Current Oncology Reports

, Volume 5, Issue 3, pp 203–209 | Cite as

Barrett’s esophagus and Barrett’s carcinoma

  • Burkhard H. A. von Rahden
  • Hubert J. Stein
  • Jörg R. Siewert

Abstract

The alarming rise in the incidence of esophageal adenocarcinomas in the Western world has focused interest on so-called Barrett’s esophagus. Barrett’s esophagus is characterized by specialized intestinal epithelium replacing the normal squamous epithelium in the distal esophagus and is considered a consequence of long-lasting and severe gastroesophageal reflux disease. A metaplasia-dysplasia-carcinoma sequence links Barrett’s esophagus with adenocarcinoma of the distal esophagus (Barrett’s cancer). Despite intensive research, many questions concerning the pathogenesis, diagnosis, and treatment of Barrett’s esophagus and associated adenocarcinoma are still unanswered. Based on current data, the malignant progression of Barrett’s esophagus cannot be substantially prevented by medical or surgical therapy for reflux. Although no firm data are available to show that surveillance strategies can reduce overall mortality from Barrett’s cancer, early detection and cure are possible. Management of Barrett’s esophagus and carcinoma is reviewed with reference to the sequence of disease from metaplasia to carcinoma.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Shaheen N, Ransohoff DF: Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: scientific review. JAMA 2002, 287:1972–1981.PubMedCrossRefGoogle Scholar
  2. 2.
    SpechlerSJ: Clinical practice: Barrett’s esophagus. N Engl J Med 2002, 346:836–842.PubMedCrossRefGoogle Scholar
  3. 3.
    Wijnhoven BP, Louwman MW, Tilanus HW, Coebergh JW: Increased incidence of adenocarcinomas at the gastrooesophageal junction in Dutch males since the 1990s. Eur J Gastroenterol Hepatol 2002, 14:115–122.PubMedCrossRefGoogle Scholar
  4. 4.
    Bareiss D, Stabenow R, Muller R, et al.: Current epidemiology of carcinoma of the esophagus and cardia in Germany [in German]. Dtsch Med Wochenschr 2002, 127:1367–1374.PubMedCrossRefGoogle Scholar
  5. 5.
    Kubo A, Corley DA. Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States. Cancer 2002, 95:2096–2102.PubMedCrossRefGoogle Scholar
  6. 6.
    Vaughan TL, Kristal AR, Blount PL, et al.: Nonsteroidal antiinflammatory drug use, body mass index, and anthropometry in relation to genetic and flow cytometric abnormalities in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev 2002, 11:745–752.PubMedGoogle Scholar
  7. 7.
    CameronAJ: Epidemiology of Barrett’s esophagus and adenocarcinoma. Dis Esophagus 2002, 15:106–108.PubMedCrossRefGoogle Scholar
  8. 8.
    Gerson LB, Shetler K, Triadafilopoulos G: Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology 2002, 123:461–467.PubMedCrossRefGoogle Scholar
  9. 9.
    Avidan B, Sonnenberg A, Schnell TG, et al.: Hiatal hernia size, Barrett’s length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol 2002, 97:1930–1936.PubMedCrossRefGoogle Scholar
  10. 10.
    Romero Y, Cameron AJ, Schaid DJ, et al.: Barrett’s esophagus: prevalence in symptomatic relatives. Am J Gastroenterol 2002, 97:1127–1132.PubMedCrossRefGoogle Scholar
  11. 11.
    Chak A, Lee T, Kinnard MF, et al.: Familial aggregation of Barrett’s oesophagus, oesophageal adenocarcinoma, and oesophagogastric junctional adenocarcinoma in Caucasian adults. Gut 2002, 51:323–328.PubMedCrossRefGoogle Scholar
  12. 12.
    FalkGW: Barrett’s esophagus. Gastroenterology 2002, 122:1569–1591.PubMedCrossRefGoogle Scholar
  13. 13.
    van SandickJW, van LanschotJB, van FeliusL, et al.: Intestinal metaplasia of the esophagus or esophagogastric junction: evidence of distinct clinical, pathologic, and histochemical staining features. Am J Clin Pathol 2002, 117:117–125.PubMedCrossRefGoogle Scholar
  14. 14.
