Review

Esophageal adenocarcinoma: A dire need for early detection and treatment

Abel Joseph, MD, Siva Raja, MD, PhD, Suneel Kamath, MD, Sunguk Jang, MD, Daniela Allende, MD, Mike McNamara, MD, Gregory Videtic, MD, Sudish Murthy, MD and Amit Bhatt, MD
Cleveland Clinic Journal of Medicine May 2022, 89 (5) 269-279; DOI: https://doi.org/10.3949/ccjm.89a.21053

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Endoscopic views of the esophagus. (A) Normal esophagus. (B) Barrett esophagus with islands of normal squamous mucosa (arrow). (C) Barrett esophagus with a discrete erythematous mass 4 × 2 cm (arrow) in the involved segment. (D) Barrett esophagus, endoscopic ultrasonographic view. (E) Esophageal adenocarcinoma (arrow).

  • Figure 2
    Figure 2

    (A) High-grade dysplasia (arrow) from the periphery of a Barrett esophagus lesion (hematoxylin and eosin, magnification × 4). (B) Complex atypical glandular proliferation diagnostic of adenocarcinoma and involving the submucosa (arrow highlights submucosa) (hematoxylin and eosin, magnification × 20).

  • Figure 3
    Figure 3

    The tumor, node, metastasis (TNM) staging system for esophageal cancer helps determine prognosis and treatment based on tumor depth, number of affected lymph nodes, and metastasis to distant organs.

    HGD = high-grade dysplasia

  • Figure 4
    Figure 4

    Our care path for early esophageal adenocarcinoma.

    FDG-PET CT = 18-fluorodeoxyglucose positron-emission tomography with computed tomography

  • Figure 5
    Figure 5

    Band endoscopic mucosal resection of Barrett esophagus nodule. (A) Barrett esophagus nodule (arrow). (B) Resection bed after successful band endoscopic mucosal resection.

Tables

  • TABLE 1

    Esophageal adenocarcinoma vs squamous cell carcinoma

    AdenocarcinomaSquamous cell carcinoma
    Proportion of esophageal cancersa64%29%
    Risk factorsBarrett esophagus
    Gastroesophageal reflux disease
    Central obesity
    Age > 50
    Male sex    		Heavy alcohol consumption
    Smoking
    Hot tea consumption
    Nitrite consumption
    Head and neck cancer
    Tylosis (autosomal dominant syndrome, mutation in RHBDF2 gene)

    • ↵a Based on 2018 data from National Cancer Institute Surveillance, Epidemiology, and End Results Program, reference 2.

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