Posts in category: Cancer

Author:  Pousali Chatterjee (AllCaN PhD Candidate)

Background

The recovery after gastrointestinal cancer surgery extends far beyond the completion of treatment. Many patients experience a prolonged period of psychological, physiological and metabolic disruption, accompanied by a gradual rebuilding of strength and confidence. Lifestyle‑based approaches, particularly structured exercise programmes, are increasingly recognised as important components of this recovery process, not only because they improve physical capacity but because they appear to influence several biological pathways that remain altered long after surgery.

One of the areas my PhD focuses on is how these lifestyles changes intersect with inflammation, a process that plays a central role in metabolic health, immune function, and, potentially, cancer risk. To study this, I examine a particle that circulates in your blood called high-density lipoprotein (HDL) or more commonly referred to as your ‘good cholesterol’. While much is known about HDL particles in the setting of heart disease, little is known about their role in cancer biology and this is a major focus of my thesis.

HDL: More Than a Heart-Health Number

HDL particles are made up of many different types of fats and proteins with over 280 proteins carried on these particles around the blood stream. These proteins dictate the function of the particles. In healthy individuals HDL particles carry a large cargo of proteins that can reduce inflammation and exert antioxidant effects – in this setting HDL is anti-inflammatory. In the setting of heart disease, there is a switch in the types of proteins on HDL with increased accumulation of pro-inflammatory proteins and loss of anti-inflammatory proteins which results in a loss of the protective anti-inflammatory properties of the particles. Importantly, these changes in the protein composition of HDL particles are not captured in currently used clinical tests in the clinic (such as your HDL-cholesterol levels); the changes in protein composition often occur even in the presence of normal levels of HDL-C.

Because the proteins on HDL change in response to disease, they can provide valuable information about a person’s heart and metabolic health. My PhD research aims to investigate whether similar changes occur in gastrointestinal cancers. More than 30% of HDL particles originate in the digestive system, meaning they may carry proteins that reflect what is happening in the gut. By measuring these proteins from a simple blood sample, we hope to develop new ways to better understand and potentially detect gastrointestinal cancers.

The first aim of my PhD project is to comprehensively profile HDL-associated proteins in individuals with gastrointestinal cancers, as well as those at high risk of developing these cancers. By identifying novel HDL protein signatures associated with cancer risk, we aim to discover biomarkers that could help identify individuals before disease progression to a metastatic stage, enabling earlier intervention and improved clinical outcomes.

Where Exercise Fits In

Exercise exerts a broad range of positive effects on metabolic and inflammatory pathways. Beyond improving cardiorespiratory fitness, regular physical activity can reduce low‑grade inflammation, modulate immune cell function, and influence lipid handling. These processes intersect directly with HDL biology. If exercise can shift HDL away from an inflammatory profile and toward a more protective one, it may help explain why lifestyle interventions improve long‑term outcomes in cancer survivors.

The second aim of my thesis therefore is to investigate how exercise interventions in patients recovering from gastrointestinal cancers influence the protein composition of HDL particles. This work will provide greater insight into the molecular mechanisms through which exercise may support recovery, reduce recurrence risk, and promote long-term remission and overall health.

Connecting Research to Real Patients: The ReStoRe Trial

A central component of my project involves analysing serum samples from participants enrolled in the ReStoRe trial, a structured lifestyle and diet intervention programme designed for individuals recovering from gastrointestinal cancer surgery. The programme provides supervised exercise, nutritional guidance, and behavioural support, creating a controlled environment in which we can examine how lifestyle changes translate into measurable biological effects.

By studying HDL‑associated proteins in these samples, we aim to determine whether exercise induces detectable shifts in HDL composition. Specifically, we are interested in whether the particle loses inflammatory proteins, regains protective ones, or shows evidence of altered GI‑derived signalling. These molecular changes may help identify individuals who respond particularly well to exercise‑based interventions and, conversely, those who may require additional support.

