Cancer WGS Frequently asked Questions

The National Genomic Test Directory search tool (opens in a new tab) can help you identify if your patient is eligible.

The discussion with the patient, which can be taken remotely, must take place according to the Consent and Confidentiality in Genomic Medicine guidelines. Training (opens in a new tab) has been developed to support the Patient Choice Consent Framework, which is available online (opens in a new tab). Training should be taken before the discussion takes place.

• The patient test order forms can be found here.
• The patient Record of Discussion can be accessed here (including sevearl languages)
• CUH clinicians can upload the fully completed and signed form on EPIC media and must be entitled 'WGS Consent/Record of Discussion' or it may be be missed
• Clinicians from other NHS Trusts should send the completed test order form, Record of Discussion and histopathology report along with the relevant sample. MDT discussions will incorporate the histopathology report results. The paperwork should be sent at the point of sending the sample, to emee.glh@nhs.net. Emails must be entitled 'Cancer WGS forms'.

• For solid cancer WGS, a Germline (peripheral blood) sample in EDTA paired with fresh-frozen tumour tissue is required.
• For Haem-onc Cancer WGS, skin or saliva samples are accepted for germline where the tumour is the blood sample or bone marrow aspirate in EDTA
• Lymphoid cases can require either peripheral blood sample in EDTA for germline and fresh-frozen lymph tumour tissue or bone marrow as tumour. Skin or saliva can still be used as germline where the tumour is in peripheral blood for lymphoma cases.

• i) Peripheral blood and bone marrow in EDTA must be transported chilled (not frozen)
• ii) Skin biopsies should be transported chillled (on ice/ice packs) and in a container either saline or non-fixative containing media (saline is safest if you are unsure). Fresh-frozen tumour tissue must be transported on dry ice.

To perform WGS, adequate tissue is required. The following guidelines are offered:

• For core biopsies: tissues totalling approx 40mm long (for 16g needle) or 80mm (18g)
• For excisions/excisional biopsies: a fragment of tissue measuring 5 x 5 x 2mm

Yes, you can send the samples together in the same delivery. However, germline blood samples must be packaged individually and separated out of the dry ice box to avoid freezing.

• Yes, we can receive extracted and stored DNA for cancer WGS from external labs, subject to quality control checks
• Internal clinicians can enquire by email/GTAB if we have DNA stored for a patient from other previous testing. We can retrieve this DNA for new WGS testing as required.

The cut off time for sample drop off/delivery is 4:30pm to ensure the appropriate team handle the sample. Please check our website for timings just prior to bank holidays.

We receive, extract, and store all samples sent to us and will send out status reports to request for the paired samples. If we do not receive all the necessary components i.e. consent and second sample, the WGS referral will be cancelled for tracking purposes. If a second sample becomes available in future, the WGS referral can easily be re-activated.

Yes, WGS can be performed on new material due to recurrence, relapse or metastasis. There is an opportunity to indicate this on the test order form. Internal clinicians must place a new order on EPIC and ensure the tumour ID is different from the block originally sequenced.

• If WGS is no longer required for a patient, please inform us and we can cancel the referral at this time.
• Referrals outstanding paired sample or consent form will automatically cancel after 12 weeks via a status report. A notification via status report will have been sent out at 6 weeks of receiving the first sample. Any sample we receive will have been extracted, stored and useable in future. It is very easy to re-activate the WGS referral if a sample becomes available; please just send the sample and we will re-activate the cancelled WGS referral.

A status report will be sent upon receiving the first sample. Additionally, a status report is sent after 6 weeks to notify of any incomplete referrals. Finally a status report is sent either upon referral completion (germline, tumour and consent received), or after 12 weeks for any incomplete referrals that have been cancelled.

Upon receipt of a complete referral, we expect data to be returned within 2-3 weeks. We aim to report all data returns at the next available Genomics Tumour Advisory Board (GTAB) meeting; these meetings occur weekly.

• Please inform us upfront if the patient's case is clinically urgent so that we can expedite any processes to the best of our capacity. CUH clinicians can use EPIC to make an order STAT while placing it. Other clinicians can indicate on the test order form that a case is clinically urgent.
• If a patient's case progresses later and becomes clinically urgent, please contact us and we will mark the case as urgent. We may not at this point be able to expedite technical processes, but we will expedite the case wherever possible.

• Yes, we aim to invite the responsible consultant and/or main contact noted on the WGS referral form. We recommend that the patient's pathologist and oncologist attend the result discussions where possible. If these are not the names noted on the form, please forward the nhs.net email addresses, along with any other relevant colleagues, to our MDT coordinator (cuh.genomics-mdtgtab@nhs.net) if you would like to receive notifications of WGS data return and attend a GTAB
• For paediatric, TYA and sarcoma patients, results are also discussed at an MDT. Please contact us on emee.glh@nhs.net with the subject title 'Cancer WGS MDT joining details'. If you attend a GTAB, you will normally be sent the MDT joining details (if applicable) as it is normally within the same week

• CUH clinicians should be able to view results on EPIC Chart and if a report is needed externally thereafter, the clinician is responsible for forwarding a copy accordingly.
• External clinicians can expect to receive their reports via the registered pool (group) email address we have on record.
• If you would like to change the email address, please email us at emee.glh@nhs.net with the subject 'Cancer WGS submitter email change'.
• Please note that the submitting hospital who receives the results by default are responsible for triaging the report to any specific individuals requiring it thereafter.

Genomic Laboratory Hub, Box 143

Level 6, Addenbrooke's Treatment Centre

Cambridge University Hospital NHS Foundation Trust

Hills Road

Cambridge CB2 0QQ

Yes, for blood samples, you use either of the following:

i) The GLH collection points in the HODS block on level 3 (Haematology) and level 4 (Biochemistry).

Runners collect samples between 9:30am and 4:30pm in one to two hourly intervals. Samples can be dropped off to these collection points within this timeframe, as long as samples are clearly marked 'For GLH, Cancer WGS' and they will be safely be collected and triaged to our team.

ii) A Shute from POD to POD. Our department POD address number is currently 308. We receive from 34 stations so please find your nearest POD and follow the instructions on the POD to send us samples clearly marked 'For GLH, POD 308, Cancer WGS'.

Please contact us if any further support is required.

Please contact us via our emee.glh@nhs.net account but must include 'Cancer WGS' in your subject.

You can also call us on 01223 348836 and ask to speak to a member of the 'Cancer WGS team'.