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Exciting progress in the battle to detect early oesophageal cancer

September 26, 2016

Oesophageal cancer is a very common cancer, particularly in men where it is the fourth leading cause of cancer death. In 2013 there were almost 9000 new cases of oesophageal cancer in the UK. The diagnosis of oesophageal cancer requires a relatively simple five minute endoscopy test to look into the oesophagus with a telescope but the problem is that patients tend to present late when the cancers are more advanced. More advanced cancers make the surgery more complicated, or often impossible due to local spread or spread to secondaries elsewhere in the body. The hallmark symptom of oesophageal cancer is when a patient develops difficulty swallowing, but unfortunately this often develops late in the course of the disease when the tumour is quite large leading to a blockage. Other symptoms are new onset of heartburn, epigastric discomfort, and constitutional symptoms such as weight loss. A significant proportion of oesophageal cancers also arise from something called Barrett's oesophagus.

This is a disease process that takes many years to evolve and is the result of the oesophageal lining cells changing to a stomach-like cells in response to prolonged acid exposure. The stomach-like cells of Barrett's oesophagus has a small annual risk of transforming to pre-cancerous changes, followed by further progression to oesophageal cancer.

This is more likely in men and in smokers. For that reason the only screening programme currently shown to be of benefit in oesophageal cancer prevention is in patients with Barrett's oesophagus who undergo close surveillance with a gastroscopy every two years. If precancerous lesions, or early cancers, are detected in the oesophagus then the outcomes are excellent due to the advancement of the ability to ablate cells in the oesophagus, and resect early tumours through the endoscope in a straightforward day case procedure.

There is therefore a need to detect oesophageal cancers much earlier given that endoscopic therapy is so straightforward and effective. There are currently no nationwide general population screening programmes for this cancer.

Recent research published on the BBC is therefore exciting (http://www.bbc.co.uk/news/health-37291840). The work in Cambridge uses a new technology where abnormal cells are labelled with a fluorescent dye making the detection of these cells easier and earlier in the disease process. This fluorescent labelling of tissue is a technology being explored in other types of cancer as well.

The research in Swansea looks at blood samples to determine if there is a high rate of mutated red blood cells as these can be a side effect of a cancer. The hope is that patients with a high rate of mutated red cells are then be offered a definitive test for the diagnosis in the form of an endoscopy.

It is some time until such advances are clinically proven to help with the early detection of cancer, but the development is exciting. Until then patients with symptoms related to be oesophagus such as new onset heartburn in patients who are old enough to develop cancer, or patient to have any difficulty swallowing should seek a gastroscopy.

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