Professor Rebecca Fitzgerald, Director of the Early Cancer Institute at the University of Cambridge, and Honorary Consultant in Cancer Medicine at Addenbrooke’s Hospital.
With her understanding of patients’ needs and the research environment, Professor Fitzgerald has been leading research to devise, test, and implement the capsule sponge - a quick, simple, and inexpensive test to detect Barrett’s oesophagus and precancerous cells.
A diagnosis of oesophageal cancer can be devastating, only 13% of patients typically survive more than five years. Cases of oesophageal cancer have risen sixfold since the 1990s, and survival has plateaued as it is tough to treat.
It is why I have been working on improving early detection of this terrible disease for the last twenty years, to enable patients to get more effective treatment early when it has the greatest potential for success.
With my colleagues at the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust (CUH), I have been working on an innovative solution – the capsule sponge – to diagnose a condition called Barrett’s oesophagus, a precursor that significantly increases the risk of developing of oesophageal cancer. The capsule sponge test can be easily administered at a GP surgery, leading to a quick diagnosis.
I’m thrilled to see how the capsule sponge is already making a different to thousands of patients. Typically, patients at risk of oesophageal cancer will need to have multiple endoscopies over their lifetime – an invasive procedure involving putting a camera down to the stomach. In our latest study published in The Lancet, we tested the capsule sponge with nearly 1,000 patients with Barrett’s oesophagus from across England and found it could replace endoscopies in half of all patients. For patients we found to be at high-risk, clinicians could prioritise their endoscopy and ensure the procedure was done by someone with the relevant expertise and therefore spend more time identifying any pre-cancerous areas that needed treatment.
If we can catch the cancer early, patients can start treatment sooner, which can drastically improve survival. When the disease hasn’t spread to the deeper layers of the oesophagus it can be treated down the endoscope as a day case, potentially avoiding the need for multiple hospital visits, rounds of chemotherapy, or an invasive operation.
This is just one example of cancer innovation in Cambridge and demonstrates why Cambridge is the home of the Early Cancer Institute, the UK’s only institute dedicated to early detection and prevention research. Cambridge continues to a be a hotbed for ground-breaking cancer research and I’m so pleased to be part of it.
I also can’t wait for the upcoming Cambridge Cancer Research Hospital, a new world-leading facility on the Cambridge Biomedical Campus bringing research discoveries from scientists at the University of Cambridge and the Cancer Research UK Cambridge Centre to patients being treated in the NHS. It will be so good to work under one roof together and I have no doubt there will be many more breakthroughs in upcoming years.
Barrett’s Oesophagus
The early detection of Barrett’s oesophagus, an indicator of potential oesophageal cancer, could halve the number of deaths each year.
Barrett’s oesophagus is the changing of some cells in the lining of the oesophagus, or food pipe, which over time can develop into cancer. It is caused by repeated acid reflux, or heartburn and is usually identified via an endoscopy and a biopsy. This is generally carried out in hospital following a GP referral. The test is time-consuming, unpleasant, and quite invasive for patients, as well as being expensive for the healthcare system.
As a junior doctor I was taken aback by the terrible outcomes for patients diagnosed with advanced disease when we know that their cancer has in fact developed very gradually over a period of years.
When I found out that most patients with Barrett’s oesophagus are not diagnosed, I wanted to do something about it. I knew it wouldn’t be feasible to do a camera test in everyone with heartburn, the main risk factor, and so started to think about how we could do things differently. After creating a series of prototypes for the device we came-up with the capsule sponge as a way to collect cells coupled with a laboratory test that we also developed. It is a relatively quick, simple, and inexpensive test. It takes just 10 minutes and can be done in a GP surgery or an outpatient clinic, usually by a nurse and the sample is tested in a centralised lab. In clinical trials, when the capsule sponge was offered to people taking medicine for heartburn, it detected 10 times more cases of Barrett’s oesophagus compared with standard practice.
The capsule sponge
The capsule sponge is a small, easy to swallow, capsule on a thread which contains a compressed sponge. The patient swallows the capsule which dissolves in the stomach and the sponge expands to the size of a 50p coin. After a few minutes, the sponge is pulled back up using the thread. As it travels up the oesophagus the sponge collects millions of cells which are then tested in a laboratory using antibody tests. These are analysed by a pathologist and our recent research also shows how AI can assist the pathologist to speed up the process. We have developed an application that picks out any potential positive areas for the pathologist to review in a very user-friendly interface, so in the future the pathologist may not need to review the negative cases.
If abnormal cells are found a patient may be monitored to see if further cell changes occur or be referred for an endoscopy. If abnormal cells aren’t found, the patient does not need an endoscopy, saving time, money, and worry for the patient.
The future of the capsule sponge
Last year we launched the BEST4 trial, the largest study in the UK exploring the potential for the capsule sponge to be delivered as a national screening programme, similar to the use of the FIT (faecal immunochemical test) test for bowel cancer. The trail will involve over 120,000 participants and we hope it will lead to the capsule sponge reaching many more individuals at risk.
We are all eagerly awaiting the publication of the NHS 10 Year Plan, however the capsule sponge is a working example of the Government’s three strategic shifts, focussing on prevention, monitoring in the community and using digital innovation through AI. There is a lot of evidence that shows how accurate this new test is, which can be performed at a local GP surgery. It doesn’t require specialist equipment and enables patients to get a rapid diagnosis closer to their homes, avoiding expensive and invasive hospital procedures — ultimately reducing waiting lists and saving the NHS money.
Here in Cambridge, we have a unique community of researchers and clinicians working together on the Cambridge Biomedical Campus — Europe’s largest life sciences cluster. The work done to develop the capsule sponge involved a variety of scientists and clinicians, including bioengineers, laboratory scientists, public health and clinical trial experts, as well as feedback from patients and the public. The Cambridge Cancer Research Hospital will benefit from this collaborative environment and has the power to accelerate the development of new diagnostics and treatments by several years.
We’re working at pace to ensure that the work we are doing in Cambridge benefits patients across the NHS and beyond. If the capsule sponge was a mainstream test across the UK used by GPs for people with heartburn, it would be a game-changer in the care, treatment, and survival rates of patients with oesophageal cancer.
If we can nip cancer in the bud, we will save so many more lives. That is what drives me, my team, and the research.