Cancer imaging research and develop a new and cutting edge portfolio of research that will aim to improve the way we diagnose and treat patients with oesophageal cancer

End of project summary

Main Messages 

This project was focused on cancer of the gullet (oesophageal cancer) and aimed to improve the way doctors and patients assess the extent and spread of their disease (staging). Patients with oesophageal cancer generally have a poor prognosis and the number of cases in Wales is rising because obesity, smoking and alcohol use are major risk factors for oesophageal cancer development. The reasons for this important project were that differences in staging practice had been discussed but never formally investigated. We know that our performance for detecting spread of disease (metastases) must be improved, and many patients have no or little effect to chemotherapy so predicting this with radiology scans would benefit patients. 

This project had three main aims;

1. we aimed to understand what current practice happens when we stage the disease in Wales and the United Kingdom,
2. we aimed to improve how good we are diagnosing metastases using radiology scans combined with new techniques and
3. we aimed to improve the way in which we attempt to predict how well a treatment is working by using radiology scans. 

We found: 

• There is widespread variation in the use of a specific test called endoscopic ultrasound (EUS) around the UK which means some patients do not have access to these services. We found there is also uncertainty about the benefits of EUS. Agreement about which patients should receive EUS, and why, should be sought. 
• New genetic markers not described before are linked to the spread of metastases to lymph nodes which means that we have discovered potential new targets for cancer treatment intervention and could make our staging performance more accurate. 
• Combining a radiology scan called positron emission tomography (PET) with a new genetic test helps us to predict which patients have had a response to chemotherapy before they have a major operation to remove the tumour.