̽��ֱ�� of Cambridge - oesophageal cancer

Landmark 'pill-on-a-thread' cancer screening trial welcomes first participants

cjb250 — Thu, 28 Nov 2024 12:00:02 +0000

A pivotal clinical trial of a 'pill-on-a-thread' test, which will decide if it becomes a new screening programme for oesophageal cancer, has welcomed its first participants.

NHS trial of sponge-on-a-string test replaces need for endoscopy for thousands of patients

cjb250 — Mon, 26 Feb 2024 11:40:36 +0000

̽��ֱ��NHS pilot, which has tested over 8,500 patients with the ‘capsule sponge test’, showed almost eight out of 10 patients who completed a test were discharged without the need for further testing, freeing up endoscopy capacity for higher-risk patients and those referred for urgent tests for oesophageal cancer.

̽��ֱ��test involves patients swallowing a small capsule-shaped device that contains a tiny sponge that collects cell samples for analysis before being extracted via a string thread attached to the sponge. It has been developed by Professor Rebecca Fitzgerald, Director of the Early Cancer Institute at the ̽��ֱ�� of Cambridge.

Professor Fitzgerald said: “It is very exciting to see the positive results of the NHS England real-world pilot for our capsule-sponge test. This is a major step forward to making this simple test more routinely available outside of clinical trials. Timely diagnosis is vital for improving outcomes for patients.”

Barrett’s oesophagus – a condition affecting the food pipe which can go on to cause oesophageal cancer in some patients – is usually diagnosed or ruled out via endoscopy (a camera test of the food pipe) following a GP referral to a gastroenterologist or other specialist practitioner who can carry out the procedure.

̽��ֱ��sponge-on-a-string test being trialled by the NHS can instead be carried out quickly in a short appointment, without the need for sedation.

Amanda Pritchard, NHS chief executive, said: “Thousands of people have now benefitted from this incredibly efficient test on the NHS – while the sponge on a string is small in size, it can make a big difference for patients – they can conveniently fit the test into their day and it can often replace the need for an endoscopy while also helping to reduce waiting lists by freeing up staff and resources.

“ ̽��ֱ��NHS is always striving to adopt the latest innovations and new ways of working that help improve patient experience and increase efficiency simple sponge on a string test is just one example of many pioneering tools we’ve trialled in recent years to help diagnose and treat people sooner.”

In a survey of over 350 patients who had the capsule sponge test, patients often said they would recommend the test to a friend or family member, and 94% of patients reported experiencing only mild or no pain at all.

̽��ֱ��NHS began piloting the test during the pandemic when there was increased pressure on services and a growing backlog for endoscopy.

Gastro-oesophageal reflux, also known as acid reflux, is a relatively common condition, affecting around one to two in every ten people to some degree, and some of these people may already have or will develop Barrett’s oesophagus, which is a precursor to oesophageal cancer.

There are around 9,300 new oesophageal cancer cases in the UK every year. ̽��ֱ��key to saving lives is to detect it an earlier stage of Barrett's oesophagus before it becomes cancerous.

̽��ֱ��NHS pilot was launched at 30 hospital sites across 17 areas in England including Manchester, Plymouth, London, Kent and Cumbria. Evaluation of the pilot showed that using capsule sponge was highly cost effective compared to using endoscopy-only for diagnosing patients – saving around £400 per patient.

Patients with positive results from the capsule sponge test who were referred on for an endoscopy had the highest prevalence of Barrett’s oesophagus at 27.2%, compared to zero patients with negative results who completed an endoscopy.

One of the first pilot sites at East and North Hertfordshire NHS Trust has now performed around 1,400 capsule sponge tests – offering to both patients with reflux symptoms via a new consultant led, nurse run early diagnosis service, as well as to patients on an existing Barrett’s surveillance programme.

In the first 1,000 patients, the capsule test identified Barrett’s in 6% patients with reflux and found two new cancers and three patients with dysplasia who may have had a longer time to diagnosis otherwise. While 72% reflux patients were discharged back to their GP without the need for an endoscopy.

As of January, 368 patients have had a positive test result of whom about half have confirmed Barrett's oesophagus.