Why This Matters: Clinical Relevance

If exercise can modulate HDL composition in a favourable direction, it provides a practical explanation for why lifestyle-based recovery programmes improve patient outcomes. Beyond the molecular insight, this creates a clinically useful tool: HDL could act as a non-invasive indicator of recovery quality, helping clinicians distinguish between patients who are progressing well and those who may require more targeted follow-up. Such stratification has direct implications for service efficiency, reducing unnecessary appointments, preventing over-monitoring of low-risk individuals, and allowing clinical teams to focus resources on patients with persistent inflammatory or metabolic disruption.

Looking Ahead:  Scientific Vision

By examining how exercise reshapes HDL in  patients in recovery from GI-related cancer,  we aim to capture the molecular consequences of lifestyle intervention in real time. This approach moves beyond traditional clinical metrics and instead uses HDL as a window into the internal environment during recovery, offering insight into how modifiable behaviours influence long-term health trajectories in individuals at risk of oesophageal cancer and other GI conditions.

HDL Modulation: Mechanistic Pathway

HDL carries proteins involved in inflammation, complement activation, oxidative stress, and lipid transport. When the particle becomes enriched with inflammatory proteins: a pattern common in obesity and metabolic strain, it may signal a biological state associated with slower recovery and higher clinical demand.

If exercise can reverse some of these changes, reducing the inflammatory burden on HDL or restoring proteins with protective roles, HDL becomes a useful molecular readout of recovery trajectory. This information can help clinicians tailor follow‑up intensity, provide streamline interventions, and allocate resources more effectively.

In this way, HDL modulation offers a biologically grounded mechanism for refining cancer care pathways.

What is immunotherapy?

Immunotherapy refers to an umbrella of drugs which enhance a patient’s own immune system to kill cancer cells. Immunotherapies are a relatively new type of treatment which have revolutionised the prognosis of many cancer types. Turning previously dismal prognosis cancers into ones with relatively favourable outcomes, but how do these work?

Normally, the immune system is able to kill cancer cells before they become an issue.  In a nutshell, cancer only becomes problematic when it is able to hide from the immune system and grow into tumours, essentially putting on a mask of disguise. We are specifically looking at a type of immunotherapy called immune checkpoint inhibitors, which in essence, prevents cancer cells from hiding from the immune system.

Being diagnosed with Barrett’s Oesophagus can feel overwhelming, particularly when many people have never heard of the condition before. For many people, the diagnosis is quickly followed by searching online to better understand what Barrett’s Oesophagus actually is, what it means for their health, and what they should do next. While Barrett’s Oesophagus is linked with an increased risk of oesophageal cancer, it is important to remember that Barrett’s Oesophagus is not cancer, and most people with the condition will never develop oesophageal cancer.

Alongside medication and surveillance, lifestyle modification is often discussed as an important part of managing Barrett’s Oesophagus and reflux symptoms. Conversations around diet, physical activity, weight management, smoking, and alcohol can suddenly become a much bigger part of everyday life. Many people are left trying to understand what these changes actually mean in practice, how realistic they feel to maintain, and how they fit around everyday life.

As part of my research, I recently conducted a scoping review, a type of study that brings together and examines findings from existing research, looking at lifestyle behaviours in people living with Barrett’s Oesophagus. The review included 55 studies representing 51 unique patient cohorts from several countries across Europe, North America, Asia, and Australia. One of the clearest findings was that many people struggle with the very things they are often advised to change.

Across the studies, around one-third to one-half of people are overweight, while up to half were living with obesity. Low levels of physical activity were also common, with many studies showing that more than half of participants were not active enough to meet recommended exercise guidelines. Diet was another area many people struggled with, with sometimes only 10% of people following dietary advice aimed at reducing symptoms of reflux. Smoking and alcohol rates also varied quite a lot, with some studies reporting relatively low numbers of smokers and drinkers, while others found much higher numbers.

