In the United Kingdom, upper gastrointestinal symptoms account for at least 3% of consultations in primary care.¹ The national esophagogastric cancer (OGC) audit reported 7044 cases of OGC diagnosed in 2016. Many patients present with advanced-stage disease and only 38% of cases can be treated with a curative intent.² Current UK referral guidelines for suspected OGC focus on alarm symptoms such as dysphagia and odynophagia, despite these symptoms having poor sensitivity and specificity for OGC and often only occur in advanced disease translating into a poor outcome and overall survival.³ There is a wide range in the rate of oesophagogastro duodenoscopy (OGD) among general practice populations in England and OGC patients belonging to practices with the lowest rates of OGD referral are at greatest risk of poor overall survival owing to advanced tumor stage at diagnosis.⁴ Furthermore, OGD is an expensive invasive investigation, with poor uptake in specific ethic minority populations consequently affecting survival.⁵ This high prevalence of upper gastrointestinal symptoms coupled with the low incidence of OGC and the nonspecific nature of symptoms in early disease highlight the need for a triage test to direct patients to have OGD.

Objective: Background: Breath VOCs have the potential to noninvasively diagnose cancer. Methods: Exhaled breath samples were collected using 2-L double-layered Nalophan bags, and were analyzed using selected-ion-flow-tube mass-spectrometry. Gold-standard test for comparison was endoscopy for luminal inspection and computed tomography (CT) to confirm cancer recurrence. Three studies were conducted: Results: Conclusion: This study suggests the association of a single breath biomarker with the primary presence and recurrence of CRCa. Further multicenter validation studies are required to validate these findings.

Background: Pancreatic cancer has a very poor prognosis as most patients are diagnosed at an advanced stage when curative treatments are not possible. Breath volatile organic compounds (VOCs) have shown potential as novel biomarkers to detect cancer. The aim of the study was to quantify differences in exhaled breath VOCs of patients with pancreatic cancers compared with cohorts without cancer. Methods: Patients were recruited to an initial development cohort and a second validation cohort. The cancer group included patients with localized and metastatic cancers, whereas the control group included patients with benign pancreatic disease or normal pancreas. The reference test for comparison was radiological imaging using abdominal CT, ultrasound imaging or endoscopic ultrasonography, confirmed by histopathological examination as appropriate. Breath was collected from the development cohort with steel bags, and from the validation cohort using the ReCIVA™ system. Analysis was performed using gas chromatography–mass spectrometry. Results: A total of 68 patients were recruited to the development cohort (25 with cancer, 43 no cancer) and 64 to the validation cohort (32 with cancer, 32 no cancer). Of 66 VOCs identified, 12 were significantly different between groups in the development cohort on univariable analysis. Receiver operating characteristic (ROC) curve analysis using significant volatile compounds and the validation cohort produced an area under the curve of 0·736 (sensitivity 81 per cent, specificity 58 per cent) for differentiating cancer from no cancer, and 0·744 (sensitivity 70 per cent, specificity 74 per cent) for differentiating adenocarcinoma from no cancer. Conclusion: Breath VOCs may distinguish patients with pancreatic cancer from those without cancer.