Researchers at Columbia University Medical Center are challenging previous claims about the origins of esophageal cancer—and their findings may prevent future cases.
Dr. Timothy Wang, a professor of medicine at the College of Physicians and Surgeons, recently published a study showing that the major biological events that can give rise to esophageal adenocarcinoma—fast becoming the most prevalent tumor in the United States—take place in the upper stomach, disproving medical experts who have thought otherwise for years.
The events that give rise to EAC were initially thought to take place in the stomach, but experts over the past few decades guessed that they started in the esophagus, which carries food from the back of the mouth to the stomach.
“Our conclusion is similar to what was originally thought, but different from what has been thought for the past 20 or 30 years,” Wang said.
A chronic inflammation called Barrett’s esophagus—often a precursor to EAC—has been found in patients with acid reflux, so the team of researchers attempted to recreate these symptoms in mice. However, mice are incapable of having acid reflux, making the research much more difficult.
“They’ve been done for almost every cancer except EAC,” Wang said.
To induce inflamed esophagi, Wang and his team injected cells into mice, creating symptoms similar to those a person with acid reflux would have.
“Interestingly, when we went back and analyzed changes over time, it became very clear that the changes were coming from the top of the stomach,” Wang said.
This finding reveals why researchers have had so much difficulty studying EAC in the past—they had been focusing on the wrong type of cell, esophageal instead of upper-stomach.
“When you are trying to make a mouse model, you have to know the cell type you are targeting,” Gloria Su, assistant professor of molecular biology at CUMC, said.
Researchers also discovered that by blocking the enzymes from reaching the Notch signaling pathway, which helps pre-malignant cells survive and spread, these healthy cells began to die out.
These findings have promising implications for patients. Barrett’s esophagus patients are screened regularly for EAC, and this new research may make EAC prevention and treatment easier.
“Anywhere between 5 percent and 10 percent of patients who have acid reflux will come down with Barrett’s,” said Chandra Ivey, assistant professor of clinical otolaryngology and director of head and neck surgery at CUMC. “If we can try to predict earlier who is going to have more difficulty, we can treat them earlier.”
These findings will be especially helpful for treatment at Columbia, which has one of the largest Barrett’s esophagus centers in the country.
“You can see how this could be a great continued collaboration at Columbia,” Su said.
COMMENTS
Comments will be moderated in accordance with our comment policy