Near-infrared fights cancer: Barrett's oesophagus

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  • Published: Oct 1, 2016
  • Author: David Bradley
  • Channels: Infrared Spectroscopy
thumbnail image: Near-infrared fights cancer: Barrett's oesophagus

Pre-cancer

Potentially precancerous changes that occur in the lining of the gullet, a condition known as Barrett's oesophagus, can be detected early using near-infrared fluorescence, according to a new study.

Sarah Bohndiek and colleagues at the University of Cambridge emphasise that early detection can mean the difference between a positive and a negative prognosis when it comes to cancer. Better still, perhaps, is the detection of significant changes at the cellular level that occur before a cancer has even begun to develop. In the case of oesophageal cancer a known risk factor are changes in the cells that line the food pipe that are often induced by severe acid reflux or other causes of inflammation. Finding that a patient has this condition could be important in treating them with medication to reduce acid reflux and lower the risk of cancer developing.

Dysplasia

Unlike the lining of the stomach, the oesophagus is not well protected against the 0.1 molar hydrochloric acid produced by the stomach to help with food digestion that can sometimes leak into the gullet should the sphincter at the top of the stomach not be as efficient a seal as it ought to be. The sensitive stratified squamous epithelium cells lining the oesophagus can be induced to undergo changes, dysplasia, that see their replacement with goblet cells, which usually line the lower gastrointestinal tract. One in every 200 people known to have Barrett's oesophagus develop oesophageal adenocarcinoma, which is very often a particularly lethal type of cancer, as such Barrett's is considered to be a premalignant condition.

There are specialist tests for such precancerous conditions in other parts of the body. Endoscopic examination is the usual hospital investigation for patients presenting with severe acid reflux about whom their physician has concerns with respect to Barrett's oesophagus. Now, Bohndiek and her colleagues have published details in the Journal of Biomedical Optics of a new way to detect this condition and so putatively reduce the incidence of oesophageal cancer. The study combines imaging expertise with engineering and biochemistry to use an infrared camera and fluorescent dyes.

Flat patch

Given that Barrett’s oesophagus presents as flat patches, rather than the lumps, growths, polyps or calcified cells of other types of cancer at the early stages it is difficult to seem. Moreover, the patches may not even be different in colour to the surrounding normal, healthy, cells. So, white light endoscopy no matter how bright that light does not necessarily reveal the premalignancy. Using infrared and fluorescent dyes sidesteps this problem as changed tissues absorb dye on to their surfaces whereas normal cells do not, and this can be easily seen in the infrared, as opposed to the visible, region of the spectrum without the fluorescent interference from normal cells, which are, as luck would have it naturally fluorescent themselves.

"People who are at a high risk of developing oesophageal cancer, such as those with Barrett’s oesophagus, could be closely monitored with this technique. But we need to do some further testing before clinical trials with patients can be set up to see how effective the approach could be at saving lives," says Bohndiek. Tests on the detection limits of this new diagnostic have already been carried out to show how smallest a patch of changed cells might be detected and the smallest amount of fluorescent dye needed to reveal differences.

Related Links

J Biomed Opt 2016, 21(8), online: "Design and validation of a near-infrared fluorescence endoscope for detection of early esophageal malignancy"

Article by David Bradley

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

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