When people talk about living with Barrett’s oesophagus the focus is on treatment, endoscopies and long-term monitoring. But for many people, the psychological and emotional impact of living with a precancerous condition can be as challenging as the physical symptoms.

A diagnosis often involves feelings of fear, anxiety and uncertainty, especially around cancer risk and ongoing surveillance. These worries, especially when combined with persistent reflux symptoms, can negatively affect health-related quality of life (HRQoL).

Stress, Anxiety and the Gut.

Stress plays a major role in gastrointestinal health, triggering a noticeable symptom increase even when reflux is under control. Acute and prolonged stress can disrupt digestion, increase acid production and heighten oesophageal sensitivity, worsening an underlying gastrointestinal reflux disease (GORD). Over time these symptoms worsen GORD, which may contribute to the development or progression of Barrett’s oesophagus. Patients recognize the cycle too well – stress worsens symptoms and those symptoms in turn increase stress.

Patient Experiences

People living with Barrett’s oesophagus can experience difficult thoughts and feelings in their everyday lives, such as:

• Persistent anxiety about progressing to cancer (cancerphobia)
• Uncertainty about what the future holds
• “Scanxiety”- before surveillance appointments
• Concerns about treatment decisions
• Feeling unable to articulate their fears and feelings to loved ones
• A sense that loved ones and peers don’t understand
• Feelings of isolation, social and emotional withdrawal

Emotional pressures can intensify physical symptoms, triggering a cycle of distress and symptom exacerbations that disrupt household routines, finances and relationships.

What is it like to be diagnosed with Oesophageal Cancer at a Younger Age?

Oesophageal Cancer in Younger Adults

Globally, approximately 9% of oesophageal cancers are diagnosed in individuals under the age of 50 years. Although relatively rare, a study from the United States of America and the Netherlands suggest that oesophageal cancer is becoming more common in younger adults under the age of 50. These studies also suggest that younger adults are  often diagnosed at a more advanced stage of disease compared to older adults.

Oesophageal cancer in younger adults has also become more widely discussed in the news.  In November 2025, Zack Van Aarde shared the story of his stage 4  oesophageal cancer diagnosis at the age of 42 on BBC, sharing that “it came as a massive shock”. In March 2026, Dale Atkinson also shared about his life-changing stage 4 oesophageal cancer diagnosis at the age of 35, as reported on Belfast Live.  

Being diagnosed with oesophageal cancer at any age is a shock, not only for patients but also for their families and friends. An oesophageal cancer diagnosis also presents unique challenges for younger adults. It’s important for us to get a better understanding of these issues so we can help to address them. I hope to investigate some of these gaps through my PhD research.

The Experience of Receiving an Oesophageal Cancer Diagnosis

Early detection is very important when it comes to oesophageal cancer. Symptoms of oesophageal cancer often include difficulty swallowing, acid indigestion or heartburn, and food coming back up. The National Health Service (NHS) website provides helpful information on oesophageal cancer symptoms and seeking medical advice. Organisations including the Oesophageal Cancer Fund and OG Cancer NI provide information resources as well as  support networks for individuals impacted by oesophageal cancer.

Understanding how people notice and respond to symptoms of oesophageal cancer is important. Alongside this, exploring how and when people seek medical attention, and understanding the experience of being referred/having tests for cancer is crucial, in order to raise awareness and improve healthcare systems. A 2020 study by Humphrys and colleagues investigated how people in England understood and experienced symptoms before being diagnosed with oesophageal or stomach cancer. This study found that many people didn’t know much about the warning signs beforehand. They often thought their symptoms were due to things like getting older, work, or their lifestyle.

Common symptoms reported in this study included acid reflux, heartburn, indigestion, trouble swallowing, feeling very tired, and losing weight. Most people only decided to see a doctor when the symptoms got worse or didn’t go away, and they usually went to their GP first. However, this study didn’t focus specifically on individuals with oesophageal cancer, or the specific experiences of younger adults aged under 50 years.

