Nanoparticle Probes for the Detection of Cancer Biomarkers, Cells, and Tissues by Fluorescence

1.1. Cancer and Early Detection Cancer is the second most common cause of death in the United States, trailing only heart disease in incidence. Despite significant worldwide investment in research, cancer remains responsible for 1 in 4 deaths in developed countries.1 Globally, over 14 million cancer diagnoses were reported in 2012, a figure expected to increase to over 22 million cases per annum in the next two decades.2 Estimated to kill over 1/2 million U.S. citizens, and with over 1.6 million new cases predicted to be diagnosed this year,3 cancer continues to present a major, yet unmet challenge to healthcare both globally and in the United States. Cancer emerges from our own tissues, complicating both detection and treatment methods due to the similarities between the diseased tissue and healthy tissue.4,5 Despite this fact, the mortality rate from cancer is often greatly reduced by early detection of the disease. For example, non-small-cell lung cancer is responsible for the most cancer related deaths worldwide, with patients in the advanced stages of the disease having only 5–15% and <2% 5-year survival rates for stage III and IV patients, respectively.6 In contrast, patients who start therapy in the early stages of the disease (stage I) have markedly improved survival rates, with an 80% overall 5-year survival rate.6 Consequently, early diagnosis is essential to improving cancer patient prognosis. At present, clinical detection of cancer primarily relies on imaging techniques or the morphological analysis of cells that are suspected to be diseased (cytology) or tissues (histopathology). Imaging techniques applied to cancer detection, including X-ray, mammography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopy, and ultrasound, have low sensitivity and are limited in their ability to differentiate between benign and malignant lesions.7,8 While cytology, such as testing for cervical cancer via a Pap smear or occult blood detection, may be used to distinguish between healthy and diseased cells or tissues, it is not effective at detecting cancer at early stages. Similarly, histopathology, which generally relies on taking a biopsy of a suspected tumor, is typically used to probe the malignancy of tissues that are identified through alternative imaging techniques, such as CT or MRI, and may not be used alone to detect cancer in its early stages. As such, the development of assays and methods for early detection of cancer, before the disease becomes symptomatic, presents a major challenge. Recent research within the field of nanotechnology has focused on addressing the limitations of the currently available methods for cancer diagnosis. Certain nanoparticle probes possess several unique properties that are advantageous for use in the detection of cancer at the early stages. In this review, we will discuss the advances in the development of nanoparticle-based methods for the detection of cancer by fluorescence spectroscopy. We will divide this topic into three categories: techniques that are designed for (1) the detection of extracellular cancer biomarkers, (2) the detection of cancer cells, and (3) the detection of cancerous tissues in vivo. We will discuss these strategies within the context of the nanoparticle probe used as well as the recognition moieties applied in each approach. Ultimately, the translation of these methods from the laboratory to the clinic may enable earlier detection of cancer and could extend patient survival through the ability to administer therapeutic treatment in the early stages of the disease. While this review provides a comprehensive overview of the nanoparticle probes that are used to detect cancer in vitro and in vivo through fluorescence, there are several other relevant reviews that may be of interest to our readers, who may refer to the references for more generalized reviews of nanomaterials used for diagnostics and therapy,9–12 or more detailed insight into the specific types of nanoparticle probes (i.e., quantum dots,13 gold nanoparticles,14,15 upconversion nanoparticles,16 polymer dots,17,18 silica nanoparticles,19 polymeric nanoparticles, 20 etc.) for cancer diagnosis.