Dr Danielle Morris, a consultant gastroenterologist at East and North Hertfordshire NHS Trust, said: “Using the capsule sponge test as a diagnosis triage tool has had huge benefits for patients, avoiding the need for unnecessary gastroscopy in almost seven out of 10 patients, and helping to reduce endoscopy waiting lists enabling us to prioritise those who really need endoscopy to have it done quickly.

“ ̽��ֱ��test is performed by a single trained practitioner in an outpatient setting, so it is very resource light compared to gastroscopy, and our patients are very supportive of the service – with almost nine in 10 patients preferring the capsule sponge to a gastroscopy.”

Adapted from a press release from NHS England.

A new test to help diagnose a condition that can lead to oesophageal cancer – developed by Cambridge researchers and trialled by the NHS – has reduced the need for invasive endoscopy in thousands of low-risk patients.

It is very exciting to see the positive results of the NHS England real-world pilot for our capsule-sponge test

Rebecca Fitzgerald

Cyted

Capsule and sponge

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Discovery of origin of oesophageal cancer cells highlights importance of screening for pre-cancerous Barrett’s oesophagus

cjb250 — Thu, 12 Aug 2021 18:00:16 +0000

̽��ֱ��study, published today in Science, found that a particular subtype of oesophageal cancer known as oesophageal adenocarcinoma is always preceded by Barrett’s oesophagus – abnormal cells of the oesophagus – even if these cells are no longer visible at the time of cancer diagnosis. This confirms that screening for Barrett’s is an important approach to oesophageal cancer control.

Cancer of the oesophagus is the sixth most deadly cancer, and oesophageal adenocarcinoma is on the rise in western countries. Scientists and doctors have known for some time that the development of this cancer is linked with Barrett’s oesophagus, which shows up in endoscopy as a pink ‘patch’ in the surface of the oesophagus and affects around one out of every 100 to 200 people in the United Kingdom. Between 3 and 13 people out of 100 with this condition will go on to develop oesophageal adenocarcinoma in their lifetime. However, the question of where these abnormal cells come from has been a mystery that has baffled scientists for decades.

A multidisciplinary group of scientists led by Professor Rebecca Fitzgerald at the Medical Research Council Cancer Unit, ̽��ֱ�� of Cambridge, today provides the most comprehensive explanation to date.

Dr Lizhe Zhuang, joint first author of the study, said: “It’s intriguing that, although Barrett’s oesophagus predominately occurs in the lower part of oesophagus close to stomach, it has so-called ‘goblet cells’ resembling a much more distant organ, the small intestine. Over the past twenty years there have been at least six different hypotheses about the origin of Barrett’s oesophagus. Using the latest techniques, we believe we have arrived at an answer to this mystery.”

̽��ֱ��research team analysed tissue samples from patients with Barrett’s oesophagus and from organ donors who have never had the condition. ̽��ֱ��samples were collected as part of the Cambridge Biorepository for Translational Medicine at Addenbrooke’s Hospital, part of Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust.

Lead authors Dr Karol Nowicki-Osuch and Dr Lizhe Zhuang established a detailed ‘atlas’ of human cells and tissues from all possible origins of Barrett’s oesophagus, including oesophageal submucosal glands, an elusive tissue structure that acts in a similar way to saliva glands and has never before been isolated from fresh human tissue.

̽��ֱ��researchers then compared the maps of cells from healthy tissues, Barrett’s oesophagus and oesophageal adenocarcinoma using a number of state-of-the-art molecular technologies. These included single cell RNA sequencing, a powerful technology that enables researchers to investigate the functions of a large number of individual cells. They also looked at methylation profiles –chemical modifications to the DNA of cells in the tissue – and at genetic linage to trace back where a particular cell type originated.

̽��ֱ��results showed a striking similarity between stomach cells and Barrett’s oesophagus, suggesting that the cells at the very top of the stomach can be reprogrammed to adopt a new tissue identity, becoming more like intestine cells, and replace the oesophageal cells. Furthermore, in this new study the team showed that two genes, MYC and HNF4A, are the keys that switch the tissue identity from stomach to intestinal cells.