The Experience of Receiving an Oesophageal Cancer Diagnosis at a Young Age

As there are limited studies reporting on the experience of younger adults receiving an oesophageal cancer diagnosis, results from studies investigating bowel cancer provide helpful insight. A report by Bowel Cancer UK in 2020 shared that of the young adults diagnosed with bowel cancer, 50% didn’t know that they could develop bowel cancer until their diagnosis, and 40% visited their GP at least three times before referral for further tests. Therefore, a study aiming to understand the experiences of younger adults receiving an oesophageal cancer diagnosis would provide insight into the service needs and unique challenges of younger adults.

My PhD

As part of my PhD, we plan to interview adults under the age of 50 years to better understand what it was like for a younger adult to receive an oesophageal cancer diagnosis in the UK and Ireland. This study will provide insight into the perception of symptoms among individuals under the age of 50 years, as well as the challenges faced around an oesophageal cancer diagnosis. We hope to open recruitment soon.  Through conducting interviews, alongside other studies through my PhD, I aim to contribute to the growing body of research that aims to influence outcomes for patients with early-onset oesophageal cancer.

A day in the life of a PhD student researching Barrett’s Oesophagus.

Hi, I’m Lorraine, a third-year PhD student researching electroporation as a novel therapy for Barrett’s Oesophagus. In this blog, I thought I would share an insight as to what a typical day looks like for a PhD student.

Mornings

Usually, I begin my day with checking my to-do list which like most jobs grows and shrinks depending on the time of year. Often my tasks include preparing presentations, data analysis and following up with orders/deliveries I need for my experiments. With that, I check my emails to follow up with company reps and answer any queries. Normally, I will plan my week on the preceding Friday using Google calendar to schedule my experiments, meetings and set reminders so that I stay on top of deadlines. As I work with patient samples, I also consult the schedule for those which Cian, our Barrett’s Biobank manager shares every Friday and plan my experiments accordingly. On Tuesday and Wednesday mornings I attend our departmental and institutional lab meetings, respectively. These are a great opportunity to learn more about what my colleagues are researching as well as the techniques they are using which often stimulates ideas for my own research. Afterwards, we usually go for coffee to discuss, and this is a lovely way to network and connect with the other researchers.

If I have experiments to do, I like to do them in the mornings or as early in the day as possible. The techniques I most commonly do are cell culture, ELISA, flow cytometry and immunohistochemistry. We are particularly interested in how electroporation affects the Barrett’s Oesophagus microenvironment and its effect on immune system activation. I use both cell line models and tissue samples to study this with each model serving as validation for the other.

Understanding Acid Reflux and Barrett’s Oesophagus: The Role of Medications

Around 10-20% of adults in Western countries experience symptoms of gastro-oesophageal reflux disease (GORD) on a weekly basis, with heartburn and acid reflux being the most common symptoms. A smaller proportion, approximately 10-15% of people with long-term GORD symptoms, develop Barrett’s oesophagus during their lifetime. In this blog, I will discuss GORD, its effects on the oesophagus, its potential link to Barrett’s oesophagus, and what current evidence suggests about the role of medications

What is GORD?

Gastro-oesophageal reflux disease, commonly shortened to GORD, occurs when stomach acid flows back into the oesophagus (food pipe), the muscular tube that connects the mouth to the stomach. Under normal conditions, a ring of muscle at the bottom of the oesophagus, known as the lower oesophageal sphincter, acts as a barrier that prevents stomach contents from moving upward. In people with GORD, this barrier may not function effectively, allowing acid to repeatedly enter the oesophagus. Common symptoms of GORD include heartburn, acid regurgitation and noncardiac chest pain.

How acid reflux can affect the oesophagus

The oesophagus functions primarily to transport food and liquids to the stomach, but its lining is not well adapted to repeated exposure to stomach acid. When reflux occurs frequently, the acidic environment can irritate the lining of the oesophagus. This irritation may lead to inflammation and damage to the tissue.

