Oesophagus cancer – is there light at the end of the tunnel?

Written by Mark Goodfellow, Assistant Litigation Executive, within the medical negligence department at Fletchers.

Around 9,000 people in the UK are diagnosed with cancer of the oesophagus each year; sadly the survival rate is very poor, with only 13% living for five years or more after diagnosis.

Globally, oesophagus cancer accounts for over 400,000 deaths each year. There are two main types of oesophageal cancer; squamous-cell carcinoma and adenocarcinoma. The risk factors for developing squamous-cell carcinoma are particularly associated with smoking, excessive drinking, poor diet and obesity. The risk factors for developing adenocarcinoma are smoking, poor diet, obesity and long-term acid reflux. It has been estimated that lifestyle factors cause around 90% of oesophageal cancers.

One of the main reasons there is such a poor survival rate is late detection. Often people are late to present with symptoms, by which time the cancer is already at an advanced stage. In addition to this, diagnostic techniques used to detect cancer early have limitations.

Diagnosis is especially important in patients who have a condition called Barrett’s oesophagus, as there is a greater risk of developing oesophageal adenocarcinoma. Barrett’s oesophagus is when the cells that line the lower part of the oesophagus get damaged by acid and bile travelling upwards from the stomach. It is a condition which is becoming more common in the UK.

Most patients with Barrett’s oesophagus will not go on to develop oesophageal adenocarcinoma, however each year around 0.5% of patients with the condition will. Often patients with Barrett’s oesophagus are recommended to undergo regular surveillance, using white-light endoscopy and tissues biopsy in an attempt to catch any cell changes early on.

Unfortunately, these diagnostic methods do have their limitations. For example, it can be hard to distinguish endoscopically where the lining of the oesophagus is normal in comparison to where it has changed, subsequently making it hard to know where is best to take a sample tissue for biopsy.
One study found that 18% of patients with no endoscopically visible Barrett’s oesophagus were then diagnosed with Barrett’s oesophagus following biopsy results.

However, recent progress in endoscope technology offers hope that more accurate diagnoses of Barrett’s oesophagus may not be too far away.
The pan-European ESOTRAC project has developed technology that allows a three-dimensional view of the oesophageal wall using a combination of multispectral optoacoustic tomography (MSOT) and optical coherence tomography (OCT).

The new technology may be able to offer a far more detailed view of the oesophageal wall, and provide a more accurate method of diagnosing Barrett’s oesophagus and early oesophageal cancer. This could then allow clinicians to track changes to the oesophageal wall over time.