Just a few months ago, Ragnhild Vigdis Langli (70) was planning her own funeral.

She contacted her local church and wrote a letter to her husband detailing her wishes for the end of her life.

“I was in such bad shape. When the doctor said I had incurable cancer, I was not that surprised. I was sure I was going to die,” said Langli.

The letter about the funeral has now been put away in a drawer. Langli has just returned home from a weekend at her cabin in Harstad, where she is now planning a new strawberry patch in her garden.

After a few rounds of chemotherapy, her cancer has been reduced by half. The chemotherapy was chosen after the researchers first tested two different treatments on Langli’s cancer cells in the laboratory.

“I hope I can live a little longer. A few more years, not just days. My Christmas wish this year is that the cancer recedes even more,” said Langli.

It is Friday morning, and we are at home in the apartment of Ragnhild and her husband Harald. On the table is a freshly ironed tablecloth and warm apple pie with custard.

It was this spring that she was diagnosed with aggressive metastatic bowel cancer. The cancer was no longer just in her colon, but had spread to her liver and lymph nodes.

Like a ticket in life’s unpredictable lottery, Langli was offered the opportunity to participate in a research project at the Norwegian University of Science and Technology (NTNU).

She is now the first patient at St. Olavs Hospital to receive chemotherapy selected through a new laboratory test for bowel cancer. Langli is participating in a future-oriented study to identify the choice of first-line treatment for metastatic bowel cancer.

The treatment cannot save her life, but it can make it easier to live. More quality time with her husband enjoying a hot coffee in the morning. More afternoons solving crosswords.

The treatment is prolonging her life, although for how long, no one knows.

“Chemotherapy is a very harsh treatment,” said Åsmund Flobak, senior consultant at St. Olavs Hospital Cancer Clinic, professor at NTNU and senior research scientist at SINTEF.

Here at the Gastro Centre at St. Olavs Hospital, large sections of the different floors are for cancer patients.

“Cancer patients who become very ill from chemotherapy are admitted on this floor,” explained Flobak as we pass by a hair salon on the ground floor. There is a glass display case with wigs in various hair colours, lengths and styles.

“All rapidly growing cells in the body are affected by chemotherapy. The cancer cells are targeted, but hair cells and the immune system are also affected. Many cancer patients have to be admitted to hospital because the treatment is so harsh, as opposed to because of the cancer,” said Flobak.

After completing his medical degree, he went on to take a Master’s degree in nanotechnology.

He is now part of a research team conducting several studies that will hopefully provide more personalized treatment for patients with incurable metastatic bowel cancer.

“Unfortunately, if this type of cancer has spread everywhere, very few of the patients will survive. The only thing we can do is try to make the rest of their days as good as possible,” said Flobak.

According to the Norwegian Institute of Public Health (NIPH), cancer is now the most common cause of death in Norway.

“Norway has one of the highest incidences of bowel cancer in the world. That is why I want to focus my work on this specific type of cancer,” explained Flobak.

He is currently engaged in a kind of research marathon spread over several stages, where the first stage is almost finished.

He has created a catalogue of cancer cells from over a hundred patients. The cancer cells have been donated for research and were collected from tumours that have been surgically removed. First, the tumours were cut up into tiny pieces, and then the different pieces were tested with various types and doses of chemotherapy.

“Patients with incurable metastatic bowel cancer receive two types of chemotherapy. No one currently knows which one works best. You simply have to pick one and try it for two or three months. If it works, you continue. If it doesn’t work, you change it. Some people receive medication that makes them very sick without the treatment even affecting the cancer,” explained Flobak.

The aim of his current research is to start the best possible treatment as soon as possible.

The goal is to avoid a possible two-three-month delay of trial and error. Because the catalogue documents how different types of cancer respond to various doses of chemotherapy, he can now compare the patients’ cancer cells and determine which treatment is most appropriate.

For Langli, the chemotherapy has been relatively easy to live with.

“I wasn’t very optimistic. That is why I feel so happy when things go well. I am pretty worn out after the first few days following a round of chemotherapy, but then I recover. I feel so much better now than before I started,” said Langli, smiling.

She has lost 13 kilos since starting chemotherapy, and some of her hair has fallen out, but she has also started exercising and has got her appetite back.

There are three categories of patients that see the cancer doctors at St. Olavs Hospital.

The first are patients who only have bowel cancer, where the cancer can be surgically removed. The second category of patients need chemotherapy in addition to surgery. The third is people who have incurable metastatic bowel cancer, where only chemotherapy is given.

All patients who fall into the third category are currently being considered for the opportunity to participate in Flobak’s research project. However, the patients must meet certain criteria in order to participate, and after assessment, some will receive an offer. So far, three patients have been invited to participate, and all of them have accepted. The goal is to get 133 patients. The third stage of the research marathon will begin at some point in the near future, where the aim is to use artificial intelligence in the work.

“Everyone likes to help people, and I am no exception,” said Flobak.

He finds it difficult to tell patients that the disease they have cannot be cured.

“I usually manage to stay composed and professional, but it is harder when I get home and share my thoughts with my wife. That is when the tears tend to come. It is comforting to know, both for the patients and myself, that we are working to ensure each individual gets the best possible treatment currently available, and that we are striving to improve cancer treatment in the future,” said Flobak.

This area of research is known as precision medicine and is a field of study that NTNU is focusing on. The research involving the catalogue of cancer cells is called the PRESORT study, and the research on the new laboratory test and personalized treatment is called the COSENSE-1 study. This study is a collaboration between St. Olavs Hospital, NTNU and the Research Area of Biotechnology and Nanomedicine at SINTEF.