̽��ֱ�� of Cambridge - MRC Cancer Unit

10 Cambridge spinouts changing the story of cancer

skbf2 — Thu, 17 Oct 2024 12:57:43 +0000

10 Cambridge spinouts on putting their research into practice to improve outcomes for cancer patients - and why Cambridge is a great place to do this.

Female scientists lead Cambridge success in Royal Society awards 2021

ta385 — Tue, 24 Aug 2021 12:00:00 +0000

Bell Burnell is one of twelve former and current Cambridge researchers, including six women, to be recognised in 2021 for their exceptional research and outstanding contributions to science.

Dame Jocelyn has been honoured for her work on the discovery of pulsars in the 1960s while she was a postgraduate student at New Hall (now Murray Edwards College) carrying out research at Cambridge's Cavendish Laboratory.

Past winners of the Copley Medal have included Charles Darwin, Albert Einstein and Dorothy Crowfoot Hodgkin. Dame Jocelyn said: “I am delighted to be the recipient of this year’s Copley Medal, a prize which has been awarded to so many incredible scientists.

“With many more women having successful careers in science, and gaining recognition for their transformational work, I hope there will be many more female Copley winners in the near future.

“My career has not fitted a conventional – male – pattern. Being the first person to identify pulsars would be the highlight of any career; but I have also swung sledgehammers and built radio telescopes; set up a successful group of my own studying binary stars; and was the first female president of the Institute of Physics and of the Royal Society of Edinburgh.

“I hope that my work and presence as a senior woman in science continues to encourage more women to pursue scientific careers”.

̽��ֱ��Copley Medal award includes a £25,000 gift which Dame Jocelyn will add to the Institute of Physics' Bell Burnell Graduate Scholarship Fund, which provides grants to graduate students from under-represented groups in physics.

Three female scientists currently working at Cambridge have been recognised in 2021. Professor Sadaf Farooqi from the MRC Metabolic Diseases Unit receives the Croonian Medal and Lecture, together with Sir Stephen O'Rahilly, for their seminal discoveries regarding the control of human body weight, resulting in novel diagnostics and therapies, which improve human health.

Dr Serena Nik-Zainal from the MRC Cancer Unit has been awarded the Francis Crick Medal and Lecture, for her contributions to understanding the aetiology of cancers by her analyses of mutation signatures in cancer genomes, which is now being applied to cancer therapy.

Professor Anne Ferguson-Smith from the Department of Genetics and currently the ̽��ֱ��’s Pro-Vice-Chancellor for Research receives the Buchanan Medal, for her pioneering work in epigenetics, her interdisciplinary work on genomic imprinting, the interplay between the genome and epigenome, and how genetic and environmental influences affect development and human diseases.

Former Cavendish Laboratory Research Fellow, Professor Michelle Simmons, has won the Bakerian Medal and Lecture, for her seminal contributions to our understanding of nature at the atomic-scale by creating a sequence of world-first quantum electronic devices in which individual atoms control device behaviour.

Professor Frances Kirwan, alumna and Honorary Fellow of Clare College, received the Sylvester Medal, for her research on quotients in algebraic geometry, including links with symplectic geometry and topology, which has had many applications.

Other current Cambridge researchers honoured include Dr Sjors Scheres from the MRC Laboratory of Molecular Biology. Scheres has been awarded the Leeuwenhoek Medal and Lecture for his ground-breaking contributions and innovations in image analysis and reconstruction methods in electron cryo-microscopy, enabling the structure determination of complex macromolecules of fundamental biological and medical importance to atomic resolution.

Emeritus Professor Michael Green from the Department of Applied Mathematics and Theoretical Physics has been awarded Royal Medal A for crucial and influential contributions to the development of string theory over a long period, including the discovery of anomaly cancellation.

̽��ֱ��Royal Society’s President, Sir Adrian Smith, said: “Through its medals and awards the Royal Society recognises those researchers and science communicators who have played a critical part in expanding our understanding of the world around us.”

“From advancing vaccine development to catching the first glimpses of distant pulsars, these discoveries shape our societies, answer fundamental questions and open new avenues for exploration.”

Find the full list of 2021 Royal Society medal, award and prize winners here.

Professor Dame Jocelyn Bell Burnell has become only the second woman to be awarded the Royal Society’s prestigious Copley Medal, the world’s oldest scientific prize.

I hope there will be many more female Copley winners in the near future

Jocelyn Bell Burnell

https://www.youtube.com/watch?v=z_3zNw91MSY

Professor Dame Jocelyn Bell Burnell

̽��ֱ��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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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

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Man experiencing heartburn

Yes

New cancer algorithm flags genetic weaknesses in tumours

Anonymous — Mon, 26 Apr 2021 23:01:00 +0000

The MMRDetect clinical algorithm makes it possible to identify tumours that have ‘mismatch repair deficiencies’ and then improve the personalisation of cancer therapies to exploit those weaknesses.

