Research for Patients

Barrett & esophageal cancer

Barret & Esophageal Cancer
Research: Visual Overview
Barret_made-with-BioRender-02

Research for Patients

What is Barrett’s esophagus?

Barrett’s esophagus (BE) is a condition in which the cells that line the lower esophagus are replaced by cells similar to the lining of the intestine. In medical terms, this process is called metaplasia (see figure below).

The exact way of how BE develops is not known; however, it is associated with gastroesophageal reflux disease (GERD). Other risk factors for BE are male gender and Caucasian origin. BE is usually diagnosed around the age of 55.

Research for Patients

What is the link between Barrett’s esophagus and esophageal cancer?

Barrett’s Esophagus (BE) is characterised by changes in the cells lining the lower esophagus (metaplasia). BE is associated with an increased risk of developing esophageal cancer, more specifically esophageal adenocarcinoma. This does not mean that cancer will definitely develop; the risk of developing esophageal cancer is relatively small. Typically, precancerous cells will emerge in the BE tissue before the cancer develops. This process is called dysplasia and is further classified as low-grade dysplasia (mildly abnormal) or high-grade dysplasia (more abnormal – looks more like cancer). Therefore, it is important for BE patients to be regularly monitored so that if cell changes are seen, it can be treated at an early stage and cancer can be prevented.
Barrett’s esophagus and esophageal cancer
Depositphotos_248059836_S

Research for Patients

Diagnosis of Barrett’s esophagus?

Barrett’s esophagus (BE) is diagnosed by performing an upper gastrointestinal endoscopy and biopsy. During this endoscopy a trained health care provider, usually a gastroenterologist, looks inside the gastrointestinal tract using an endoscope, a thin tube with a small camera inside. This endoscope is also used to take a small piece of esophageal tissue, a biopsy, which can later be analysed in the laboratory to check for the presence of BE cells. Biopsies are also taken to detect dysplasia. Since dysplasia does not affect all the Barrett tissue, one biopsy is not enough to diagnose dysplasia. Multiple biopsy samples, usually from at least four different areas within the Barrett tissue, are taken.

Research for Patients

Treatment of Barrett’s esophagus?

Barrett’s esophagus (BE) treatment depends on the overall health of the patient and whether (low-grade or high-grade) dysplasia is present. These are the main treatment options for BE:

Medication:

Most BE patients suffer from Gastroesophageal Reflux Disease (GERD). Acid-suppressing medication will be prescribed to prevent GERD, further esophageal damage, and development of dysplasia and cancer.

Repeated surveillance:

Periodic endoscopies and biopsies to look for cellular changes indicating dysplasia or early cancer. The frequency of surveillance is clearly defined and depends on the status of dysplasia. For example, surveillance will be more frequent in patients with low-grade dysplasia compared to those with no dysplasia.

Endoscopic therapy:

Endoscopic mucosal ablation (EMA):
Ablation is a minimally invasive procedure that will destroy the pre-cancerous cells (dysplasia) in the esophagus. It helps to prevent progression to EAC. Multiple methods for ablation exist. Currently,  the heat-based technique known as radio frequency ablation (RFA) is used most. No open surgery is needed with this technique.

Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD):
These techniques are applied to dissect the dysplastic or early cancers from the BE segment. The dysplastic or malignant BE mucosa is cut off and then removed using an endoscope. No open surgery is needed with this technique.

Surgery:

Surgery (esophagectomy) is an alternative to endoscopic therapy or applied in case of more advanced cancer stages. Esophagectomy is a surgical procedure in which almost the entire esophagus is removed. The esophagus is recreated using a part of the stomach or large intestine. Surgery involves more complications. Therefore, endoscopic therapy is preferred if the cancer is still in an early stage.

Research for Patients

Visual Overview: Problem, Goal, Impact

Get a visual overview of the current problem, the goal and expected impact of our research:

Current Problem

Barrett with early cancer

Endoscopic treatment

Stable remission

Recurrent disease

High frequency follow-up for all

  • Quality of life for patients
  • Healthcare costs
  • Patient-centred treatment

Our goal

Use biological tools* to identify Barret patients at high risk

Apply these for risk stratification and directing treatment and follow-up:

  • Risk
  • Follow-up
  • Risk
  • Follow-up

Expected impact

  • Quality of life for patients
  • Healthcare costs
  • Patient-centred treatment

*Biological tools or biomarkers are biological molecules found in blood, other body fluids, DNA/RNA, or tissues. These molecules are measurable indicators of a certain biological state or condition.