A new test of esophageal cancer uses genetic biomarkers to detect changes in esophageal cells

Esophageal cancer makes more than 400,000 victims each year in the world. In the absence of an effective and reliable method of screening for the disease, by the time the symptoms become apparent, it is often too late to save the patient.

A Johns Hopkins researcher who has devoted his career to the detection and prevention of esophageal cancer today published an article in the journal Clinical research on cancer which, in his opinion, could finally allow a simple and inexpensive detection of the deadly disease.

In this article, Stephen Meltzer, a gastroenterologist, professor of medicine and oncology at the Johns Hopkins University School of Medicine, accompanied by a team of researchers, clinicians, and researchers, is one of the world's leading researchers. Biomedical engineers describes a test – "the EsophaCap" – that uses specific genetic biomarkers to detect dangerous changes in cells that line the interior of the esophagus.

Previous studies have demonstrated the ability of Meltzer's biomarkers to detect a condition called Barrett's esophagus, which forces the body to replace the tissue that lines the organ with cells that may become cancerous.

But the large-scale methods for deploying these biomarkers as a screening tool have been elusive until now.

The principle of EsophaCap is simple, says Meltzer. The patient swallows a small capsule to which is attached a long string. Once the capsule has made its way into the esophagus and into the stomach – process that takes only about a minute -, the gelatin coating on the capsule begins to dissolve .

From this capsule emerges a 2 cm polyurethane sponge, still attached to the string, much of which is still hanging from the patient's mouth.

The sieve gently pulls the twine and the sponge begins its journey back, out of the stomach, into the esophagus and finally out of the patient's mouth.

As it ascends, the sponge comes into contact with the entire length and width of the esophagus, collecting genetic material throughout the course. Then, when the sponge approaches the top, the sifter pulls one last shot by gently pulling the sponge past the upper sphincter muscle of the organ. The sponge emerges loaded with genetic material that holds the key to the patient's esophageal health.

The sponge is then sent to a company that performs simple genetic tests on the material to determine the cancer risk of the patient's esophagus.

"Early detection is the complete game in esophageal cancer," said Meltzer. "Patients are much more likely to treat or even prevent it, knowing they are at risk, and we believe this little sponge can provide easy and inexpensive screening for people around the world."

With nearly half a million new cases a year, esophageal cancer is the eighth most prevalent cancer in the world, with the highest rates in some parts of Africa and Africa. d & # 39; Asia.

In 2016, nearly 17,000 new cases were diagnosed in the United States and about 16,000 deaths from esophageal cancer. These numbers have risen sharply in recent years.

The five-year survival rate of people with esophageal-confined cancer is 43%. When it spreads to nearby tissues or organs, this rate drops to 23%. And oesophageal cancer that spreads to remote areas of the body provides only a five-year survival rate of only 5%.

In previous research, Meltzer had performed rigorous tests on all of the genetic biomarkers that he used to diagnose Barrett's esophagus. The gene combination of p16, NELL1, AKAP12 and TAC1 yielded a sensitivity of nearly 92% and offered reliable diagnostics.

Medicine has never had routine screening methods for the disease The endoscopy and biopsy are not ideal because they are inexact, expensive and rely on random tissue samples, rather than on material from all the lining of the esophagus.

"It is indeed possible to miss out on early cancer cells using endoscopy with biopsy and most patients with Barrett syndrome never endoscopy," says Meltzer. "At the present time, we are confident that we have the necessary tools to identify this type of cancer, but we previously had no way of collecting enough genetic material to diagnose the patient with confidence. believe that EsophaCap now provides a solution to this serious problem. "

Meltzer administered the EsophaCap test to 94 people during the study. Eighty-five percent of the subjects were able to swallow the capsule and 100% managed to recover their sponge. The endoscopic evaluation of patients after the administration of EsophaCap, said Meltzer, revealed no signs of bleeding, pain, trauma or other adverse reactions to the test .

In the review article, Meltzer reports that in patients able to swallow the capsule, almost half would be diagnosed with Barrett's esophagus – a rate well above that of the general American population. He notes that most patients enrolled in the study were treated for gastrointestinal symptoms. "This may explain why we found Barrett's esophagus rate to be higher than that of the general population," he says.