” “biomolecular condensates,” “molecular analysis,” “circular RNA,” “gene regulators,” “incidence,” “popu- lation,” “risk group,” “smokers,” “teratogenic factor,” “bad habits,” “mortality,” “prognosis,” “risks,” “research perspectives,” “standardisation of diagnostics,” “ultrasound diagnostics,” “com- puted tomography,” “regional spread of the tumour,” “regional lymph nodes,” “Pancosta syndrome,” “low-dose tomography,” “health insurance,” “diagnostic limitations,” “clinical manifesta- tions,” “peripheral tumour growth,” “paraneoplastic syndromes,” “positron emission tomography,” “scintigraphy,” “gun biopsy,” “navigation biopsy,” “fibre optic biopsy.” In general, the approach to the problem involves the use of var- ious methods of analysis, synthesis, generalisation, and classifica- tion, which contributes to a more complete and deeper understand- ing of the topic under study. The method of analysis, which includes collecting information and breaking down the main state- ment into theses, made it possible to systematise the data and high- light key aspects of the problem. Literary analysis, based on the collection and processing of scientific literature, provides access to relevant and authoritative sources, which contributes to qualitative analysis and conclusions. The hermeneutic method used to inter- pret the texts and identify the main concepts and provisions deter- mined the semantic depth and meaning of key terms in the context of the problem under study. This action is especially important when researching such a serious problem as the oncology of vari- ous localisations and studying modern methods of cancer diagno- sis with their advantages and disadvantages. This integrated approach to analysing and processing information allowed us to gain a comprehensive understanding of the problem and formulate informed recommendations and conclusions. The classification method provided information on the clinical division by location of different types of cancer. In addition, benign neoplasms of various organs were also con- sidered to select the optimal diagnostic method. The integration of statistical data from various countries, such as Albania, Korea, Europe, the United States, Canada, Australia, and Japan, has pro- vided a more complete picture of the prevalence and characteris- tics of the problem on a global scale. The statistics provide an opportunity to analyse the probable causes of the sharp rise in can- cer incidence in different countries, regardless of where they live, and to analyse both standard and advanced diagnostic methods to ensure timely detection of the tumour process. Meta-analysis, as a type of statistical method, is important when analysing large amounts of data from various sources on the topic of oncology diagnostics. This method was used to combine the results of mul- tiple studies to obtain a more generalised and reliable assessment of the effectiveness of diagnostic methods, as well as to assess the degree of consistency of results between different studies. Despite the potential for bias in opinion or data, meta-analysis still pro- vides valuable information to form an average assessment or opin- ion about the purpose and problem of oncology diagnosis. Social and political factors affecting public health [page 96] [Healthcare in Low-resource Settings 2024;12(s2):12831] Non -co mmerc ial us e o nly Results and Discussion Cancer is a disease with different genetic characteristics The results by Wang et al.10 showed that effective interven- tions can prevent 30-50% of cancer cases. Early diagnosis is sub- stantial in improving the prognosis and survival of patients with cancer. The development of new molecular biomarkers for tumours that are highly sensitive and specific and have a low false-positive rate is becoming particularly important.11 The use of these biomarkers can help detect cancer progression over time. Modern methods of oncology diagnostics include a wide range of technologies, from molecular to imaging. Technologies that play an important role in improving the accuracy and speed of diagno- sis: i) radiomics; ii) machine learning; iii) rare biopsies; iv) immunodiagnostics; v) genomic and proteomic diagnostics; vi) blood immunology testing; vii) mass spectrometry. One of the most promising areas in oncology diagnostics is a personalised approach. This includes analysing the patient’s genetic makeup, the molecular characteristics of the tumour and other factors to select the most effective diagnostic and treatment methods for each individual. There are large differences in how innovative cancer diagnostic technologies are implemented in various nations and healthcare systems. While developed countries like the US, Japan, and many European countries are leading the way in implementing cutting-edge methods like genomic profiling, AI- assisted imaging, and liquid biopsies, many developing nations find it difficult to obtain these advancements because of infras- tructure and resource limitations.12 For example, PET/CT scans are rarely available in low- and middle-income countries, despite being widely used for cancer staging in high-income countries. In a similar vein, the use of genomic testing-based precision medicine techniques is expanding quickly in certain areas