    Cameron AJ, Souto EO, Smyrk TC: Small adenocarcinomas of the esophagogastric junction: association with intestinal metaplasia and dysplasia. Am J Gastroenterol 2002, 97:1375–1380.PubMedCrossRefGoogle Scholar
  15. 15.
    GoldblumJR: The significance and etiology of intestinal metaplasia of the esophagogastric junction. Ann Diagn Pathol 2002, 6:67–73.PubMedCrossRefGoogle Scholar
  16. 16.
    OdzeR. Cytokeratin 7/20 immunostaining: Barrett’s oesophagus or gastric intestinal metaplasia? Lancet 2002, 359:1711–1713.PubMedCrossRefGoogle Scholar
  17. 17.
    Shen B, Ormsby AH, Shen C, et al.: Cytokeratin expression patterns in noncardia, intestinal metaplasia-associated gastric adenocarcinoma: implication for the evaluation of intestinal metaplasia and tumors at the esophagogastric junction. Cancer 2002, 94:820–831.PubMedCrossRefGoogle Scholar
  18. 18.
    Taniere P, Borghi-Scoazec G, Saurin JC, et al.: Cytokeratin expression in adenocarcinomas of the esophagogastric junction: a comparative study of adenocarcinomas of the distal esophagus and of the proximal stomach. Am J Surg Pathol 2002, 26:1213–1221.PubMedCrossRefGoogle Scholar
  19. 19.
    Siewert JR, Stein HJ: Classification of carcinoma of the oesophagogastric junction. Br J Surg 1998, 85:1457–1459.PubMedCrossRefGoogle Scholar
  20. 20.
    Siewert JR, Feith M, Werner M, Stein HJ: Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000, 232:353–361.CrossRefGoogle Scholar
  21. 21.
    Theisen J, Stein HJ, Dittler HJ, et al.: Preoperative chemotherapy unmasks underlying Barrett’s mucosa in patients with adenocarcinoma of the distal esophagus. Surg Endosc 2002, 16:671–673.PubMedCrossRefGoogle Scholar
  22. 22.
    Kauer WK, Stein HJ: Role of acid and bile in the genesis of Barrett’s esophagus. Chest Surg Clin N Am 2002, 12:39–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Souza RF, Shewmake K, Terada LS, Spechler SJ: Acid exposure activates the mitogen-activated protein kinase pathways in Barrett’s esophagus. Gastroenterology 2002, 122:299–307.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaur BS, Triadafilopoulos G: Acid- and bile-induced PGE(2) release and hyperproliferation in Barrett’s esophagus are COX-2 and PKC-epsilon dependent. Am J Physiol Gastrointest Liver Physiol 2002, 283:G327-G334.PubMedGoogle Scholar
  25. 25.
    Krishnan K, Brenner DE: Prostaglandin inhibitors and the chemoprevention of noncolonic malignancy. Gastroenterol Clin North Am 2001, 30:981–1000.PubMedCrossRefGoogle Scholar
  26. 26.
    Zhang F, Altorki NK, Wu YC, et al.: Duodenal reflux induces cyclooxygenase-2 in the esophageal mucosa of rats: evidence for involvement of bile acids. Gastroenterology 2001 121:1391–1399.PubMedCrossRefGoogle Scholar
  27. 27.
    Buskens CJ, Van Rees BP, Sivula A, et al.: Prognostic significance of elevated cyclooxygenase 2 expression in patients with adenocarcinoma of the esophagus. Gastroenterology 2002, 122:1800–1807.PubMedCrossRefGoogle Scholar
  28. 28.
    Jenkins GJ, Doak SH, Parry JM, et al.: Genetic pathways involved in the progression of Barrett’s metaplasia to adenocarcinoma. Br J Surg 2002, 89:824–837.PubMedCrossRefGoogle Scholar
  29. 29.
    Bian YS, Osterheld MC, Fontolliet C, et al.: p16 inactivation by methylation of the CDKN2A promoter occurs early during neoplastic progression in Barrett’s esophagus. Gastroenterology 2002, 122:1113–1121.PubMedCrossRefGoogle Scholar
  30. 30.
    Geddert H, Heep HJ, Gabbert HE, Sarbia M: Expression of cyclin B1 in the metaplasia-dysplasia-carcinoma sequence of Barrett esophagus. Cancer 2002, 94:212–218.PubMedCrossRefGoogle Scholar
  31. 31.