Dr Karol Nowicki-Osuch, joint first author of the study, said: “ ̽��ֱ��techniques we used have shown us the internal processes that happen in the stomach cells when they become Barrett’s. ̽��ֱ��big question now is: what triggers these genes? It’s likely to be a complex combination of factors that include bile acid reflux (often felt as heartburn) and other risk factors, such as obesity, age, male sex and Caucasian ethnicity.”

Importantly, the researchers found that all oesophageal adenocarcinoma cells begin as stomach cells before transforming into Barrett’s cells and then into cancer cells.

Professor Fitzgerald added: “Even if the pre-cancerous Barrett’s is not visible at the time of cancer diagnosis, our data suggests the cancer cells will have been through this stage. This has been debated for some time, but our conclusion is important as it means that screening for Barrett’s is an important approach to controlling oesophageal cancer.”

Michelle Mitchell, Chief Executive of Cancer Research UK, said, “Today’s insights into the origin of oesophageal adenocarcinoma could help inform future research efforts into how to diagnose this type of cancer early – which is key for improving patient outcomes.

“This research goes hand in hand with other recent successes in early detection such as Cytosponge, the sponge-on a-string test, which we funded to detect Barrett’s in patients with heartburn symptoms.”

Detecting cancer earlier will be a key focus of the Cambridge Cancer Research Hospital, a partnership between Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust and the ̽��ֱ�� of Cambridge to build a new specialist cancer hospital. ̽��ֱ��hospital will combine modern NHS clinical space with two new research institutes, including the National Institute for the Early Detection of Cancer, which will lead the way in helping advance early cancer detection techniques.

̽��ֱ��research was largely funded by the Medical Research Council, Wellcome and Cancer Research UK.

Further information on oesophageal cancer and Barrett’s oesophagus is available via Cancer Research UK.

Reference
Nowicki-Osuch, K & Zhuang, L et al. Molecular phenotyping reveals the identity of Barrett’s esophagus and its malignant transition. Science; 13 Aug 2021; DOI: 10.1126/science.abd1449

Abnormal cells that develop into oesophageal cancer – cancer that affects the tube connecting the mouth and stomach – start life as cells of the stomach, according to scientists at the ̽��ֱ�� of Cambridge.

̽��ֱ��techniques we used have shown us the internal processes that happen in the stomach cells when they become Barrett’s. ̽��ֱ��big question now is: what triggers these genes?

Karol Nowicki-Osuch

Adobe Stock

Man experiencing heartburn

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Artificial intelligence could be used to triage patients suspected at risk of early-stage oesophageal cancer

cjb250 — Thu, 15 Apr 2021 15:00:49 +0000

When researchers applied the technique to analysing samples obtained using the ‘pill on a string’ diagnostic tool Cytosponge, they found that it was capable of reducing by half pathologists’ workload while matching the accuracy of even experienced pathologists.

Early detection of cancer often leads to better survival because pre-malignant lesions and early stage tumours can be more effectively treated. This is particularly important for oesophageal cancer, the sixth most common cause for cancer-related deaths. Patients usually present at an advanced stage with swallowing difficulties and weight loss. ̽��ֱ��five-year overall survival can be as low as 13%.

One main subtype of oesophageal cancer is preceded by a condition known as Barrett oesophagus, in which cells in the lining of the oesophagus change shape. Barrett oesophagus occurs in patients with Gastro-oesophageal Reflux Disease (GORD), a digestive disorder where acid and bile from the stomach return into the oesophagus leading to heartburn symptoms. In Western countries, 10-15% of the adult population are affected by GORD and are hence at an increased risk of having Barrett oesophagus.

At present Barrett oesophagus can only be detected by a gastroscopy and tissue biopsy. Researchers at the ̽��ֱ�� of Cambridge have developed a far-less invasive diagnostic tool called the Cystosponge – a ‘pill on a string’ that dissolves in the stomach and which, as it is withdrawn, picks up some cells from the lining of the oesophagus. These cells are then stained using a laboratory marker called TFF3 and can then by examined under a microscope.