but is still out of reach for a large portion of the world’s population. These differences in the availability of state-of-the-art diagnostics underscore the necessity of international collaboration and poli- cies aimed at closing the worldwide disparity in cancer care. Adapting and deploying affordable versions of these technologies in areas with limited resources is essential to guaranteeing more equitable access to modern cancer diagnostics globally. The importance of RNA in cancer diagnosis Following Cervena et al.,13 long non-coding RNAs (lncRNAs) are substantial in tumour formation and development, regulating the malignant biological activity of tumour cells at the levels of transcription, post-transcription, and gene epigenetics. Their influ- ence on transcription processes organises and coordinates gene expression, which affects various biological functions of the cell, including growth, division, and metastasis. At the post-transcrip- tional level, lncRNAs can interact with RNA molecules and pro- teins, regulating mRNA processing and stabilisation and affecting gene transfer mechanisms in cancer. These long, non-coding RNAs can affect the epigenetic landscape of a cell by altering chromatin availability and interactions with regulatory elements. This is of great importance for controlling gene expression and tumour development. For instance, high expression of SNHG3 can promote tumour cell proliferation and migration by activating sig- nalling pathways such as TGF-β and IL-6/JAK2/STAT3. This, in turn, leads to an increase in the growth rate of tumour cells and inhibition of apoptosis by inhibiting the expression of KLF2 and p21 genes. Recent studies have confirmed that SNHG3 affects can- cer progression by regulating its interaction with microRNAs, in particular miR-384, miR-182-5p, and miR-139-5p.14, 15 This inter- action increases, which leads to a decrease in the effectiveness of control over cellular balance and contributes to the acceleration of cancer progression. Biopsy is a basic method of cancer screening Following Park et al.16 and Shende et al.,17 the number of can- cer cases in Korea has decreased over the past few years, which can be explained by modern early diagnosis. However, when studying the issue of lung cancer, the study determined that the proportion of patients among men is decreasing, while among women it is increasing. The reason is that more and more men are quitting smoking, and women are smoking more and more often. The author focuses on the problems of early diagnosis of peripher- al lung cancer. One of the most promising diagnostic methods is a biopsy from the pathological focus, but this procedure has several advantages and disadvantages in its use (Table 1). An important statistic is the fact that more than 85% of ovarian cancer cases occur in women without an increased hereditary risk.18 Since the ovarian cancer screening procedure requires Social and political factors affecting public health Table 1. Characteristics of different types of biopsies Type of biopsy Advantages Disadvantages Fibre optic bronchoscopy The diagnostic efficiency of detecting The efficiency of diagnosis of non-endobronchial central and endobronchial lesions has been and peripheral lesions is low significantly improved. Ultrasound-guided endobronchial Real-time ultrasound imaging facilitates the detection Assessment of peripheral lung and other lymph node transbronchial needle aspiration of central lung lesions and some lymph nodes located involvement may be limited in the mediastinal, paratracheal, subcarinal, hilar, and interlobular regions. Also provides the ability to collect cells and lung tissue fragments for further analysis. Endobronchial transbronchial Real-time ultrasound imaging provides improved The high cost of professorship and the need for ultrasound-guided needle aspiration access to more peripheral lesions. specialist skills with a special guiding sheath Also provides the ability to collect cells and lung tissue fragments for further analysis. Bronchoscopy with navigation capability The purchase of a reconstructed and virtual roadmap High requirements of the navigation system helps to improve access to more peripheral lesions. and highcost Also helps collect cells and lung tissue fragments. Pistol biopsy The diagnostic efficiency of biopsy needles is high. Pneumothorax and pulmonary bleeding are Ensure that sufficient lung tissue is collected for analysis. common complications Source: compiled by the authors based on16. [Healthcare in Low-resource Settings 2024;12(s2):12831] [page 97] Non -co mmerc ial us e o nly surgery, it is recommended that the positive predictive value should be at least 10%.19 This is to ensure that the benefits of screening are balanced against the potential harm of unnecessary procedures. This approach maximises the benefits of screening for women by reducing the likelihood of unnecessary medical inter- ventions. Various methods are used to detect ovarian cancer at an early stage, with ultrasound imaging and blood tests, such as CA125, being among the main ones. Transabdominal and, more recently, transvaginal sonography has also been investigated in several large scientific studies. Nebgen et al.18 described that 90% of patients with stage