Oesophageal cancer – a disease that affects the food pipe – is a big problem. Long-term survival rates are poor. In the UK, it’s the sixth most common cause of cancer death – and almost as many people die from the disease each year as are diagnosed.
This would change if we could diagnose the disease earlier – oesophageal cancer can be cured if it’s spotted early, and survival is much higher.
That’s why a trial of something called the ‘Cytosponge’ is absorbing a lot of interest.
Led by Professor Rebecca Fitzgerald from the University of Cambridge, the trial – called BEST-2 – is looking at the accuracy of this ‘sponge on a string’, which aims to help doctors diagnose oesophageal cancer at an early stage.
We wrote about BEST-2 when it launched in 2011. But recently, the trial team published encouraging new findings, so we thought it would be time for a quick update on how it’s progressing.
Oesophageal cancer – a big problem
But first, a quick recap. The challenge with oesophageal cancer is that many people don’t realise there is a problem until they start to have trouble swallowing – something this post highlights.
But there’s often an intermediate phase to developing full blown cancer, called Barrett’s oesophagus. This is much more common, and doesn’t always develop into cancer – but it presents an opportunity for doctors to intervene at this stage, and spot problems before it’s too late.
Barrett’s oesophagus is caused by acid reflux – not the kind that will be cured by reaching for the Rennies, but long-term acid reflux that causes the cells at the bottom of the gullet to change.
These cells are usually happy, flat pink cells. But with constant irritation from stomach acid they can morph into tall, red, cells, similar to those found in the harsh conditions of the stomach. It’s a bit like trying to live by a volcano in a tent; to survive you’d need to turn it into a lava-proof, reinforced house.
But this shape-shifting is costly, and the cells run the risk of forming abnormally – known as dysplasia (from the ancient Greek for ‘bad formation’). A cell with dysplasia is not cancerous, but is more likely than other cells to develop into cancer. And it’s these suspicious looking cells that doctors need to spot in order to detect early signs that could become oesophageal cancer.
This is done via an endoscopy – a tube with a camera inserted down your throat into your oesophagus to look for problems.
This can be uncomfortable (and costs the NHS several hundred pounds a pop).
Of course, not everyone with Barrett’s will go on to develop cancer. So, once they’ve been diagnosed, people with Barrett’s are regularly monitored with annual endoscopies .
So – both to detect and monitor Barrett’s – it would be better if there were a cheaper, simpler way to investigate people with long-term heartburn – after all, given how common the condition is, it’s simply not possible to send everyone for an endoscopy.
And researchers desperately need a better way to identify people whose heartburn might be Barrett’s oesophagus, and then from those diagnosed, find the people at risk of developing cancer.
Enter the Cytosponge. We’ve talked a lot about this nifty, sponge-on-a-string device in the past, and you can watch how it works by watching the video below.
So what’s new?
The BEST2 trial has now recruited over 1000 patients from Centres across the country, half of whom had Barrett’s oesophagus, the other half didn’t.
To test the performance of the Cytosponge, every participant on the trial first had to swallow the small, sponge-containing capsule. Next, each patient went on to have the slightly more cumbersome standard endoscopy to allow the sponge-based analysis to be compared with the current test for Barrett’s.
And the researchers analysing the samples from the sponges had no idea whether the sample had come from a patient with Barrett’s or not.
They used the sponge samples to search for the presence of a protein called Trefoil factor 3 (TFF3) – known to be produced by cells that are becoming ‘gut-like’ – and a hallmark of the onset of Barrett’s (a bit like looking for evidence of the bricks and mortar of the lava-proof house, to return to our earlier analogy).
The results of this analysis, presented at this year’s NCRI Cancer Research Conference, showed that, not only is the Cytosponge preferred by patients over other methods, but crucially, that it is able to accurately diagnose Barrett’s oesophagus just as well as an endoscopy.
So what next?
The team are now aiming to identify which patients with Barrett’s oesophagus are more likely to develop cancer, by looking for tell-tale markers in the cells captured by the sponge, such as known cancer-related red flags like mutations in the p53 gene, which seem to occur as Barrett’s develops into oesophageal cancer.