Over time, the body may respond to this repeated irritation by altering the type of cells that line the lower part of the oesophagus. These cellular changes provide insight into how chronic reflux may affect the oesophageal lining.

GORD and Barrett’s Oesophagus

One possible outcome of chronic acid reflux is Barrett’s oesophagus. In this condition, the cells lining the lower oesophagus undergo abnormal changes. This change is thought to occur as an adaptive response to repeated exposure to stomach acid.

Barrett’s oesophagus itself does not usually cause noticeable symptoms beyond those associated with reflux. However, it is considered a precursor that carries an increased risk of developing oesophageal adenocarcinoma. It is important to note that most people with Barrett’s oesophagus do not develop cancer, and studying its progression from GORD helps explain how the oesophageal lining changes.

About Me

My name is Abigail, and I am a first-year PhD student at Queen’s University Belfast. I completed my undergraduate degree in Biomedical Science in 2022 at Queen’s University Belfast, and later pursued my Masters of Public Health in Global Health at Queen’s University Belfast as well. During my undergraduate degree, I completed a summer studentship at the Northern Ireland Cancer Registry, where I developed an interest in how cancer occurs in different groups of people (also known as Cancer Epidemiology). I would like to continue in the field of Cancer Epidemiology, and I am therefore very excited to be working on a project investigating oesophageal cancer in younger people in Ireland, based in the Centre for Public Health at Queen’s University Belfast.

How Common is Oesophageal Adenocarcinoma?

Oesophageal adenocarcinoma is one of two common subtypes of oesophageal cancer that commonly occurs in the lower part of the oesophagus. It is the most common subtype in countries such as Australia, Canada, and other countries in Western and Northern Europe and North America. It is also more common in men. Having gastroesophageal reflux and being overweight/obese can increase an individual’s risk of developing oesophageal adenocarcinoma. 

In Northern Ireland, between the years 2018 and 2022, 1,109 individuals were diagnosed with oesophageal cancer, 9.4% of whom were under 54 years of age. In the Republic of Ireland, between 2017 and 2021, there were 2,522 oesophageal cancer diagnoses, 10.5% of whom were under 54 years of age.  

What is Barrett’s Oesophagus?

Barrett’s oesophagus is a condition where the cells that line the oesophagus have changed to resemble cells that line the intestine. While there is a chance that these cells can progress to oesophageal adenocarcinoma, not all individuals with Barrett’s oesophagus will develop oesophageal adenocarcinoma. In Northern Ireland, for example, only 0.3% of people with Barrett’s oesophagus progress to develop oesophageal adenocarcinoma per year.

When you think of a “pathologist,” you might picture a person in a lab coat, looking at slides containing patient tissue under a microscope. In fact, if you search for “pathologist” online, most pictures will show that. But the job has changed a lot recently. Now, instead of just using a microscope, pathologists can take digital pictures of the slides and like photos on your phone, can view them on a computer. This helps them work faster as they are able to get second opinions quicker instead of sending a slide by post.

As the records are all digitised (in Northern Ireland since 2022) this means sample tracking has become much more robust, which makes it easier to figure out what’s wrong. This is important because pathologists help other doctors figure out about 70% of all medical diagnoses, and in Northern Ireland, there are 40 million pathological diagnostic tests every year.

Diagnosis of Barrett’s oesophagus is one of these tests (Figure 1). Barrett’s oesophagus can be found by looking at tiny pieces of tissue under a microscope, taken from your food pipe (or gullet) during a procedure called an endoscopy. Once a pathologist identifies Barrett’s oesophagus, they need to also look for the potential presence of dysplasia. But what does “dysplasia” mean? This is when cells in the body start growing in the wrong way. If enough cells become abnormal, it may lead to cancer. Pathologists sort Barrett’s into four types:

1. Non-Dysplastic (normal cells).
2. Indefinite for Dysplasia (not sure if the cells are abnormal).
3. Low-Grade Dysplasia (cells starting to look different).
4. High-Grade Dysplasia (cells look very different).