III-IV ovarian cancer can have elevated lev- els of CA125 in the blood. However, in stages I-II, the sensitivity of this marker decreases, and only 50-60% of patients may have elevated CA125 levels. This means that CA125 cannot always be used effectively to detect early stages of ovarian cancer, and other diagnostic methods such as ultrasound and transvaginal sonogra- phy may also be required to fully assess the patient’s condition. The same opinion is shared by Budny et al.20 in a description of ovarian and breast cancer. In addition, the authors addressed the heredity and medical history of patients and emphasised the impor- tance of ultrasound, biopsy, and tumour marker testing. A high per- centage of ovarian cancer cases are observed in women with genet- ically determined factors, such as mutations in the BRCA1 and BRCA2 genes, as well as the Li-Fraumeni, Cowden, and Peitz- Jeghers syndromes. Women with genetic mutations or syndromes have a significantly increased risk of developing ovarian cancer compared to the general population.21, 22 Following Connal et al.23 and Xu et al.,24 surgery is an effective cancer treatment that provides the best chance of a complete cure and is reported to have fewer side effects than chemotherapy and radiotherapy. Early diagnosis of cancer not only saves lives but also significantly reduces treatment costs. However, current clini- cal tests lack sensitivity and specificity in the early stages of can- cer. Many cancers can be asymptomatic in the early stages, making them difficult to detect. The liquid biopsy test can open new oppor- tunities to improve screening and triage at an early stage, increas- ing the proportion of patients with abnormalities who need further investigation. This improvement in the efficiency of the diagnostic process can help reduce delays in diagnosis and lower healthcare costs. An effective liquid biopsy triage test should be affordable so that it can be used by large populations of patients with nonspecific symptoms. This will allow for regular screening and early detec- tion of pathological changes in liquid biopsy without unnecessary costs and efforts.25, 26 The use of such a test can also reduce unnec- essary diagnostic procedures, overtreatment, and patient anxiety. As a result, it is possible to expect a reduction in healthcare costs and an improvement in the quality of patient care. Pandey et al.27 and Bradshaw et al.28 addressed the diagnostic capabilities of molecular methods in the detection of gastric can- cer. The development and progression of gastric cancer are associ- ated with various molecular biomarkers that play an important role in the diagnosis, prognosis, and selection of treatment methods for this disease. The HER2 protein (the so-called human epidermal growth factor 2) is one of the key biomarkers of gastric cancer. Increased HER2 expression is associated with a more aggressive course of gastric cancer and a poorer prognosis. Assessing the level of HER2 expression is important in selecting the appropriate ther- apy, as some patients may benefit from targeted anti-HER2 thera- py, such as trastuzumab. The tyrosine kinase receptor of the epider- mal growth factor receptor (EGFR) family also plays a significant role in the development and progression of gastric cancer. EGFR expression is often associated with more aggressive forms of gas- tric cancer and may affect prognosis and treatment options. Targeted therapy against EGFR may be effective in subgroups of patients with high levels of EGFR expression. Thus, the assess- ment of HER2 and EGFR expression levels is of great clinical importance in the management of gastric cancer, and the use of tar- geted therapies against these molecules may be an effective approach in the treatment of certain subtypes of this disease. Instrumental diagnostic methods in solving the problem of cancer screening Following Liu et al.29 and Brito et al.,30 Computed Tomography (CT) is widely used to detect and stage primary lesions in patients with unknown primary lesions, particularly those with a particular sensitivity to primary lesions in the lung, pancreas, or kidney, and is useful for detecting metastatic lesions in the liver, lung, and bone. However, it is worth noting that in some cases, CT may miss smaller or inconspicuous lesions without abnormal morphological or vascular changes. This can occur, for example, in cases where the lesions are very small or in areas that are difficult to visualise with CT. Positron emission tomography/computed tomography (PET/CT) is a powerful diag- nostic tool that combines functional and structural information to Social and political factors affecting public health [page 98] [Healthcare in Low-resource Settings 2024;12(s2):12831] Table 2. Comparison of imaging techniques in cancer diagnostics Imaging Strength Limitations Main applications in cancer diagnostics technique CT - High resolution for bone and lung tissue - Limited soft tissue contrast - Detecting and staging primary lesions - Quick scan time - Radiation exposure - Identifying metastases in liver, lung, and bone - Widely available - May miss smaller lesions MRI - Excellent soft tissue contrast - Long scan times - Detailed assessment of soft tissue tumours - No radiation exposure - Expensive - Brain and spinal cord imaging - Multiplanar imaging - Not suitable for patients with certain - Evaluating tumour invasion into surrounding structures metal implants PET/CT - Combines functional and anatomical information - Lower spatial resolution than CT or MRI alone - Detecting primary tumours of unknown origin - High sensitivity for metabolically active tumours - Expensive - Assessing treatment response - Whole-body imaging - Limited availability - Identifying distant metastases Ultrasound - Real-time imaging - Operator-dependent - Guiding biopsies - No radiation exposure - Limited depth penetration - Evaluating superficial masses - Portable and relatively inexpensive - Not effective for imaging bone or air-filled organs - Assessing blood flow in tumours Source: compiled by the authors. Non -co mmerc ial us e o nly study pathological changes in the body in detail. In the case of gas- tric cancer and other cancers, PET/CT can be used to determine the extent of tumour spread, detect metastases to other organs, and assess the effectiveness of treatment. This method can be used to visualise areas of increased metabolism, which often correspond to cancer cells, and to accurately localise the tumour. PET/CT is a powerful diagnostic tool that combines functional and structural information, providing accurate localisation and characterisation of bodily damage. These two methods comple- ment each other, making PET/CT particularly valuable in clinical practice. PET/CT uses a radioactive tracer, usually 18F-fluo- rodeoxyglucose (18F-FDG), which is similar to glucose.31 After intravenous injection of 18F-FDG, it is phosphorylated by hexok- inase and accumulates in tissues with increased glucose metabolism, such as tumours. 18F-FDG is not further metabolised and remains in the cells, which allows visualisation of active tumour foci on the scan. 18F-FDG in PET/CT can be used to detect and evaluate tumour activity, as increased glucose metabolism is typical for most malignant tumours. Thus, PET/CT with 18F-FDG becomes a molecular probe for the diagnosis of cancer processes, which makes it an important tool for assessing the extent of cancer spread, monitoring the effectiveness of treat- ment, and making decisions on further treatment. This method pro- vides more detailed information about the volume, size, and activ- ity of tumours, which helps in making treatment decisions and determining prognosis.32 Studies confirm that the concentration of 18F-fluorodeoxyglucose (18F-FDG) used in PET/CT can effec- tively distinguish malignant lesions from benign ones. 18F-FDG is an analogue of glucose and accumulates in tissues with increased glucose metabolism, which is typical for tumour cells. Therefore, on a PET/CT scan, areas with increased glucose metabolism activ- ity may indicate the presence of cancer or other malignant process- es. The high diagnostic accuracy provided by PET/CT can be used to determine the stage of the disease, assess its spread in the body, and determine the effectiveness of treatment. This is especially important for planning the optimal treatment strategy and monitor- ing the dynamics of the disease. The use of 18F-FDG PET/CT imaging allows the detection of primary tumour lesions with high diagnostic value. The results by Gharehzadehshirazi et al.33 have shown a decrease in the incidence of unknown primary lesions among head and neck cancers from 2-9 to 1-2% after the introduc- tion of PET/CT. In addition, PET/CT can simultaneously detect other metastatic sites and assess their extent, which has a signifi- cant impact on determining the stage of the tumour, its recurrence, and the choice of treatment methods. Consequently, PET/CT plays a key role in the diagnosis of CUP, providing a more accurate and comprehensive assessment of patients with unknown primary lesions. Magnetic Resonance Imaging (MRI) can also be used to diagnose stomach cancer, especially if the tumour is suspected to have invaded neighbouring structures or metastasised. MRI pro- vides higher image resolution and contrast, especially in soft tis- sues, making it a useful tool for detailed assessment of the tumour process.34 Table 2 provides a comparative overview of various imaging techniques mentioned before that are used in cancer diagnostics, highlighting their strengths, limitations, and primary applications. Although the diagnosis of cancer can be much improved with these cutting-edge imaging methods, there are a number of obsta- cles to overcome in their use. Many healthcare facilities may find the expensive cost of equipment, particularly for PET/CT and MRI, to be unaffordable, especially in environments with low resources. Furthermore, these technologies frequently call for spe- cific training for both use and interpretation, which can result in a staffing shortage. These sophisticated procedures typically offer more precision and detail when compared to more conventional techniques like X-rays.35 For example, PET/CT might identify metabolically active tumours that traditional CT alone might miss, which could result in an earlier diagnosis and better patient out- comes. But the price of each exam goes up with this greater preci- sion. It is also important to carefully consider the diagnostic bene- fits of CT and PET/CT