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  • Review Article
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The '–omics' revolution and oesophageal adenocarcinoma

Nature Reviews Gastroenterology & Hepatology volume 11, pages 19–27 (2014)Cite this article

Subjects

Key Points

  • The majority of patients with oesophageal adenocarcinoma (OAC) undergoing surgery with curative intent will relapse and eventually succumb to their disease

  • The presence of Barrett oesophagus is a risk factor for developing OAC, although patients at the highest risk of developing OAC need to be identified

  • So-called –omics studies have provided novel insights into OAC biology, identifying recurrent mutations and mutational signatures important in disease pathogenesis

  • Controversy over the aetiology of gastro-oesophageal junctional tumours remains, but so-called –omics studies are providing resources to begin to subclassify this disease

  • Nearly half of OACs have a potential actionable mutation; clinical trials using targeted therapies are in their infancy and initial experiences have been disappointing, supporting the need for more accurate molecular stratification

  • Advances in molecular assays applied to nonendoscopic cell collection devices and blood-based biomarkers might enable noninvasive diagnosis of OAC, as well as monitoring response to different treatment regimes

Abstract

Oesophageal adenocarcinoma (OAC) is the eighth most common cancer type worldwide with a dismal 5-year survival. Barrett oesophagus, the replacement of the normal squamous epithelia with glandular cells, is the first step in the pathway towards OAC. Although most patients with OAC present de novo, the presence of the easily detectable OAC precursor lesion, Barrett oesophagus, enables the possibility of early detection of high-risk patients who are more likely to progress. Currently, identification of high-risk patients depends on histopathological assessment of dysplasia with no regards to molecular pathogenesis. In the future, screening and risk stratification initiatives for Barrett oesophagus that incorporate molecular profiles might permit improved early diagnosis and intervention strategies with the possibility of preventing OAC. For the majority of patients presenting de novo at an advanced stage, combining so-called –omics datasets with current clinical staging algorithms might enable OACs to be better classified according to distinct molecular programmes, thereby leading to better targeted treatment strategies as well as cancer monitoring regimes. This Review discusses how the latest advances in –omics technologies have improved our understanding of the development and biology of OAC, and how this development might alter patient management in the future.

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Figure 1: Current clinical management pathway for OAC.
Figure 2: Illustrations of the different –omics technologies.
Figure 3: Proposed –omics-based management algorithms for Barrett oesophagus and OAC.

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  1. MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Hills Road, Cambridge, CB2 0XZ, UK

    Jamie M. J. Weaver, Caryn S. Ross-Innes & Rebecca C. Fitzgerald

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J. M. J. Weaver and C. S. Ross-Innes made equal contributions to researching data for the article. J. M. J. Weaver, C. S. Ross-Innes and R. C. Fitzgerald made equal contributions to discussion of content, writing and reviewing/editing the manuscript before submission.

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Correspondence to Rebecca C. Fitzgerald.

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The Cytosponge™ and assay technology developed by R. C. Fitzgerald has been licenced by the Medical Research Council to Covidien. The other authors declare no competing interests.

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Weaver, J., Ross-Innes, C. & Fitzgerald, R. The '–omics' revolution and oesophageal adenocarcinoma. Nat Rev Gastroenterol Hepatol 11, 19–27 (2014). https://doi.org/10.1038/nrgastro.2013.150

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