Now, in a study published today in Nature Medicine, a team at Cambridge has applied deep learning techniques to the sample analysis, stratifying patients into eight triage classes that determine whether a patient sample requires manual review or if automated review would suffice. ̽��ֱ��algorithms were trained using 4,662 pathology slides from 2,331 patients.

Professor Rebecca Fitzgerald from the MRC Cancer Unit at the ̽��ֱ�� of Cambridge, who developed the Cytosponge and worked with the AI team, said: “Any system that supports clinical decisions needs to balance its performance against workload reduction and potential economic impact. Replacing pathologists entirely could lead to substantial workload reduction and speed up diagnoses, but such an approach would only be viable if the performance remains comparable to that of human experts and there are regulatory hurdles to overcome.”

For the analysis of Cytosponge-TFF3 samples, the triaging approach showed several benefits, substantially reducing workload and matching the sensitivity and specificity of experienced pathologists. Sensitivity is the ‘true positive’ rate – that is, how often a test correctly generates a positive result for people who have Barrett oesophagus. Specificity, on the other hand, measures a test’s ability to correctly generate a negative result for people who don’t have the disease.

̽��ֱ��researchers showed that a fully manual review by a pathologist achieves 82% sensitivity and 93% specificity. In a fully automated approach, they observed a sensitivity of 73% and a specificity of 93%. ̽��ֱ��team was able to demonstrate that using a triage-driven approach, up to two-thirds of cases can be reviewed automatically while achieving a sensitivity of 83% and specificity of 93%. ̽��ֱ��team estimates that this approach would reduce workload for the pathologists by 57%.

̽��ֱ��team were able to build into their algorithm problem-solving techniques applied by pathologists familiar with Cytosponge-TFF3 samples. This meant that the algorithms were interpretable – in other words, a clinician would be able to understand why they had reached a particular decision. This is important for accountability.

Dr Florian Markowetz from the CRUK Cambridge Institute, who led the work on the AI algorithm, said: “We’ve shown that it’s possible to use computer-aided tools to streamline identification of people at risk of Barrett oesophagus. By semi-automating the process, we can reduce the workload by more than half while retaining the accuracy of a skilled pathologist. This could potentially speed up the diagnosis of Barrett oesophagus and, potentially, the identification of those individuals at greatest risk of oesophageal cancer.”

̽��ֱ��team say that this triage-driven approach could be applied beyond the Cytosponge to a number of tests for other conditions such as pancreatic cancer, thyroid cancer or salivary gland malignancies.

̽��ֱ��research was supported by Cancer Research UK, the Medical Research Council and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust.

Reference
Gehrung, M et al. Triage-driven diagnosis of Barrett esophagus for early detection of esophageal adenocarcinoma using deep learning. Nat Med; 15 Apr 2021; DOI: 10.1038/s41591-021-01287-9

Artificial intelligence ‘deep learning’ techniques can be used to triage suspected cases of Barrett oesophagus, a precursor to oesophageal cancer, potentially leading to faster and earlier diagnoses, say researchers at the ̽��ֱ�� of Cambridge.

We’ve shown that it’s possible to use computer-aided tools to streamline identification of people at risk of Barrett oesophagus... This could potentially speed up the diagnosis of Barrett oesophagus and, potentially, the identification of those individuals at greatest risk of oesophageal cancer

Florian Markowetz

Cytosponge

Yes

New model predicts oesophageal cancer eight years early for half of all patients

cjb250 — Mon, 07 Sep 2020 15:00:38 +0000

Oesophageal cancer is often preceded by Barrett’s oesophagus, a condition in which cells within the lining of the oesophagus begin to change shape and can grow abnormally. ̽��ֱ��cellular changes are cause by acid and bile reflux – when the stomach juices come back up the gullet.

Barrett's oesophagus and oesophageal cancer are diagnosed using biopsies, which look for signs of dysplasia, the proliferation of abnormal cancer cells. Between one and five people in every 100 with Barrett's oesophagus will go on to develop oesophageal cancer in their life-time, but as this type of cancer can be difficult to treat, particularly if not caught early enough, researchers have been trying to identify ways to catch the disease early.