radiation exposure vs. radiation exposure, particularly in situations when repeat imaging is necessary. Despite these difficulties, the enhanced diagnostic powers of these sophis- ticated procedures can result in more accurate staging, better treat- ment planning, and possibly better patient outcomes compared to more conventional approaches. For instance, MRI is very useful for tracking treatment response over time since it may give com- prehensive soft tissue imaging without exposing the patient to radi- ation. A key difficulty in enhancing overall cancer care is striking the correct balance between introducing these cutting-edge tech- nologies and guaranteeing universal access to fundamental diag- nostic tools as healthcare systems continue to change.36 The development of nanotechnology opens broad prospects for the diagnosis and treatment of cancer. According to Jin et al.37 and Gupta et al.,38 nanotechnology is a promising area of research that can significantly improve the diagnosis, treatment, and monitoring of cancer. Nanoparticles and nano vectors can be used to deliver drugs directly to tumour cells, which increases the effectiveness of treatment and reduces side effects. Nanoparticles can be used to deliver gene constructs to tumour cells, which modulate their func- tion and regulate growth and division. Various nanomaterials, such as gold nanoparticles and quantum dots, can be used in these appli- cations due to their unique physical and chemical properties. The use of nanotechnology in oncology opens new opportunities to improve the diagnosis and treatment of cancer, and research in this area may lead to the development of new innovative methods of combating this disease.39 These materials can work at the molecu- lar level, which can be used for accurate cancer diagnosis and visu- alisation of pathological processes. For instance, nanoparticles can be loaded with drugs and delivered directly to the tumour, provid- ing precise and targeted treatment. Nanotechnologies are also used to develop nanosensors for detecting cancer biomarkers with high sensitivity and specificity.40 All these advances in nanotechnology open new opportunities for early diagnosis and effective treatment of cancer, which will significantly improve the prognosis and qual- ity of life of patients. Thakur et al.41 described the possibility of predicting the occur- rence of cancer in their research. As determined, the known gene signature can be successfully used for histopathological classifica- tion of non-small cell lung cancer. Ji and Cui,42 Bahrami and Ferns43 presented one method of cancer prognosis based on gene expression. The main purpose of this classifier is to predict early- stage recurrence of the disease in patients with colorectal cancer. This gene expression-based classifier identifies patients at increased risk of colorectal cancer recurrence and prescribes addi- tional treatment or monitoring promptly. This method can improve treatment results and reduce the likelihood of recurrence. Such studies open new opportunities for an individualised approach to cancer treatment and improve the efficiency of predicting treat- ment outcomes based on genetic data. Recent years have brought significant advances in genomic and transcriptomic engineering based on the CRISPR system. The CRISPR-Cas13 RNA-targeting system is a unique tool with poten- tial for cancer diagnosis, therapy, and research. Cas13, as part of this system, has several biochemical properties that make it a promising tool in the fight against cancer. Cas13-based diagnostic Social and political factors affecting public health [Healthcare in Low-resource Settings 2024;12(s2):12831] [page 99] Non -co mmerc ial us e o nly methods offer early detection and monitoring of cancer markers from liquid biopsy samples such as blood or urine without the need for sophisticated devices. This can simplify the diagnostic process and improve the results of disease treatment, as it will allow the detection of cancer at early stages when treatment is more effec- tive.44 In addition, Cas13 can be used for targeted cancer therapy by degrading and manipulating cancer-associated transcripts. This method has high efficiency and specificity, which makes it promis- ing for use in the treatment of cancer. Thus, the RNA-targeted CRISPR-Cas13 system opens new opportunities in cancer diag- nostics, therapy, and research, which can significantly affect the practice of clinical oncology and improve patient outcomes. This, in turn, opens new opportunities for the development of innovative treatments aimed at precisely targeting cancer cells with minimal side effects. In cancer therapy, the CRISPR-Cas13 system can be used for targeted editing of the tumour cell genome, which allows for the inactivation of oncogenes or enhancing the activity of tumour sup- pressor genes. This fact opens up prospects for the development of innovative cancer treatment methods with high efficiency and safety. In cancer research, the CRISPR-Cas13 system plays an important role in identifying new molecular mechanisms of tumour development, investigating mechanisms of drug resistance, and finding new therapeutic targets. This contributes to the devel- opment of more effective methods of cancer diagnosis