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| Adenocarcinoma of Esophagus |
| Etiology •The great majority of esophageal adenocarcinoma arise in the lower third of the esophagus in the setting of pre-existant Barrett's esophagus •Since Barrett's esophagus represents metaplastic mucosa secondary to reflux esophagitis it is worth reviewing esophageal reflux |
| Pathogenesis •The evolution of esophageal adenocarcinoma follows the following path: reflux esophagitis-metaplastic Barrett's esophageal mucosa-glandular epithelial dysplasia-adenocarcinoma •The incidence of adenocarcinoma in Barrett's esophagus is probably less than 5-10% but is really unknown because the true incidence of Barrett's is not known, |
| Epidemiology •Adenocarcinomas represent 50% of esophageal cancer (NCI CancerNet 7/97) •The incidence of esophageal adenocarcinoma is increasing •The mean age at diagnosis (64yrs) and the marked male predominance is similar to that of squamous carcinoma •In contrast to squamous carcinoma adenocarcinoma is found predominantly in whites reflecting its origin in Barrett's esophagus |
| General Gross Description •Adenocarcinomas occur almost exclusively in the distal esophagus where they represent almost half of the tumors of the distal third •Tumor is first seen as a thickened plaque-like white mucosa •Larger lesions form exophytic polypoid masses which are white, and usually have well demarcated margins •Occasional tumors appear papillary •Tumor spread is through the esophagus into periesophageal tissues •These tumors may be multifocal |
| General Microscopic Description •Esophageal adenocarcinomas are microscopically indistinguishable from gastric adenocarcinomas •The majority are classified as moderate to well differentiated intestinal type and form glands with moderately large columnar to cuboidal epithelium having nuclei with a coarse chromatin pattern, nucleoli, and ample cytoplasm within which mucin can be demonstrated •A minority of tumors will have the diffuse type pattern with signet ring cells present •Occasionally squamous metaplasia or papillary features are noted |
| Clinical Correlation •Dysphagia and weight loss are the two most common symptoms •Symptoms of pre-existing reflux are present in less than 50% of patients •Five year survival is dismal being less than 15% •Primary therapy is surgery or chemothery with radiation therapy, but chemotherapy and radiation therapy are less effective in adenocarcinoma than in sqamous ca. |
| References •Gastrointestinal Pathology, Fenoglio-Preiser CM (ed) New York, Raven Press, 1989, pp. 96-100 |
| Adenocarcinoma of Esophagus |
| Synopsis by: Martin Nadel, M.D. (T62000M81403)[372] |
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