Professor Rebecca Fitzgerald from the MRC Cancer Unit at the ̽��ֱ�� of Cambridge said: “Early diagnosis of cancer is one of the best strategies to improve patient survival and decrease the side-effects from treatments. However, this strategy can result in overtreatment – patients incorrectly identified as high-risk and given unnecessary treatments. We need to find new ways to accurately spot cancer progression at a very early stage to help us identify those patients at greatest risk.”

A phenomenon commonly seen in the DNA of tumours – but not in healthy tissues – is one whereby whole ‘chunks’ of DNA are either deleted or repeated several times as cells copy and multiply. These are known as ‘copy number alterations’. In a study published today in Nature Medicine, researchers at Cambridge have shown how these DNA ‘signals’ could help diagnose patients earlier.

̽��ֱ��team used whole genome sequencing to analyse 777 samples from 88 patients and compared their DNA against that from control samples collected during clinical surveillance for Barrett's oesophagus. They were looking for differences in the DNA between the patients who were eventually diagnosed with cancer versus those who were not.

̽��ֱ��researchers found that the genomes in samples from individual patients who went on to develop cancer tended to have a higher number of copy number alterations, and that the number and complexity of such alterations increased over time. They used this information to develop a statistical model that could predict whether a patient was at a high or low risk of cancer from a single, tiny biopsy sample taken years before. ̽��ֱ��model was then used to predict and classify risks for individuals in a validation cohort of 76 patients and 213 samples.

̽��ֱ��model accurately predicted oesophageal cancer eight years before diagnosis for half of all patients who went on to develop the disease. This increased to more than three-quarters of patients one to two years before a diagnosis.

Equally importantly, the model accurately and consistently predicted patients who were at a low risk of developing cancer over many years of clinical surveillance. This meant that these patients did not need to be subjected to regular, invasive monitoring or treatment.

̽��ֱ��researchers found a high degree of variability in copy number alternations even within a single biopsy, but even so, the model provided surprisingly stable predictions of a patient’s risk of progression to cancer.

Dr Sarah Killcoyne from the MRC Cancer Unit at the ̽��ֱ�� of Cambridge and EMBL-EBI, joint first author, said: “Our research shows the power of genomic medicine for the early detection of cancer. We combined low-cost sequencing of standard tissue biopsies with statistical modelling to identify which patients were at greatest risk of progressing from Barrett’s oesophagus to oesophageal cancer.”

Eleanor Gregson from the MRC Cancer Unit, joint first author, added: “This new approach could allow us to intervene earlier, helping improve a patient’s outcome, while at the same time avoiding the need for low-risk individuals to have regular and invasive monitoring or even unnecessary treatment.”

̽��ֱ��research was funded by the Medical Research Council and United European Gastroenterology, with support from the National Institute for Health Research Cambridge Biomedical Research Centre.

Reference
Killcoyne, S. et al. Genomic copy number predicts esophageal cancer years before transformation. Nat Med; 7 Sept 2020; DOI: 10.1038/s41591-020-1033-y

DNA from tissue biopsies taken from patients with Barrett’s oesophagus – a risk factor for oesophageal cancer – could show which patients are most likely to develop the disease eight years before diagnosis, suggests a study led by researchers at the ̽��ֱ�� of Cambridge and EMBL’s European Bioinformatics Institute (EMBL-EBI).

Our research shows the power of genomic medicine for the early detection of cancer

Sarah Killcoyne

Stefano

DNA

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‘Pill on a string’ test to transform oesophageal cancer diagnosis

Anonymous — Thu, 30 Jul 2020 22:30:00 +0000

̽��ֱ��test, which can be carried out by a nurse in a GP surgery, is also better at picking up abnormal cells and potentially early-stage cancer.

Barrett’s oesophagus is a condition that can lead to oesophageal cancer in a small number of people. It’s usually diagnosed in hospital by endoscopy – passing a camera down into the stomach – following a GP referral for longstanding heartburn symptoms.

̽��ֱ��Cytosponge test, developed by researchers at the ̽��ֱ�� of Cambridge, is a small pill with a thread attached that the patient swallows, which expands into a small sponge when it reaches the stomach. This is quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis using a laboratory marker called TFF3.

