At the 2026 Red Trouser Day charity launch on the 23rd of April we were delighted to have Professor Gina Brown deliver us a presentation on her teams latest research into colorectal cancer. This is state-of-the-art medical research that our charity helped fund, and we’re very pleased that the monies our patrons & volunteers raised is being used so effectively.
You can watch the video of her presentation, or read a summary below.
Summary:
Mercury 3: Revolutionising Rectal Cancer Diagnosis and Treatment
• The Problem with Outdated Staging Systems
The current staging system for rectal cancer, based on the Dukes classification from 1932, is nearly 100 years old and no longer serves patients effectively. This antiquated system relies primarily on lymph node assessment and doesn’t accurately predict prognosis or outcomes. As a result, patients receive incomplete information about their disease progression, making informed treatment decisions impossible. The lack of proper documentation creates a vicious cycle: without measuring what patients start with, improvements cannot be tracked or evaluated. Gina Brown emphasises that this fundamental documentation failure costs nothing to fix yet faces significant resistance from the medical establishment, which demands evidence before changing practices — creating a paradox that Mercury 3 aims to break by rapidly generating that evidence.
• The Postcode Lottery and Inconsistent Treatment
Across the UK and globally, there is shocking variation in how rectal cancer patients are treated based on geography rather than medical need. Hospital-by-hospital analysis reveals that some patients receive surgery alone while others receive various pre-operative treatments, with no relationship between treatment received and actual outcomes. Survival rates vary dramatically with no clear explanation, as the outdated staging system cannot adequately characterise disease differences. This inconsistency means treatment decisions are essentially random — a “flip of a coin” depending on which hospital and which team makes the decision. Mercury 3 addresses this by establishing evidence-based guidelines that will create consistency in treatment selection across all healthcare settings.
• Reinterpreting Lymph Nodes and Understanding Vascular Invasion
Traditional radiological training teaches that enlarged lymph nodes are inherently dangerous, but this misunderstands immunology. Enlarged lymph nodes often indicate an active immune system fighting cancer — a positive prognostic sign, not a negative one. Research shows that patients with more lymph nodes experience improved survival rates, with benefits exceeding those from chemotherapy. Conversely, the critical marker being overlooked is extramural vascular invasion (EMVI) — tumour spread into blood vessels. These vessels act as highways for cancer to reach the liver and lungs; in 95% of liver metastasis cases, the tumour has first invaded veins. Additionally, what pathologists call lymph nodes are sometimes actually tumour deposits (seeds along vessels), a biologically distinct and far more serious condition associated with worse survival. Mercury 3 introduces a new TDV staging system measuring tumour deposits and vascular invasion, showing remarkable separation in survival outcomes compared to traditional TNM staging.
• Advancing Toward Personalised Treatment Decisions
The new TDV staging system enables truly personalised medicine by identifying which patients genuinely need intensive treatment and which will do well with surgery alone. Patients with no tumour deposits, no vascular invasion, but many lymph nodes have excellent 90% survival rates and don’t benefit from aggressive chemotherapy or radiotherapy. Conversely, patients with tumour deposits and vascular invasion require comprehensive treatment and will accept side effects knowing their prognosis demands it. This strategic approach contrasts sharply with current practice, which either under-treats or over-treats many patients. By providing patients with meaningful prognostic information, shared decision-making improves, treatment becomes targeted rather than blanket, and quality of life improves for those avoiding unnecessary toxicity while survival improves for those receiving needed treatment.
• Mercury 3 Implementation and Future Impact
Mercury 3 collects retrospective 2019 data from 15 hospitals across the UK, analysing original scans, pathology reports, treatment decisions, and patient outcomes. The research team will recode all cases using both old and new staging systems, quantifying how many patients were under-treated or over-treated under the outdated approach. Prospectively, the study measures quality of life, hospital readmissions, and shared decision-making processes before and after implementing the new staging system. By end of 2025, preliminary data will demonstrate the new system’s superiority, providing evidence to establish new national and potentially global standards for rectal cancer staging. This approach generates the evidence base needed to overcome institutional resistance and create lasting change within 12 months rather than the typical decade-long timeline for medical practice transformation.
Note: This is an A.I. Summary, for exact references please watch the video
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