and treat- ment. These new technologies allow researchers to better under- stand the mechanisms of cancer development, identify genes that may be responsible for drug resistance, and discover new molecu- lar markers that can be used as therapeutic targets.45,46 In addition, the CRISPR-Cas13 system is applicable for precise RNA editing, which opens new opportunities for the development of person- alised cancer treatments. Researchers actively using CRISPR- Cas13 technologies can develop new next-generation cancer diag- nostic and treatment strategies that can be effective and safe for patients. PSA and ACPP are just two examples of protein biomark- ers found in areas of high concentration in tissues, and many others are being studied. In addition to selective gene expression, the expression of tissue-specific proteins can result from mechanisms such as differential splicing, which generates tissue-specific vari- ants.47,48 While new technologies have the potential to revolutionise cancer diagnosis, a lot of them use AI, which also raises significant ethical concerns. The possibility of bias in AI algorithms, which might result in differences in diagnosis and treatment is one of the main problems. AI systems may generate biassed results and dis- advantage some groups based on factors such as ethnicity, gender, or socioeconomic position if they are trained on datasets that are not representative of varied communities. Furthermore, maintain- ing confidence in AI decision-making processes depends on their transparency. Clear explanations and accountability systems are necessary for patients and healthcare professionals to be able to comprehend and critically examine the reasoning behind AI-driven decisions. The use of AI in cancer diagnosis could worsen already- existing healthcare disparities and erode patient confidence in new technologies if these ethical issues are not resolved. Post-translational processing and modification of proteins are important aspects of their functional regulation. In the human body, proteins can undergo various types of post-translational modifications, such as phosphorylation, glycosylation, acetylation, methylation, and others, which can significantly affect their struc- ture, function, and interaction with other molecules. The proteome is the set of all proteins synthesised in a cell or organism, and it represents a more complex level of organisation of biological sys- tems than the genome. As estimated by Yadav et al.,49 in general, many different proteoforms can exist in the human body due to various types of post-translational modifications and alternative splicing. One example of a protein modification used as a biomark- er for malignant diseases, as mentioned, is CA19-9. CA19-9 is a glycoprotein, and its levels may be elevated in the blood of patients with certain types of cancer, such as pancreatic and gastric cancer. Changes in CA19-9 glycosylation can be used as a disease marker and in the diagnosis of cancer. Thus, the understanding of post- translational modifications of proteins and their role in pathology contributes to the development of new methods of diagnosis and therapy of various diseases, including cancer. Although oncofoetal antigens may be considered an unexpected source of tumour-spe- cific markers, tumours seem to regularly express tumour-specific modified proteins or neoantigens resulting from mutations. These neoantigens are of interest because they can stimulate the body’s immune response to fight tumours. In addition, they can serve as targets for diagnostic or therapeutic applications.49 Thus, the study of neoantigens opens new prospects for the development of effec- tive methods of cancer diagnosis and treatment. Recent advances in immune-oncology therapy targeting PD-1, PD-L1, and CTLA4 proteins are opening new perspectives in can- cer treatment. Studies show that many tumours stimulate specific immune responses. However, progressive tumours can develop mechanisms to avoid the immune response, which necessitates the improvement of treatment methods.50 One of the key aspects of this research is the identification of new molecular mechanisms underlying the interaction between tumours and the immune sys- tem.51 This describes why some tumours become resistant to immunotherapy, while others respond effectively to this therapy. One of these mechanisms is the tumour’s ability to neutralise the immune response through molecular mechanisms, such as PD-L1 expression or the production of immunomodulators. This makes them less vulnerable to immune system attacks. However, given the ongoing research, it is possible to develop new treatments that can overcome these mechanisms. Studies also show those immune responses can be directed to specific targets in the tumour.52,53 This opens the possibility of developing individualised immunotherapy that addresses the molecular characteristics of each patient’s spe- cific tumour. RNA plays an important role in many aspects of oncology, including diagnosis, prognosis, disease progression, therapy selec- tion, and monitoring of treatment efficacy. Some microRNAs may be associated with cancer and serve as biomarkers for diagnosis or prognosis. For example, fusion RNAs: in some cases of cancer, genes can be rearranged