His boyhood dream was to be an air force pilot just like his grandfather. Instead, Gustav Stålhammar became a double specialist in ophthalmology and pathology. Today, he manages several eye cancer studies. One is about the micrometastases that malignant melanoma of the eye seeds at an early state of the disease.
"It’s easy to motivate myself. We research an illness that kills between a third and half of all patients. Currently, we can’t do much to stop it. It makes me anxious to act. But resources are limited, so the challenge is to make wise decisions and do what benefit the most patients," says Gustav Stålhammar, Eye Specialist and Pathologist at St. Erik Eye Hospital and Associate Professor/Research Group Leader at the Department of Clinical Neuroscience, Karolinska Institutet.
Since micrometastases are the reason for malignant melanoma of the eye being so lethal, Gustav Stålhammar's research group wants to determine whether everyone with this form of eye cancer carries them. If that is the case, they could be the target group for new types of treatment.
"These micrometastases can be dormant for years and are so small that they neither show up on radiological exams nor give any symptoms. Once they start growing, the prognosis is dismal," says Gustav Stålhammar.
Focusing on the liver
Previous studies have focused on the occurrence of micrometastases in bone marrow, but Gustav Stålhammar's group is instead focusing on the liver.
"It is better to have micrometastases in the bone marrow, where the immune system handles them and keeps them dormant. We are working to confirm the hypothesis that malignant melanoma of the eye creates micrometastases in the liver, where they pose a greater threat."
According to Gustav Stålhammar, treatment of ocular melanoma has been lagging behind. This is in part due to it being a difficult form of cancer to treat, not responding to the types of treatments that many other cancers do, and in part due to its relative rareness, with only between 60 and 80 new cases in Sweden each year.
Unique treatment study
The goal of the group's other research area is therefore to be able to treat the micrometastases. If everything goes according to plan, Gustav Stålhammar will launch a treatment study as early as next year.
"It will be the biggest study in the field. I cannot say what medicine we will evaluate yet, but it will aim to keep the micrometastases dormant," says Gustav Stålhammar.
It would be revolutionary if it works, as there currently is no treatment that improves the survival rate among these patients.
As a researcher, this was exactly what drew him in. To make important discoveries. At the age of 15, he read Darwin's On the Origin of Species and was given a very romantic image of what research and being a doctor meant. However, this image would eventually crumble. Early on in his medical training, he saw tired colleagues in a "grey and exhausting reality".
"I thought a lot about my choice of specialisation, because I wanted to avoid falling into that trap. Over time, I found that there was one category of doctors who were that little bit extra committed to their field – the pathologists. Within ocular oncology, individual research groups can also make a real difference for the patients."
That is exactly where Gustav Stålhammar wants to be.
Close to the patient
These days, he splits his time as a researcher with being an eye doctor and a pathologist, analysing tissue samples from the eye and nearby areas. Sometimes, he has removed the tissue samples himself during surgery.
"For example, I look for changes in the cells' shapes and growth patterns. Some parts of the work are enhanced by digital image diagnostics, which is something I am working to have implemented in clinical work and not just in our studies."
Personally, Gustav Stålhammar has researched digital image diagnostics for eight years and showed that it is useful in a number of situations. Most recently, he led a study on retinoblastoma, the most common form of eye tumour among children. The study took place in cooperation with two American university hospitals, where the image analysis took place.
"By using digital image analysis, we have been able to detect changes on a chromosomal level, which show which types of tumours have an increased risk of serious outcomes," says Gustav Stålhammar.
He notes that the human eye does not stand a chance in comparison. But thus far, digital image analysis is not being used in clinical practice for eye tumours.
"There is a built-in inertia in the system, which has some benefits as it reduces the risk of us getting ourselves into projects that we end up regretting. But a lot of the time, the lag between research and clinical practice is far too long. It can be a matter of financial resources or slow bureaucracy in the regions. For us researchers, it is also a matter of convincing the people placing orders for the medical services, which also takes time."
The demand for digital image diagnostics will increase, according to Gustav Stålhammar. We want to know more about various diseases and the treatments available to us.
"Digital image analysis will not take jobs away from pathologists but will act as a useful complement. For example, I am currently counting coloured cells by hand. A computer can do that far quicker and with more precision."
Text: Jenny Ryltenius