̽��ֱ��pill is a quick, simple and well tolerated test that can be performed in a GP surgery and helps tell doctors who needs an endoscopy. This can spare many people from having potentially unnecessary endoscopies.

In a study funded by Cancer Research UK, the researchers studied 13,222 participants who were randomly allocated to the sponge test or were looked after by a GP in the usual way. Over the course of a year, the odds of detecting Barrett’s were ten times higher in those offered the Cytosponge with 140 cases diagnosed compared to 13 in usual care. In addition, the Cytosponge diagnosed five cases of early cancer (stage 1 and 2), whereas only one case of early cancer was detected in the GP group.

Alongside better detection, the test means cancer patients can benefit from less severe treatment options if their cancer is caught at a much earlier stage.

“It’s taken almost a decade of research and testing thousands of patients to show that we’ve developed a better route to diagnosing Barrett’s oesophagus,” said Professor Rebecca Fitzgerald from the Medical Research Council Cancer Unit at the ̽��ֱ�� of Cambridge, who led the research. “And the sponge could also be a game-changer in how we diagnose and ensure more people survive oesophageal cancer. Compared with endoscopies performed in hospital, the Cytosponge causes minimal discomfort and is a quick, simple test that can be done by a GP. Our test is already being piloted around the country, so we hope more people across the UK could benefit from it.”

Because COVID-19 has reduced the number of endoscopies that can be carried out by the NHS, Addenbrooke’s Hospital in Cambridge has already fast-tracked the Cytosponge into use in order to help identify priority cases with suspected cancer who need further tests urgently.

̽��ֱ��researchers are currently putting the Cytosponge test through an economic evaluation and hope that it will be rolled out within GP practices within three to five years. It’s expected that the Cytosponge will be offered by GPs to patients on medication for acid reflux symptoms.

Professor Peter Sasieni, whose King’s College London team have been leading the clinical evaluation of the Cytosponge over the last decade, said: “ ̽��ֱ��results of this trial exceeded my most optimistic expectations. Use of Professor Fitzgerald’s simple invention will hopefully lead to a significant reduction in the number of people dying from oesophageal cancer over the next 20 years. This trial found that both patients and staff were happy with the Cytosponge test and it is practical to consider rolling it out within the NHS.”

“It’s great news for patients that there’s proven benefit to taking the Cytosponge test, and they won’t have to undergo a potentially uncomfortable endoscopy unless it’s needed,” said Dr Julie Sharp, Cancer Research UK’s head of health and patient information. “We hope that people will be able to access the Cytosponge from their GP as soon as possible. It will also help doctors enormously, as it will allow them to more accurately predict if someone is at risk of oesophageal cancer.

Around 9,200 people are diagnosed with oesophageal cancer in the UK each year and around 7,900 sadly die. Early diagnosis is crucial to patients’ survival and a shift in stage can have a large impact on outcomes. 85% of people diagnosed with the earliest stage of oesophageal cancer in England survive their cancer for 1 year or more. This figure drops to 21% if the cancer is diagnosed at the most advanced stage.

Liz Chipchase, a retired scientist from Cambridge, was one of the people who took part in the Cytosponge clinical trial. She felt in good health, but abnormalities were discovered and she was referred for further tests. Not only did she have Barrett’s oesophagus, she also had cancer.

“If I hadn’t been invited and gone on the trial, I would’ve had no idea that I needed treatment for an early stage cancer. And I’m also aware that the survival rate for oesophageal cancer isn’t good, so the fact I am clear of cancer is wonderful.

“I feel so lucky thinking about the chain of events that led to the cancer being caught when it was. To me, this trial saved my life.”

̽��ֱ��BEST3 study was primarily funded by Cancer Research UK (CRUK). ̽��ֱ��National Institute for Health Research (NIHR) covered service support costs and National Health Service commissioners funded excess treatment costs.

Reference:
Fitzgerald RC, et al. ‘A pragmatic randomised, controlled trial of an offer of Cytosponge-TFF3 test compared with usual care to identify Barrett’s oesophagus in primary care.’ ̽��ֱ��Lancet (2020). DOI:

Adapted from a Cancer Research UK press release.