As with many challenges faced by cancer researchers, progress is slow and incremental. These are just the first of what we hope to be a string of interesting results from this trial.
There are almost certainly going to be challenges ahead. But smarter thinking, like the Cytosponge, will help us to diagnose these cancers sooner.
Emily Hoggar is a science communications manager at Cancer Research UK
Angela Deighton December 9, 2014
Very informative and clear video demonstration. Very encouraging to know this test is available.
miss elizabeth mccann December 8, 2014
could I have this test done
Margaret Barwell December 6, 2014
Great to hear about the sponge test and the promising improvements in patient experience achieved without compromising diagnostic accuracy. Would a screening programme such as the cervical smear programme be appropriate, and if so is it affordable with the sponge sampling technique?
Carole coote December 6, 2014
As someone who has had Barretts for at least 10 years with bi-annual endoscopy I am very interested in this sponge idea. My last endoscopy in January was so traumatic and the doctor who performed it was extremely heavy handed with virtually no bedside manner. If it wasn’t fot the fact that I am terrified of ending up with cancer I would never go for another endoscopy after the ordeal he put me through.
Lesley December 6, 2014
This is such a good idea. I lost my sister in law to this awful cancer in April.
Catherine December 5, 2014
I have acid reflux for 20 years and grade 2 Imflamation of the oesophagas diagnosed 6 years ago following 2 endoscopy’s. could this be barratts desease? I would like to try the sponge test.
Theresa Chipulina December 5, 2014
If this sponge test is cheaper perhaps nurses in doctors surgeries can do the test for patients saving visits to hospital at this initial stage. Nurses can be trained to do this. If result is positive then a visit to hospital for appropriate treatment.
Ann Gregory December 5, 2014
My husband Derek died of Oesophagus cancer 9 year’s ago this xmas .It would be absolutely amazing if more people could be saved from this horrible illness
[email protected] December 5, 2014
I was very impressed watching this test as when I had a endoscopy I had great difficulty as the back of my throat seemed very restricted so I chocked the whole time.very distressing.would hate to have to do it again ,but the sponge would be my answer
pembe ismail December 5, 2014
very informative and effective diagnosis
Nuala Gaughan December 5, 2014
I very much appreciate your straightforward reporting and explanations of your ressearch
Jackie December 5, 2014
My mom died of osphagus cancer last
Year , her sister died 8 years ago of the same . It would be beneficial to me my sister and cousins if there was an easy test to check us all out for this horrible disease
Tricia evans December 5, 2014
I have Barretts but I am only monitored every 2/3 years. Is this dangerous?
Jennifer Wilson December 5, 2014
Great news, my dad died of this terrible disease after suffering acid reflux problems for years, my 28 year old sister has the same issues but the doctor’s don’t seem to know what the problem is. Any step towards potentially stopping Cancer in its tracks, makes my day.
janet whitfield December 5, 2014
Can I request a cytosponge test if I visit my doctor or is it not generally available yet? Reading the symptoms of Barrett’s oesophagus I feel I have them all. I did see my doctor in May last year and was given heartburn relief-type tablets but I don;’t want to take them all the time as I feel this could be masking the symptoms.
lesley brown December 5, 2014
I have GORD and have fo have anti reflux surgery could i have Barretts because of my reflux disease
David Allan December 5, 2014
My friend recently died from oesophagal Cancer . It was into ally treated by his HP as a throat infection. As the Cancer developed, my friend problems feeding by mouth, and drinking. Clinical interventions we’re uncomfortable for him and stressful. The quality of his life declined rapidly, as did his heath if only his Gp had been aware of how tge can we can develop and been able to make an earlier diagnosis. This is valuable research.
Margaret White December 5, 2014
I think this is wonderful news. In 2012 I needed to have an oesophajectomy after taking PPI’s for heartburn for many years. Barrett’s was diagnosed in Oct 2011 and several endoscopes later – in quite a short period of time, dysphasia was diagnosed. Initially, I can’t remember what it was called but- some form of laser treatment was considered. However – on the day it was to begin, some ulceration was found to have developed and it was no longer thought to be a safe option, so I had the op. I think I’m very lucky to have been in the process of being monitored while these changes in the cells were taking place.