A translational programme to elucidate the pathophysiology of oesophago-gastric cancer and develop clinical innovations

Cancers of the gullet (oesophagus) and at the junction with the stomach are the sixth most common cause of cancer mortality worldwide. In the UK rates of this cancer type have increased 6-fold in the past 30-years and the outcomes are poor with fewer than 20% living beyond 5-years because of late diagnosis. On the other hand, there is the opportunity to detect these cancers early and prevent progression to life-threatening disease because they develop gradually from pre-cancerous stages over a period of years.

One example of our work to date has been the development of the Cytosponge sampling device and laboratory test (called TFF3) which can be given to patients with heartburn, who are at risk of the pre-cancerous condition Barrett's oesophagus. Cytosponge is now CE marked and commercially available with compelling clinical trial data to support its use and plans for NHS implementation.

The key aims in the next five years are to better understand why mutations accumulate in cells of the oesophagus and stomach that make cancer more likely to develop. We would like to understand whether there is more than one cell of origin for the development of these cancers or whether it is one type of disease with different sub-types that each have a different prognosis.

We will develop clinical prediction models to determine whether patients with Barrett's are likely to have an indolent or an aggressive path and then apply this to Cytosponge samples and incorporate sophisticated endoscopy imaging techniques.

The Fitzgerald group is highly collaborative and includes clinicians and scientists with a range of expertise. We are ideally placed to translate our findings into clinical trials through the nearby Clinical Research Facility with state-of-the-art endoscopy equipment.

In summary, we plan an ambitious programme that will provide a bridge to clinical trials to improve management strategies for this aggressive cancer.