All about me

I’m Victoria Child and I’m a Research Fellow at Centre for Public Health Queen’s University, Belfast. I completed my undergraduate and PhD studies in Nutrition at the Coleraine campus of Ulster University on the scenic North Coast of Northern Ireland. Following my studies, my love of research and desire to ultimately improve the care experience for individuals living with chronic disease led me to pursue a career in Public Health research. Alongside my work, I enjoy spending time doing things that balance out the demands of my professional life including sewing, cake decorating, spending time with friends and family and volunteering at a variety of local community-based youth and women’s organisations.

My journey in cancer and premalignant epidemiology and surveillance started in 2014, firstly working in the Northern Ireland Cancer Registry and most recently in my role as project manager for the Northern Ireland Barrett’s oesophagus register. My current role is jointly funded by Breakthrough Cancer Research and Oesophageal Cancer Fund as part of the All-Ireland Oesophageal Cancer (AllCaN oesophageal) network. This network seeks to to bring together two unique large-scale Barrett’s oesophagus registry data across the island of Ireland, for the first time.

The Foundation of the Northern Ireland Barrett’s oesophagus Register

The Northern Ireland Barrett’s oesophagus register was established in the early 1990s by Professor Liam Murray with the help of pump priming funding from the Ulster Cancer Foundation, now known as Cancer Focus NI. Further updates and funding for the registry were supported by the UK Medical Research Council and the HSC R&D Office Northern Ireland.  Its current stewardship lies with Professor Helen Coleman, thanks to funding via a Fellowship from Cancer Research UK, working with a clinical steering group comprising Professor Brian Johnston (Gastroenterology), Dr Damian McManus (Pathology) and Dr Richard Turkington (Oncology). It is one of the largest population-based registers worldwide with data on more than 28,000 individuals diagnosed with Barrett’s oesophagus in Northern Ireland since 1993.

With over £2.6 million invested across three decades, the register is not just a data repository, it’s a key resource for advancing epidemiological, clinical research and forms a sampling frame for groundbreaking biomarker studies all aimed at better understanding and managing Barrett’s oesophagus.

Key Findings from the Northern Ireland Barrett’s oesophagus Register

 Several important discoveries have emerged from the Northern Ireland registry data collected, which have been instrumental in shaping our understanding of Barrett’s oesophagus:

1. Rising Incidence: Between 1993 and 2005, the number of new cases of Barrett’s oesophagus in Northern Ireland increased by 150%, underscoring the need for more effective detection and surveillance strategies.
2. Low Cancer Progression: Despite concerns, the progression to oesophageal adenocarcinoma in patients with Barrett’s oesophagus is surprisingly low, ranging from 0.2% to 0.4%. This offers reassurance but also highlights the need to identify the small group of patients at higher risk.
3. Identifying Risk Factors: The register has highlighted key risk factors for progression to oesophageal adenocarcinoma, including tobacco smoking, ulceration within Barrett’s segments, and certain biomarkers. These insights allow doctors to focus their attention on high-risk patients for more intensive monitoring.
4. Survival Benefits of Surveillance: Perhaps the most encouraging finding is that regular surveillance significantly improved survival rates for those patients with Barrett’s oesophagus who went on to get oesophageal adenocarcinoma. This reinforces the importance of early detection of Barrett’s oesophagus and ongoing check-ups for those diagnosed with Barrett’s oesophagus.

The accompanying biomarker research underway, working in conjunction with Dr Richard Turkington and collaborators, aims to further deepen our understanding by determining how long someone has had Barrett’s and pinpointing biological factors linked to cancer progression—ultimately helping doctors identify those Barrett’s patients in need of closer monitoring.