Oesophageal cancer awareness month: 4 articles on the latest in prevention and treatment

The oesophagus, also known as the gullet or food pipe, is the tube that carries food from your mouth down to your stomach.  

Like most parts of the body, it can be susceptible to cancer when abnormal cells grow in an uncontrolled way.  

Oesophageal cancer is the 14th most common cancer in the UK, accounting for around 2% of all new cancer cases. Survival has hugely improved since the 1970s, but it’s still relatively low. Only around 12% of people in the UK survive oesophageal cancer for 10 years or more. 

This is partly because the symptoms of oesophageal cancer, such as problems with swallowing, often aren’t recognisable until a later stage in the disease, when treating it is a lot harder. But we’re funding a lot of pioneering research into oesophageal cancer, making discoveries and developing tools to help doctors diagnose the disease earlier and treat it more effectively. 

So, for oesophageal cancer awareness month, we’ve rounded up four of our articles on our latest research into oesophageal cancer diagnosis, treatment and prevention.  

1. Can a capsule sponge change how we diagnose oesophageal cancer?

One of the biggest challenges when it comes to oesophageal cancer is late-stage diagnosis.  

But there can be an opportunity to detect the disease earlier. In fact, around 59% of all UK oesophageal cancers are preventable.  

Some people develop a condition called Barrett’s oesophagus before developing oesophageal cancer.  

Barrett’s oesophagus is much more common than oesophageal cancer, and although it will only lead to cancer in a handful of cases, it presents an opportunity for doctors to spot a problem early and intervene before cancer develops. But the typical test for Barrett’s oesophagus, endoscopy, is both invasive and expensive.   

It’s been piloted for people on endoscopy waiting lists in parts of England, Scotland and Northern Ireland. We’ve even learned it can detect 10 times more cases of Barrett’s oesophagus than standard practice.  

Now we’re on the home straight. At the beginning of the year, we launched the BEST4 trial. This trial will recruit 120,000 people to find out if the capsule sponge test can reduce deaths from oesophageal cancer.  

If the BEST4 trial is successful, the capsule sponge could become a national screening programme across the NHS. 

• Learn more about BEST4

2. Uncovering the origins of oesophageal cancer using patient data

Cancer is the most complex health challenge we face.  

At a genetic level, each individual cancer is as unique as the person it affects, so there’s no guarantee that a drug that worked for one person will work for the next. 

Scientists are always searching for new ways to make cancer treatments more effective for more people, and one way they can do that is by using patient data – including from people with oesophageal cancer.  

As well as her pioneering work on the capsule sponge, Professor Rebecca Fitzgerald leads the OCCAMS (Oesophageal Cancer Clinical and Molecular Stratification) project.  

As part of OCCAMS, doctors and nurses collect blood and tumour samples from people with oesophageal cancer. Scientists then use these samples to decode each cancer’s genetic sequence – producing a complete map of its DNA.

From there, research teams match clinical data about how each person’s cancer progresses with lab data on its genetic sequence to see how DNA changes drive oesophageal cancer.

Patient data plays a vital role in this project. Whether the researchers are investigating what makes cancers develop differently, finding out why some patients respond well to treatment while others don’t or trying to identify risk factors that could predict if a cancer is likely to return, every person’s data provides a new piece of the puzzle.    

These patients’ contributions are helping make things better for everyone with oesophageal cancer. Already, Fitzgerald’s team have been able to describe for the first time some of the DNA mutations that they think cause the disease, and there are likely to be many more findings to come.   

• Read more about OCCAMS in our patient data article

3. A surprising use for erectile dysfunction drugs in oesophageal cancer

The tumour microenvironment is a kind of ecosystem around a tumour made up of blood vessels, immune cells, enzymes and a variety of other cells that a tumour need to survive.  

A tumour is constantly interacting with its microenvironment, and research suggests that the microenvironment is key to a cancer’s development. In some cases, like oesophageal cancer, the tumour microenvironment can even help tumours resist treatment.  

Luckily drugs that target PDE5 already exist, but they might not be what you expect…  

Drugs like Viagra, used to treat erectile dysfunction, are PDE5 inhibitors.  

The researchers found that they could use PDE5 inhibitors to make oesophageal tumour samples from patients that had previously shown a poor response to treatment more sensitive to the effects of chemotherapy.  

Although this is early discovery research, PDE5 inhibitors combined with chemotherapy may be able to shrink some oesophageal tumours more than chemotherapy could alone. They could be a way to tackle chemotherapy resistance, which is one of the major challenges in treating oesophageal cancer.

• Read more about the research

4. Studying precancer to prevent oesophageal cancer

By looking more closely at how cancers start, we can work out how to stop them.  

That’s why Cancer Grand Challenges team eDyNAmiC are investigating how DNA changes lead to cancer.  

Specifically, they’re looking at extrachromosomal DNA (ecDNA): strange rings of DNA that aren’t where they’re supposed to be in our cells. These are often associated with cancer, and it was thought that they were a late effect of the disease. But last year that all changed. 

In a collaboration with Professor Fitzgerald’s OCCAMS team, eDyNAmiC used patient data to look directly at the changes that took place as Barrett’s oesophagus transitioned to oesophageal cancer. Then, they compared those changes to what happened in cases that didn’t become malignant.  

That new approach paid off.

Surprisingly, the team discovered that people can have ecDNAs in abnormal oesophageal cells that aren’t cancerous. But this changes how the cells behave.  

Once ecDNA appears, the chances of Barrett’s oesophagus turning into oesophageal cancer get much higher. That suggests that, rather than being a late effect of cancer, ecDNA might be a driving force behind it. 

So, what does this really mean? 

Extrachromosomal DNA appears in half of all cancer types. It’s a feature of many of the most aggressive and hard-to-treat tumours.  

Now, because we can see what ecDNA is doing, we can work out specific ways to stop it. And, as eDyNAmiC begin to focus on targeting ecDNA with drugs, this new way of understanding cancer could become a way to intercept and prevent it, too.

• Read more about eDyNAmiC’s work on oesophageal cancer