or fused, leading to the formation of fusion proteins.54 The detection of fusion RNAs can indicate spe- cific mutations that are targeted for drug therapy. These circulating RNAs can serve as non-invasive biomarkers for the diagnosis, prognosis, and monitoring of cancer. RNA sequencing: modern RNA sequencing methods can be used to analyse gene expression on a large scale and identify new changes in the genome that may be associated with cancer. The role of DNA in cancer diagnosis DNA is also important in oncology and is used to diagnose, predict, and treat cancer. Genetic mutations: changes in DNA can lead to the development of cancer. Some genetic mutations can be inherited, while others can be caused by external factors, such as ultraviolet radiation or chemical carcinogens. DNA analysis can identify these mutations and establish their association with specif- ic types of cancer. Genetic tests can identify individuals at high risk of developing cancer as a result of specific genetic variants. Social and political factors affecting public health [page 100] [Healthcare in Low-resource Settings 2024;12(s2):12831] Non -co mmerc ial us e o nly This can help in the detection and prevention of the disease. Determination of microsatellite instability can be used to diagnose hereditary forms of cancer and select treatments, such as immunotherapy.55 All of these aspects demonstrate the importance of DNA analysis in oncology for the diagnosis, prognosis, and treatment of cancer. Modern methods of molecular analysis of cancer used in diag- nosis and treatment are often expensive and require sophisticated equipment. For example, genetic tests, DNA sequencing, and other molecular techniques can be costly and require specialised equip- ment and qualified personnel to perform them.56 In addition, target- ed therapeutic agents such as monoclonal antibodies and small molecule drugs may have off-target effects and are available only for a limited range of cancer-causing targets.57 This limits their effectiveness and use in a wide range of cancers. In this regard, there is a constant need to develop universal, effective, and accu- rate tools for the diagnosis and treatment of cancer. These tools may include new molecular analysis technologies that are more affordable and easier to use, as well as innovative treatments that provide targeted effects on cancer cells with minimal side effects. Such developments can significantly improve the efficiency and results of the fight against cancer. Conclusions Thus, modern technologies play a key role in the development of cancer diagnostic methods. They ensure not only early detection of cancer but also the accuracy and objectivity of the diagnosis. Immunohistochemical methods, molecular genetic research, and medical image processing have become essential tools in modern oncological diagnostics. Diagnosing cancer remains an important but also challenging problem in medical practice. Ways to address this problem include the development of new technologies, improved screening methods, and increased health literacy among the population. Significant progress in the diagnosis and treatment of cancer can only be achieved through joint efforts. The overall progress in oncology diagnostics has resulted in a significant improvement in the ability to detect and treat cancer. Innovative methods, together with personalised approaches, are opening new prospects for improving the effectiveness of the fight against this disease. Future research in oncology diagnostics may include the development of new technologies, such as nanotech- nology and molecular sensors, as well as the search for new biomarkers and other disease markers. An important component is the ability to closely monitor patients during treatment, which helps to detect any changes in the course of therapy in time and adjust it if necessary. This approach to the diagnosis and monitor- ing of patients with central and endobronchial lesions helps to increase the effectiveness of treatment and improve prognosis. The growing interest in health and regular medical check-ups, together with ongoing research and development of new treat- ments, has led to a significant increase in demand for the purchase of instruments for routine diagnostics as well as for companion diagnostics. This demand is growing, as accurate and rapid diag- nostics play a critical role in the detection and treatment of various diseases. Innovative treatments require accurate and reliable diag- nostic results, which makes molecular and tissue science very important in modern medicine. Cancer screening tests play an important role in the early detection of the disease in asymptomatic patients to reduce mortality and morbidity. Early detection of can- cer can start treatment at earlier stages when the disease has not yet reached an advanced level, which increases the chances of a com- plete cure or increases the patient’s life expectancy and quality of life. The second goal of cancer screening tests is to reduce the inci- dence of cancer by detecting and treating its precursors or pre-can- cerous conditions. This helps to prevent the development of cancer in the future and reduce the overall number of cases. 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