New Barrett’s Oesophagus Research published in Nature’s Medicine Journal

Trinity Fellow and Head of Oncology at Cambridge Professor Rebecca Fitzgerald and colleagues at the Li Ka Shing Early Cancer Institute have confirmed that Barrett’s oesophagus is the genesis of the most common type of oesophageal cancer in the developed world.

Their research published in Nature Medicine could help improve the early detection of oesophageal cancer, which is often diagnosed at an advanced staged when treatment options are limited.

Cancer of the oesophagus, including the most common form oesophageal adenocarcinoma, is on the rise in western countries.

Scientists and doctors have known for some time that the development of oesophageal cancer is associated with Barrett’s oesophagus, which affects around one out of every 100 to 200 people in the United Kingdom. Between three and 13 people out of 100 with Barrett’s oesophagus will go on to develop oesophageal adenocarcinoma.

Professor Fitzgerald, who specialises in gastroenterology, developed the capsule sponge, which can be administered at a GP surgery, to test for Barrett’s oesophagus.

In this latest research Professor Fitzgerald’s team analysed data from 3,100 patients with oesophageal adenocarcinoma who were undergoing cancer surgery.

The team also examined the individual tissue DNA of 710 patients and the protein-coding regions of genes, known as the exome, in multiple samples from 87 patients. The exome contains genetic variants that can cause disease. This process threw light on how patients’ tumours had evolved and if and how different parts of the same cancer differed genetically.

The research found that half of patients diagnosed with oesophageal cancer had no detectable Barrett’s oesophagus – perhaps because the growing tumour destroys the original Barrett’s tissue.

However, the researchers did find biomarkers for Barrett’s oesophagus in cells at all stages of the disease, including before the cancer developed even when no Barrett’s was evident clinically. This offers potential for new screening programmes ‘and emphasises the importance of testing for Barrett’s oesophagus.’

‘Though Barrett’s is the precursor as we now show in-depth, most individuals aren’t diagnosed with their Barrett’s so that is why we need more proactive screening for people at risk, Professor Fitzgerald said.

The main risk factors for Barrett’s oesophagus are heartburn, older age and family history.

Co-author Dr Lianlian Wu said: ‘What we need now are more sensitive, minimally invasive tests that identify people at risk based on molecular markers rather than relying solely on visible changes found during endoscopy.’

The research was supported by Cancer Research UK and the Medical Research Council, with additional support by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre.