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Esophageal cancer

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Precancerous conditions of the esophagus

Barrett’s esophagus is the most common precancerous condition of the esophagus. In Barrett’s esophagus, the normal cells that line the esophagus are replaced by cells that are like the lining of the intestine or stomach. The process by which the normal cells change into abnormal cells is called intestinal metaplasiametaplasiaChanges in mature, specialized cells to a form that is abnormal for that tissue. Cells look normal under a microscope, but are not the type of cell usually found in the tissue.. Intestinal metaplasia usually occurs in the lower part of the esophagus near where the esophagus joins the stomach (called the gastroesophageal, or GE, junction).

People with Barrett’s esophagus may develop dysplasia, which means that the cells are different from normal cells in size, shape and organization within tissue. Dysplasia is described by how abnormal the cells look. In mild, or low-grade, dysplasia the abnormal cells look slightly different from normal cells. In severe, or high-grade, dysplasia the cells look very abnormal.

High-grade dysplasia has the greatest chance of becoming cancer. People with high-grade dysplasia have a higher risk of developing adenocarcinoma than those with metaplasia, low-grade dysplasia or normal esophagus. About 0.5% of people with Barrett’s esophagus develop adenocarcinoma of the esophagus.

Risk factors

Gastroesophageal reflux disease (GERD) increases your risk for developing Barrett’s esophagus. GERD is a condition in which stomach acid backs up into the esophagus. When this happens over a long period of time, it is called chronic reflux. Chronic reflux can cause changes, or metaplasia, in the lining of the esophagus. Barrett’s esophagus can also occur in people who don’t have symptoms of GERD. Most people with chronic GERD symptoms don’t develop Barrett’s esophagus.

The following risk factors can also increase your chance of developing Barrett’s esophagus:

  • obesity
  • smoking
  • alcohol

Symptoms

Not all people who have Barrett’s esophagus have symptoms. The symptoms of Barrett’s esophagus include:

  • heartburn
  • acid reflux
  • indigestion
  • nausea and vomiting
  • difficulty swallowing
  • bringing up, or regurgitating, stomach acid

Diagnosis

If you have symptoms of Barrett’s esophagus or your doctor thinks you might have Barrett’s esophagus, you will be sent for tests. Tests used to diagnose Barrett’s esophagus include:

  • upper gastrointestinal (GI) endoscopy
  • biopsy

Endoscopic ultrasound (EUS) may be done if high-grade dysplasia is found with endoscopy and biopsy. Find out more about these tests and procedures.

Treatments

Barrett’s esophagus might not need to be treated right away. Doctors may use endoscopy along with biopsy to watch how Barrett’s esophagus progresses. Treatment would start when doctors see cancerous changes in the esophagus.

Treatments for Barrett’s esophagus include the following.

Drug therapy with proton pump inhibitors and H2 blockers can be used to treat the reflux and control how much acid the stomach makes.

Endoscopic mucosal resection (EMR) may be used to treat high-grade dysplasia in the esophagus. The doctor uses an endoscope to do EMR. It removes the inner layer, or mucosa, of the esophagus that contains the abnormal areas.

Radiofrequency ablation (RFA) may be used alone to treat abnormal areas in the esophagus, or it may be used after EMR to destroy any abnormal cells left behind. RFA uses a high-frequency electrical current to destroy cancer cells. A balloon connected to the end of an endoscope is inflated beside the area of the esophagus that will be treated. A high-frequency electrical current is given through the wall of the balloon. The balloon may be moved to treat other abnormal areas of the esophagus.

Photodynamic therapy (PDT) uses a drug that makes cells sensitive to light (called a photosensitizer). The doctor gives the drug, which is taken up by cancer cells. Then the doctor uses an endoscope to expose the cells to light. PDT may be used after EMR to destroy any abnormal cells left behind.

Electrocoagulation uses an electrical current to destroy abnormal cells. It may be used to destroy areas of metaplasia and dysplasia. It is done through an endoscope.

Argon plasma coagulation uses argon gas and a high-frequency electrical current to destroy abnormal cells. It may be used to destroy areas of metaplasia and dysplasia. It is done through an endoscope.

Fundoplication involves wrapping and stitching the fundus (top of the stomach) around the lower esophagus. This surgery may be used to strengthen the lower esophageal sphincter to prevent heartburn.

Esophagectomy is surgery to remove all or part of the esophagus. It may be used to treat high-grade dysplasia in Barrett’s esophagus. It is done if there are large areas or many areas of dysplasia and you are healthy enough to have surgery.

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