Adenocarcinoma of the esophagus is a malignant tumor in which cancer cells form in the
glandular lining of the lower esophagus.
Adenocarcinoma of the esophagus is one of the most lethal of all malignancies due to
advanced stage at diagnosis, for several reasons: 1) it is commonly asymptomatic in early
phases; 2) spreads quickly to the outer layer of the esophagus and from there to multiple
lymph node chains in the neck, chest and abdomen, and 3) due to proximity of the esophagus
to vital organs in the chest.
Adenocarcinoma of the esophagus is the most common malignant tumor of the esophagus
(approximately 60%) and its incidence increased 10 times over the last 30 years.
People with Barrett's esophagus carry the highest risk for developing adenocarcinoma that
is 30-150 times that of age-matched population.
Although the patients with Barrett's esophagus are at increased risk for adenocarcinoma,
only a small fraction (0.5-1%) actually develop the cancer during the course of their
disease.
The risk factors for adenocarcinoma include:
- longstanding history of reflux especially at night or in association with regurgitation
is associated with a higher risk for developing adenocarcinoma
- men are affected 3 to 7 times more frequently than women
- adenocarcinoma is 14 times more common in whites when compared with African-Americans
- extensive Barrett's esophagus, involving more than 3 cm (1.3 inches) of the esophageal
lining (long-segment Barrett's esophagus) is associated with a higher risk for developing
adenocarcinoma when compared with short segment Barrett's esophagus.
It is uncommon to have any symptoms when the cancer is in its earliest stage (involving
only the inner layer of the esophageal wall). Once the cancer spreads deeper into the
wall, it forms a constricting mass that hinders the passage of food through the esophagus.
Therefore, the most common symptom of esophageal cancer is difficult and painful
swallowing (dysphagia).
Marked, unintentional weight loss is another sign associated with cancer, including
esophageal adenocarcinoma.
Hoarseness and chronic cough, sometimes bringing up blood or bloody tissue fragments may
occur in the advanced stages of esophageal adenocarcinoma.
- Barium X-ray (esophagram) is the initial test performed to diagnose adenocarcinoma of
the esophagus. During this procedure, the patient drinks a thick white fluid (barium)
which makes the esophagus easier to see on X-ray film.
- The next recommended procedure is upper endoscopy, during which a thin tube (endoscope)
equipped with a video camera is pushed down the esophagus. The images of the esophageal
lining are captured by the camera, projected on a monitor and interpreted by the
gastroenterologist. At the same time, small tissue fragments (biopsies) can be removed
with forceps attached to the endoscope, and sent to the pathology laboratory for
microscopic examination by specialized pathologists.
- After confirmation by pathologist, additional studies are needed to evaluate the extent
of the cancer (staging). Staging is necessary to establish the prognosis of the cancer and
the most adequate treatment. Endoscopic ultrasound is a procedure used to evaluate the
spread of esophageal adenocarcinoma into the nearby tissues. During this test an endoscope
equipped with a small ultrasound probe is placed in the esophagus. The probe produces
sensitive sound waves that bounce off the esophageal layers, enabling doctors to assess
how locally advanced is the cancer.
- Another study that is routinely recommended for staging is computerized tomography scan
(CT scan). This X-ray test involves detailed image taking of the internal organs to assess
for the presence of distant spread (metastasis) of the cancer to thoracic or abdominal
organs.
Due to the advanced stage of diagnosis, the survival of the patients with
adenocarcinoma after 5 years is low. However, the patients with Barrett's esophagus in
which adenocarcinoma was detected during the surveillance program enjoy better survival rates due to the lower
stage of the cancer at diagnosis.
Surgery is the most common form of therapy offered to the patients with esophageal
adenocarcinoma and consists of removal of lower part of the esophagus and upper part of
the stomach (esophagogastrectomy). This type of surgery is offered alone or in combination
with chemotherapy to patients that are healthy enough to withstand major surgical stress.
Chemotherapy with radiation is routinely offered before surgery to the patients with
locally advanced cancer in order to lower the stage of the cancer and make it more
resectable. Chemoradiation is also used to relieve the symptoms of inoperable advanced
cancer and to lower the tumor burden in the patients with metastatic disease.
Additional information about esophageal disorders:
MD Anderson Cancer Center
Memorial Sloan-Kettering Cancer
Center
Mayo Clinic
Cleveland Clinic Foundation