    Geddert H, Zeriouh M, Wolter M, et al.: Gene amplification and protein overexpression of c-erb-b2 in Barrett carcinoma and its precursor lesions. Am J Clin Pathol 2002, 118:60–66.PubMedCrossRefGoogle Scholar
  32. 32.
    Brabender J, Lord RV, Wickramasinghe K, et al.: Glutathione Stransferase-pi expression is downregulated in patients with Barrett’s esophagus and esophageal adenocarcinoma. J Gastrointest Surg 2002, 6:359–367.PubMedCrossRefGoogle Scholar
  33. 33.
    van der Woude CJ, Jansen PL, Tiebosch AT, et al.: Expression of apoptosis-related proteins in Barrett’s metaplasia-dysplasiacarcinoma sequence: a switch to a more resistant phenotype. Hum Pathol 2002, 33:686–692.PubMedCrossRefGoogle Scholar
  34. 34.
    Tselepis C, Perry I, Dawson C, et al.: Tumour necrosis factoralpha in Barrett’s oesophagus: a potential novel mechanism of action. Oncogene 2002, 21:6071–6081.PubMedCrossRefGoogle Scholar
  35. 35.
    SamplinerRE: The Practice Parameters Committee of the American College of Gastroenterology: updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 2002, 97:1888–1895.PubMedCrossRefGoogle Scholar
  36. 36.
    SpechlerSJ: Screening and surveillance for complications related to gastroesophageal reflux disease. Am J Med 2001, 111(Suppl 8A):130S-136S.PubMedCrossRefGoogle Scholar
  37. 37.
    van Blankenstein M: Barrett’s esophagus: so what! Dis Esoph 2002, 15:1–4.CrossRefGoogle Scholar
  38. 38.
    Gerson LB, Triadafilopoulos G: Screening for esophageal adenocarcinoma: an evidence-based approach. Am J Med 2002, 113:499–505.PubMedCrossRefGoogle Scholar
  39. 39.
    Cooper GS, Yuan Z, Chak A, Rimm AA: Association of prediagnosis endoscopy with stage and survival in adenocarcinoma of the esophagus and gastric cardia. Cancer 2002, 95:32–38.PubMedCrossRefGoogle Scholar
  40. 40.
    Incarbone R, Bonavina L, Saino G, et al.: Outcome of esophageal adenocarcinoma detected during endoscopic biopsy surveillance for Barrett’s esophagus. Surg Endosc 2002, 16:263–266.PubMedCrossRefGoogle Scholar
  41. 41.
    Kaur BS, Khamnehei N, Iravani M, et al.: Rofecoxib inhibits cyclooxygenase 2 expression and activity and reduces cell proliferation in Barrett’s esophagus. Gastroenterology 2002, 123:60–67. An important observation that may result in strategies for chemoprevention.PubMedCrossRefGoogle Scholar
  42. 42.
    Buttar NS, Wang KK, Leontovich O, et al.: Chemoprevention of esophageal adenocarcinoma by COX-2 inhibitors in an animal model of Barrett’s esophagus. Gastroenterology 2002, 122:1101–1112.PubMedCrossRefGoogle Scholar
  43. 43.
    Schlemper RJ, Riddell RH, Kato Y, et al.: The Vienna classification of gastrointestinal epithelial neoplasia.Gut2000,47, 251–255.PubMedCrossRefGoogle Scholar
  44. 44.
    Werner, M, Flejou, JF, Hainaut, P, et al.: Adenocarcinoma of the oesophagus. In World Health Organization Classification of Tumours: Patholgy and Genetics—Tumours of the Digestive System. Edited by Hamilton SR, Aaltonen, L. Lyon, France: IARC Press; 2000:20–25.Google Scholar
  45. 45.
    Ormsby AH, Petras RE, Henricks WH, et al.: Observer variation in the diagnosis of superficial oesophageal adenocarcinoma. Gut 2002, 51:671–676. You cannot always rely on your pathologist!PubMedCrossRefGoogle Scholar
  46. 46.
    Walker SJ, Selvasekar CR, Birbeck N: Mucosal ablation in Barrett’s esophagus. Dis Esophagus 2002, 15:22–29.PubMedCrossRefGoogle Scholar
  47. 47.
    Ortner MA, Zumbusch K, Liebetruth J, et al.: Is topical delta-aminolevulinic acid adequate for photodynamic therapy in Barrett’s esophagus? A pilot study. Endoscopy 2002, 34:611–616.PubMedCrossRefGoogle Scholar
  48. 48.
