A new diagnostic test to help detect the early stages of oesophageal cancer
Supported by the NIHR Cambridge Biomedical Research Centre, Medical Research Council and Cancer Research UK, Cambridge researchers have developed an innovative test for Barrett’s Oesophagus – a condition that can increase a person’s risk of developing oesophageal (food pipe) cancer.
It’s a cheap and simple test that can be done in a GP surgery- so you only need to go to hospital for an endoscopy if it is really necessary to confirm the diagnosis.
Research is vital in discovering new tests and treatments for patients. But it takes time to go from ‘bench’ (starting with the initial idea in the lab) to ‘bedside’ (used in improving routine health care). Follow Professor Rebecca Fitzgerald and her team as they develop the Cytosponge.
Before any clinical trials could begin, Rebecca and the team had to investigate the idea further to see if this approach was feasible.
This is known as ‘pre-clinical or basic research’ – the stage of testing the concept in theory before testing in people.
From focus groups looking at the acceptability of the Cytosponge procedure to working with engineers on the materials required, each process provided evidence that the sponge was safe and would work to detect pre-cancer.
Results from the Cytosponge pilot study were compared with GPs’ usual practice of referral for an endoscopy, analysing everything from the effectiveness of the test to the number of cases of Barrett’s Oesophagus detected with both methods.
This enabled Rebecca and her team to conduct further clinical trials. With 10 times more cases found, using Cytosponge in the latest trial, the evidence for using the Cytosponge continues to build.
During phase 2 and 3 Rebecca realised that she needed to partner with industry to make the research prototype into a product that would pass the device regulations and be CE marked. To do this the MRC who owned the patent and trademark for Cytosponge licensed it to a company called Covidien who made the ablation treatment for Barrett’s Oesophagus.
Covidien were then acquired by Medtronic who now make the Cytosponge devices. In order to provide the lab testing, Rebecca and her team also created a spin-out called Cyted, which acquired Huntingdon-based Pathognomics, to provide centralised laboratory testing and digital pathology technology to scale up the evaluation of samples to the level needed for the NHS and beyond.
Future hopes are that the Cytosponge could become a mainstream test in GP surgeries to help decide which patients with heartburn need an endoscopy. It is also possible in the future that it is offered to everyone over a certain age like prostate and smear tests.
How long is the string?
The string attached to the Cytosponge is around 50cm long.
Why is it called the Cytosponge?
“Cyto” originates from Greek ‘kutos’ meaning a vessel/ container. It is also a prefix meaning cell.
How long does it take to dissolve?
The capsule takes 5-7 mins to dissolve in the stomach.
How big is the sponge once the capsule has dissolved?
The sponge expands to about the size of a 50 pence piece.
How many cells does the Cytosponge collect?
The Cytosponge collects well over a million cells to analyse – this is why we use TFF3 to highlight the abnormal cells to speed up the work for the pathologist.
Who have gastroesophageal reflux, also known as acid reflux / heartburn.
One in 10 individuals in the UK with a history of long-standing heartburn is estimated to have Barrett’s Oesophagus, which can lead to oesophageal cancer in a small number of people.
It’s usually diagnosed in hospital by endoscopy and a biopsy – passing a camera down into the stomach – following a GP referral.
Who will be able to use the lab test to see if there are precancerous Barrett’s cells which can be identified by an antibody that stains for Trefoil Factor 3 (TFF3) which picks out the tell-tale goblet cells.
If positive cells are found clinicians will be able to organise further investigations for the patient using an endoscopy to determine if there is pre-cancer or sometimes cancer in the oesophagus. If the patient does have early stages of cancer, they can provide treatment a lot sooner to the patient rather than waiting for the symptoms to develop.
Receiving a Barrett’s Oesophagus diagnosis does not mean it is always cancerous, in fact in most patients it does not progress to cancer. If Barrett’s Oesophagus is detected patients are monitored with regular check-ups through an endoscopy and biopsy.
Trials are also ongoing to evaluate the role for Cytosponge to monitor patients as well. Alongside better detection, the test means cancer patients can benefit from less severe treatment options that can be performed during an endoscopy, without chemotherapy or surgery, if their cancer is caught at a much earlier stage.
The following people and organisations have made the research journey of the Cytosponge possible.
Professor Rebecca Fitzgerald and her team would like to thank them for their support:
Thank you to all the patients involved in our clinical trials, without you this research would not be possible.
Also, for the expertise of the Patient and Public Panel members at Cancer Research UK and Cambridge University Hospitals who provided their invaluable help and support.
To the many researchers and clinicians who have made up the team, from Cambridge and from the trials team at King’s College London.
Also, to the following people: Prof Peter Sasieni, Dr Maria O’Donovan, Dr Massi di Pietro, Irene Debiram-Beecham and Tara Evans.
And to the following organisations:
The NIHR Cambridge BRC is part of the NIHR and hosted by Cambridge University Hospitals NHS Foundation Trust in partnership with the University of Cambridge. We are at the heart of the Cambridge Biomedical Campus, Europe’s largest health research area.
Cambridge Biomedical Research Centre
Box 277
Hills Road
Cambridge
CB2 0QQ
Tel: 01223 348490
Could you lead an innovative data-enabled clinical trial to answer important research questions in health and social care?
We're offering research funding for ambitious proposals! For more details and to apply, please see: https://www.nihr.ac.uk/funding/ambitious-data-enabled-e-trials/2024216
The @NIHRresearch evidence collection on #HealthLiteracy makes the case for improving #PatientInformation.
It also includes tips on how to make sure everyone can understand the information they are given.
https://evidence.nihr.ac.uk/collection/health-information-are-you-getting-your-message-across/
#HIW2025 #HealthInformation #HealthInformationWeek
Would you like to gain new perspectives and expand your professional network? Are you an early to mid-career researcher based in NIHR infrastructure or Research? The NIHR Mentoring Programme has expanded! Register interest before 4pm on 18th Feb.
https://bit.ly/3CizbmU #NIHR
We are delighted to share the news announced by the Secretary of State for Health and Social Care today that Cambridge Cancer Research Hospital can proceed as planned following the New Hospital Programme review.
👉🏼https://bit.ly/ccrhnhp
@CUH_NHS @Cambridge_Uni @CRUKCamCentre
📢 Watch out for our content over the next week or so highlighting our imaging research.
Advanced cancer imaging is changing how we see and treat cancer. Watch this video that explains what it is and when it's used.👇
#FocusOnCamCancer @CRUKCamImaging @CUH_NHS @CRUKresearch
#BePartOfResearch - Read about how taking part in a research study, looking at a new treatment option for chronic rhinosinusitis and nasal polyps, has enhanced Alan Towse's ability to smell....'It has improved my life so much' @NIHRrdn