̽��ֱ��study, led by researchers from the ̽��ֱ�� of Cambridge’s Department of Medical Genetics and MRC Cancer Unit, identified nine DNA repair genes that are critical guardians of the human genome from damage caused by oxygen and water, as well as errors during cell division.

̽��ֱ��team used a genome editing technology, CRISPR-Cas9, to ‘knock out’ (make inoperative) these repair genes in healthy human stem cells. In doing so, they observed strong mutation patterns, or mutational signatures, which offer useful markers of those genes and the repair pathways they are involved in, failing.

̽��ֱ��study, funded by Cancer Research UK and published today in the journal Nature Cancer, suggests that these signatures of repair pathway defects are on-going and could therefore serve as crucial biomarkers in precision medicine.

Senior author, Dr Serena Nik-Zainal, a Cancer Research UK Advanced Clinician Scientist at Cambridge ̽��ֱ��’s MRC Cancer Unit, said: “When we knock out different DNA repair genes, we find a kind of fingerprint of that gene or pathway being erased. We can then use those fingerprints to figure out which repair pathways have stopped working in each person’s tumour, and what treatments should be used specifically to treat their cancer.”

̽��ֱ��new computer algorithm, MMRDetect, uses the mutational signatures that were identified in the knock out experiments, and was trained on whole genome sequencing data from NHS cancer patients in the 100,000 Genomes Project, to identify tumours with ‘mismatch repair deficiency’ which makes them sensitive to checkpoint inhibitors, immunotherapies. Having developed the algorithm on tumours in this study, the plan now is to roll it out across all cancers picked up by Genomics England.

̽��ֱ��breakthrough demonstrates the value of researchers working with the 100,000 Genomes Project, a pioneering national whole genome sequencing endeavour.

Parker Moss, Chief Commercial and Partnerships Officer at Genomics England, said: “We are very excited to see such impactful research being supported by the 100,000 Genomes Project, and that our data has helped to develop a clinically significant tool. This is a fantastic example of how the sheer size and richness of the 100,000 Genomes Project data can contribute to important research.

“ ̽��ֱ��outcomes from Dr Nik-Zainal and her team’s work demonstrate perfectly how quickly and effectively we can return value to patient care by bringing together a community of leading researchers through Genomics England’s platform.”

̽��ֱ��study offers important insights into where DNA damage comes from in our bodies. Water and oxygen are essential for life but are also the biggest sources of internal DNA damage in humans.

Dr Nik-Zainal said: “Because we are alive, we need oxygen and water, yet they cause a constant drip of DNA damage in our cells. Our DNA repair pathways are normally working to limit that damage, which is why, when we knocked out some of the crucial genes, we immediately saw lots of mutations.”

“Some DNA repair genes are like precision tools, able to fix very specific kinds of DNA damage. Human DNA has four building blocks: adenine, cytosine, guanine and thymine. As an example, the OGG1 gene has a very specific role of fixing guanine when it is damaged by oxygen. When we knocked out OGG1, this crucial defence was severely weakened resulting in a very specific pattern of guanines that had mutated into thymines throughout the genome.”

To be most effective, the MMRDetect algorithm could be used as soon as a patient has received a cancer diagnosis and their tumour characterised by genome sequencing. ̽��ֱ��team believes that this tool could help to transform the way a wide range of cancers are treated and save many lives.

Michelle Mitchell, Chief Executive of Cancer Research UK, said: “Determining the right treatments for patients will give them the best chance of surviving their disease. Immunotherapy in particular can be powerful, but it doesn’t work on everyone, so figuring out how to tell when it will work is vital to making it the most useful treatment it can be.

“Our ability to map and mine useful information from the genomes of tumours has improved massively over the past decade. Thanks to initiatives like the 100,000 Genomes Project, we are beginning to see how we might use this information to benefit patients. We look forward to seeing how this research develops, and its possibilities in helping future patients.”

This study was funded by Cancer Research UK (CRUK), Wellcome, Medical Research Council, Dr Josef Steiner Foundation and supported by the Cambridge NIHR Biomedical Research Campus.

Reference

Xueqing Zou et al., 'A systematic CRISPR screen defines mutational mechanisms underpinning signatures caused by replication errors and endogenous DNA damage', Nature Cancer (26 April 2021). DOI: 10.1038/s43018-021-00200-0.

A new way to identify tumours that could be sensitive to particular immunotherapies has been developed using data from thousands of NHS cancer patient samples sequenced through the 100,000 Genomes Project.

Dr Serena Nik-Zainal

Yes

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

Unexpected experiences: Meet the volunteers behind the masks at the Cambridge Testing Centre

zs332 — Mon, 05 Oct 2020 08:00:36 +0000

They juggled their jobs and sacrificed sleep to volunteer at the Cambridge Testing Centre, a collaboration between the ̽��ֱ��, AstraZeneca and GSK to support the national effort to boost COVID-19 testing. They say they were simply fulfilling their duty as scientists. Meet the volunteers behind the masks.

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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