A ‘pill on a string’ test can identify ten times more people with Barrett’s oesophagus than the usual GP route, after results from a 3-year trial were published in the medical journal ̽��ֱ��Lancet.

It’s taken almost a decade of research and testing thousands of patients to show that we’ve developed a better route to diagnosing Barrett’s oesophagus

Rebecca Fitzgerald

Cancer Research UK

Cytosponge

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“All this cancer talk is new to me, but I do know there isn’t a stage five”

cjb250 — Fri, 08 Dec 2017 08:00:27 +0000

Read more about how clinical researchers, physicists, engineers and social scientists are among those collaborating as part of the Cancer Research UK Early Detection Programme.

Kate Gross was just 36 years old when she died of cancer. Researchers at Cambridge – including her husband – are trying to ensure that others receive their diagnoses early enough to stop their cancer.

Billy Boyle/William Collins

Kate Gross

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

Oesophageal cancer treatments could be tailor-made for individual patients, study finds

sjr81 — Tue, 06 Sep 2016 09:42:35 +0000

̽��ֱ��findings, published in Nature Genetics on Monday, could help find drugs that target specific weaknesses in each subtype of the disease, potentially making treatment more effective and boosting survival.

Researchers looked at the complete genetic make-up of 129 oesophageal cancers and were able to subdivide the disease into three distinct types based on patterns detected in the DNA of the cancer cells called signatures.

̽��ֱ��first subtype they found had faults in their DNA repair pathways. Damage to this pathway is known to increase the risk of breast, ovarian and prostate cancers. Patients with this subtype may benefit from a new family of drugs called PARP inhibitors that kill cancer cells by exploiting this weakness in their ability to repair DNA.

̽��ֱ��second subtype had a higher number of DNA mistakes and more immune cells in the tumours, which suggests these patients could benefit from immunotherapy drugs already showing great promise in a number of cancer types such as skin cancer.

̽��ֱ��final subtype had a DNA signature that is mainly associated with the cell ageing process and means this group might benefit from drugs targeting proteins on the surface of the cancer cells which make cells divide.

Professor Rebecca Fitzgerald, lead researcher based at the MRC Cancer Unit at the ̽��ֱ�� of Cambridge, said: “Our study suggests we could make changes to the way we treat oesophageal cancer.

"Targeted treatments for the disease have so far not been successful, and this is mostly down to the lack of ways to determine which patients might benefit from different treatments. These new findings give us a greater understanding of the DNA signatures that underpin different subtypes of the disease and means we could better tailor treatment.

“ ̽��ֱ��next step is to test this approach in a clinical trial. ̽��ֱ��trial would use a DNA test to categorise patients into one of the three groups to determine the best treatments for each group and move away from a one-size-fits-all approach.”

Each year around 8,800 people are diagnosed with oesophageal cancer in the UK, with just 12 per cent surviving for at least ten years. Cancer Research UK, who along with the Medical Research Council funded the study, has prioritised research into oesophageal cancer to help more people survive the disease by bringing people together, building infrastructure and developing the next generation of research leaders.

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “Being able to distinguish distinct types of oesophageal cancer is a genuinely new discovery from this work. For the first time we may be able to identify and test targeted treatments designed to exploit the cancer’s specific weaknesses. Although survival rates from oesophageal cancer have been slowly rising in the last few years they are still far too low, and this research points the way to a completely new way of understanding and tackling the disease.”

̽��ֱ��study, funded by Cancer Research UK and the Medical Research Council, is part of the Cancer Research UK-funded International Cancer Genome Consortium.

Reference

Secrier, M. et al. Mutational signatures in esophageal adenocarcinoma reveal etiologically distinct subgroups with therapeutic relevance Nature Genetics, 2016.

Tailored, targeted treatment for patients with oesophageal cancer could be developed after scientists discovered that the disease can be classified into three different subtypes

Our study suggests we could make changes to the way we treat oesophageal cancer.

Rebecca Fitzgerald

Image of an oesophageal carcinoma

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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