The presence of Barrett's esophagus is associated with increased risk of developing an invasive cancer (adenocarcinoma). Columnar epithelial dysplasia as seen in Barrett's esophagus is a premalignant lesion for adenocarcinoma. Adenocarcinoma does not develop "out of the blue". Instead, adenocarcinoma in Barrett's esophagus develops in a sequence of changes, from nondysplastic (metaplastic) columnar epithelium, through low-grade and then high-grade dysplasia (preancerous change detected under the microscope) and finally invasive cancer. This makes early detection and early treatment a possibility.
Patients with Barrett's esophagus have a 30- to 125-fold increased risk of the development of esophageal cancer in comparison with the general population. The disease is most common in white males.
At Johns Hopkins, patients with esophageal cancer are evaluated and treated by members of the Esophageal Multidisciplinary Group. This group consists of cancer specialists from the Departments of Medicine, Oncology, Radiology, Surgery, and Pathology. This group meets weekly to discuss treatment strategies for each patient.
Approximately 30% of the esophageal cancers treated with pre-operative chemoradiation have no residual cancer cells in the excised specimen. These patients have prolonged survival over those treated by surgery alone. There are also several clinical trials currently available for patients with esophageal cancer. Each patient can be offered a trial best tailored to to provide benefits.
The treatment of choice for a biopsy-proven early esophageal cancer is surgical resection where the intrathoracic esophagus (the part in the chest) must be removed. Esophageal adenocarcinomas can spread (metastasize) to any of several lymph nodes (lymph "glands") in the chest. As such, diagnosis of metastatic disease in these lymph nodes is best confirmed prior to surgical resection.
A surgeon is best qualified to assess whether surgery is a possible option. When adenocarcinoma is detected at an early, usually presymptomatic stage in patients with Barrett's esophagus, the chance of surgical cure is high - 50 to 80%.
The current treatment at Johns Hopkins for patients with invasive esophageal cancer is pre-operative chemoradiation followed by surgery. Each patient is staged (evaluated to assess the extent of disease) using various diagnostic tools, including CT scan, MRI, endoscopic ultrasound, and laparascopic examination prior to chemoradiation.
What Does Esophageal Cancer Look Like?
This specimen is a segment of an esophagus and a portion of the stomach from a patient with high-grade dysplasia in Barrett's esophagus. The esophagus and stomach have been opened and the esophagus is the narrower area on the right of the frame. The inside lining is whitish on the right but appears reddish and velvety closer to the stomach. The reddish area is Barrett's esophagus. There is no tumor (mass) in this specimen, which showed high-grade dysplasia (severe pre-cancerous change) on microscopic examination.
This specimen depicts a cancer at the area of the junction between the esophagus and stomach. It is a large irregular mass. The objective of endoscopic surveillance in Barrett's esophagus is to detect these processes early on when there is a high probability for cure.