Concerns over rising cancer trend

The rise in oesophageal cancer is a national cause for concern – it is now the fifth most common cause of cancer death, while the survival rate is one of the lowest in the UK. In the chief medical officer’s previous annual report (published in 2008), Sir Liam Donaldson identified the disease as a priority area of public health, which must be addressed. He acknowledged that levels of oesophageal cancer in the population of England are among the worst in Europe. Furthermore, while rates in some other nations are falling, the situation in this country is getting worse – over the last two decades, incidence has risen by 87% for men and 40% for women. A national symposium recently hosted by the charity, Barrett’s Oesophagus Campaign, held at University College London, highlighted important new research into Barrett’s aimed at reversing this disturbing trend.

Risk factors

There are two main types of oesophageal cancer: squamous cell carcinoma and adenocarcinoma. The CMO report points out that smoking and low fruit and vegetable intake are risk factors for both types of cancer, but each has its own specific risk factors – excess alcohol is a risk factor for squamous cell carcinoma, particularly when combined with smoking, while obesity and gastro-oesophageal reflux, where acid from the stomach damages the oesophagus, are strongly associated with adenocarcinoma. Normally, the oesophagus is lined by a layer of short, squat cells, called squamous cells. When gastric and duodenal juices flow back up into the oesophagus repeatedly over an extended period, this long-term exposure to acid and bile can injure the lining of the oesophagus causing inflammation (oesophagitis). In some cases, as healing occurs, the normal lining of the oesophagus (squamous epithelium) is replaced by an intestinal-type lining (columnar epithelium), a process described as “metaplasia”, which can result in Barrett’s oesophagus. These columnar Barrett’s cells are vulnerable to further changes (dysplasia), which can potentially lead to the development of adenocarcinoma. At least 375,000 people are estimated to have Barrett’s oesophagus in the UK and some 37,500 of these patients will develop oesophageal cancer. Of those diagnosed with cancer, 30,000 will die within five years. The survival rate is extremely poor, but, if Barrett’s oesophagus is detected early and treated, the prognosis can be good. Identification of risk factors, early diagnosis, low-cost screening techniques and the development of non-invasive treatments are all key priority areas currently under investigation.