New 'sponge on a string' test can pick up early signs of oesophageal cancer

Patients at risk of oesophageal cancer are being offered a new ‘sponge on a string’ test to help pick up the earliest signs of the disease – allowing doctors to take steps to prevent it.

The one-minute procedure, which can be carried out by a GP or a nurse, involves swallowing a pill containing a sponge-like material attached to a piece of thread. 

Once in the stomach, the pill dissolves and the sponge inside expands.

When it is drawn out, it gently scrapes away cells that line the oesophagus. The cells are then tested for pre-cancerous changes.

Called the Cytosponge, it offers an alternative to an endoscopy, in which a tube and camera are passed down the throat under local anaesthetic. 

Pictured: How the one-minute procedure, which can be carried out by a GP or a nurse, works

Pictured: How the one-minute procedure, which can be carried out by a GP or a nurse, works

Endoscopies have to be done in a hospital or specialist unit and the procedures are notoriously uncomfortable.

The Cytosponge could help catch oesophageal cancer at its earliest stages or before it even begins, dramatically improving survival odds.

During initial trials, the test picked up an early-stage cancer in Liz Chipchase, 72, who said: ‘It saved my life.’

At present, about 9,200 Britons a year are diagnosed with the disease, and just 12 per cent survive more than a decade from diagnosis.

The cancer kills more than 7,000 people each year. Although age is the main risk factor, many cases are said to be preventable because they are linked to smoking, alcohol and obesity.

A condition known as Barrett’s oesophagus – pre-cancerous changes to the cells that line the lower part of the gullet – also increases the risk.

It is thought that about four million Britons suffer from Barrett’s, although many are unaware of it, and up to one in ten could go on to develop oesophageal cancer.

It is thought to be caused by acid reflux, where acid ‘leaks’ back up into the oesophagus from the stomach. Over time, this can change the cells that line the oesophagus.

While the cell changes of Barrett’s itself do not cause symptoms, acid reflux does – primarily heartburn or chest pain, but also an unpleasant taste in the mouth, a persistent cough, particularly at night, problems swallowing, nausea and vomiting. Oesophageal cancer causes similar problems.

These symptoms should warrant a referral for further investigations which, previously, would have involved an endoscopy.

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The Cytosponge offers a simpler and less obtrusive alternative, say experts. There has also been concern about whether endoscopies can be carried out safely. 

The device blows air into the stomach to inflate it, but this can mean tiny moisture particles known as aerosols can be propelled out of the patient’s mouth and into the air. These particles may contain the Covid virus, putting doctors at risk.

In contrast, the Cytosponge procedure is ‘aerosol-free’, and it has already been fast-tracked in some hospitals to deal with the mounting diagnostic delays brought on by the pandemic. 

Earlier this month, the Scottish Government pledged £500,000 to help roll out the test.

Developed by researchers at Cambridge University and Addenbrooke’s Hospital, the Cytosponge may be able identify ten times more people with Barrett’s oesophagus than the current route, according to a study earlier this year.

This is because the procedure is much quicker than an endoscopy and can be carried out by GPs, meaning that more people will be able to access it.

If Barrett’s is diagnosed, patients may be offered medication to control stomach acid and offered lifestyle advice. In more advanced cases, they will be offered surgery to help reduce the risk of cancer developing.

Professor Rebecca Fitzgerald, who helped to develop the test, said the sponge could be a game-changer in the fight against oesophageal cancer.

She added: ‘Compared with endoscopies performed in hospital, the Cytosponge causes minimal discomfort and is a quick, simple test that can be done by a GP.

‘Our test is already being piloted around the country, so we hope more people across the UK could benefit from it.’ 

Addenbrooke’s Hospital recently fast-tracked the Cytosponge into use in order to help identify patients with suspected cancer who need further tests urgently.

This, along with its launch in Scotland, came in response to the major drop-off in cancer diagnosis during the coronavirus crisis.

According to Cancer Research UK, 2,700 fewer people a week have been diagnosed with cancer compared with last year.

Prof Fitzgerald hopes it will soon be available to GPs across the UK.

Ms Chipchase, who had suffered from acid reflux for years, took part in a Cytosponge trial programme in 2017. She said: ‘If I hadn’t been invited and gone on the trial, I would have had no idea that I needed treatment.’

She visited her GP for the test and received her results 12 days later.

The test indicated the retired scientist had Barrett’s oesophagus and, because of this, she was sent for an endoscopy to see if the cells were cancerous.

That procedure showed she had early-stage oesophageal cancer, and she was quickly started on treatment. 

She said: ‘I feel so lucky thinking about the chain of events that led to the cancer being caught when it was. The experience has changed me. I smile a lot more.’