    Ahmad NA, Kochman ML, Long WB, et al.: Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 2002, 55:390–396.PubMedCrossRefGoogle Scholar
  49. 49.
    Schnell, TG, Sontag, SJ, Chejfec, G, et al.: Long-term nonsurgical management of Barrett’s esophagus with high grade dysplasia. Gastroenterology 2001, 120:1607–1619.PubMedCrossRefGoogle Scholar
  50. 50.
    Pacifico RJ, Wang KK: Nonsurgical management of Barrett’s esophagus with high-grade dysplasia. Surg Oncol Clin N Am 2002, 11:321–336.PubMedCrossRefGoogle Scholar
  51. 51.
    DeMeesterTR. Surgical therapy for Barrett’s esophagus: prevention, protection and excision. Dis Esophagus 2002, 15:109–116.PubMedCrossRefGoogle Scholar
  52. 52.
    Headrick JR, Nichols FC, Miller DL, et al.: High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thor Surg 2002, 73:1697–1703.CrossRefGoogle Scholar
  53. 53.
    Reid BJ, Levine DS, Longton G, et al.: Predictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol 2000, 95:1669–1676.PubMedGoogle Scholar
  54. 54.
    Stein HJ, Feith M, Müller J, et al.: Limited resection for early Barrett’s cancer. Ann Surg 2000, 232:733–742.PubMedCrossRefGoogle Scholar
  55. 55.
    Banki F, Mason RJ, DeMeester SR, et al.: Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg 2002, 236:324–335.PubMedCrossRefGoogle Scholar
  56. 56.
    Buttar NS, Wang KK, Lutzke LS, et al.: Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus. Gastrointest Endosc 2001, 54:682–688PubMedGoogle Scholar
  57. 57.
    May A, Gossner L, Pech O, et al.: Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett’s esophagus (SSBE): curative treatment using local endoscopic treatment techniques. Endoscopy 2002, 34:604–610.PubMedCrossRefGoogle Scholar
  58. 58.
    Siewert JR, Stein HJ, Sendler A, et al.: Esophageal cancer: clinical management. In Gastrointestinal Oncology: Principles and Practice. Edited by Kelsen DA, et al. Philadelphia: Lippincott Williams & Wilkins; 2002:261–288.Google Scholar
  59. 59.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al.: Hospital volume and surgical mortality in the United States. N Engl J Med 2002, 346:1128–1137. An important message: Esophagectomy should be performed in highvolume centers only.PubMedCrossRefGoogle Scholar
  60. 60.
    Stein HJ, Brücher BLDM, Sendler A, Siewert JR: Esophageal cancer: patient evaluation and pretreatment staging. Surg Oncol 2001, 10:103–111.PubMedCrossRefGoogle Scholar
  61. 61.
    Altorki N, Kent M, Ferrara C, Port J: Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 2002, 236:177–183.PubMedCrossRefGoogle Scholar
  62. 62.
    Hulscher JB, van SandickJW, de BoerAG, et al.: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002, 347:1662–1669. A well-performed trial, but no conclusive answers: Compared with a transhiatal approach, transthoracic esophagectomy is associated with higher morbidity but may prolong survival.PubMedCrossRefGoogle Scholar
  63. 63.
    Stein, HJ, Sendler A, Fink U, Siewert JR: Multidisciplinary approach to esophageal and gastric cancer. Surg Clin N Am 2000, 80:659–682.PubMedCrossRefGoogle Scholar
  64. 64.
    Medical Research Council Oesophageal Cancer Working Group: Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 2002, 359:1727–1733. The first large-scale randomized trial to show that preoperative chemotherapy prolongs survival in patients with esophageal cancer. This effect was more pronounced in adenocarcinoma than in squamous cell cancer.CrossRefGoogle Scholar
  65. 65.
    Weber WA, Ott K, Becker K, et al.: Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001, 19:3058–3065.PubMedGoogle Scholar
  66. 66.
    Flamen P, Van Cutsem E, Lerut A, et al.: Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol 2002, 13:361–368.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Burkhard H. A. von Rahden
  • Hubert J. Stein
    • 1
  • Jörg R. Siewert
  1. 1.Chirurgische Klinik und PoliklinikKlinikum rechts der Isar der TU MünchenGermany

Personalised recommendations