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2017 ; 6
(2
): 99-109
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Pathology of esophageal cancer and Barrett s esophagus
#MMPMID28446998
Jain S
; Dhingra S
Ann Cardiothorac Surg
2017[Mar]; 6
(2
): 99-109
PMID28446998
show ga
Esophageal cancer is a serious malignancy with high mortality. The two common
distinctive pathologic subtypes of esophageal cancer are squamous cell carcinoma
and adenocarcinoma. These differ with regards to etiology, ethnic distribution,
pathogenesis, and location in the esophagus. The precursor lesions are also
unique to each subtype. Squamous cell carcinoma is more common in East Asia, is
linked to smoking and tobacco use, more commonly involves the middle esophagus,
and the precursor lesion is squamous dysplasia. Adenocarcinoma is more common in
the United States and certain European countries, associated with obesity and
gastroesophageal reflux disease (GERD), more commonly involves the distal
esophagus, and the precursor lesion is Barrett's esophagus. Endoscopic
surveillance with biopsy evaluation is the standard of care in high-risk groups.
Endoscopic ablative therapies for early cancers have lower morbidity than
surgery. Despite increased awareness, identification of high-risk groups and
endoscopic surveillance, a large proportion of patients present with advanced
cancers. Surgery and chemoradiation, either in neo-adjuvant or adjuvant setting,
is the usual treatment for patients with advanced but resectable esophageal
cancers. The prognosis and further management largely depends upon the pathologic
tumor-node-metastasis (TNM) staging provided by the American Joint Committee on
Cancer (AJCC) and the International Union against Cancer. Currently, the 7th
edition of TNM staging system is being applied for prognostication and this is
more focused on pathologic evaluation. Eighth edition of AJCC/UICC TNM staging
has been introduced and will be implemented for clinical use in 2018.