esophagus adenocarcinoma

Esophageal Adenocarcinoma: A Malignant Tumor Proliferation

Esophageal adenocarcinoma is a type of cancer that affects the glandular cells of the lower esophagus, specifically at the junction with the stomach. It is characterized by malignant differentiated glandular tumor proliferation in this region.

Definition and Incidence

Adenocarcinoma of the esophagus is defined as a malignant tumor that originates from the gland cells (cells that make mucus) in the lower part of the esophagus. This type of cancer has been increasing in incidence in the United States, particularly among white men.

Types and Characteristics

There are two main types of esophageal adenocarcinoma:

• Well-differentiated adenocarcinoma: More than 95% of the tumor comprises glands, with pathologists describing these tumors as grade 1.
• Moderately differentiated adenocarcinoma: 50 to 95% of the tumor comprises glands, with pathologists describing these tumors as grade 2.

Symptoms and Diagnosis

Adenocarcinoma of the esophagus can start from the goblet cells of Barrett’s esophagus (see above). This is the most common type of esophageal cancer. Symptoms may include trouble swallowing, chest pain, or weight loss. Diagnosis is typically made through endoscopy, biopsy, and imaging studies.

References

• [3] Esophageal adenocarcinoma is the most common subtype of esophageal cancer in the United States.
• [10] Adenocarcinoma begins in the cells of the glands in the esophagus. These glands produce mucus.
• [11] Adenocarcinoma of the esophagus and esophagogastric junction is a malignant epithelial neoplasm of the esophagus with glandular or mucinous differentiation.
• [15] Adenocarcinoma of the esophagus is graded as follows: Well differentiated adenocarcinoma, Moderately differentiated adenocarcinoma.

Common Signs and Symptoms of Esophageal Adenocarcinoma

Esophageal adenocarcinoma, a type of cancer that affects the esophagus, can exhibit several signs and symptoms. These may include:

• Difficulty swallowing (dysphagia): This is often the first symptom to appear, as the tumor grows and blocks the passage of food [1].
• Chest pain: Pain or pressure in the chest area can be a symptom of esophageal adenocarcinoma [2].
• Weight loss: Unintentional weight loss can occur due to difficulty swallowing and eating [3].
• Hoarseness: Changes in voice tone or pitch can be a sign of esophageal cancer [4].
• Chronic coughing or hoarseness: These symptoms can occur as the tumor grows and affects the surrounding tissues [5].

Early Detection is Key

It's essential to note that most esophageal cancers do not cause symptoms until they have reached an advanced stage, making early detection crucial for effective treatment. If you experience any of these symptoms, it's vital to consult a healthcare professional for proper evaluation and diagnosis.

References:

[1] Difficulty swallowing is the most common symptom of esophageal cancer (Source: [2]) [2] Chest pain can be a symptom of esophageal adenocarcinoma (Source: [3]) [3] Weight loss can occur due to difficulty swallowing and eating (Source: [4]) [4] Hoarseness can be a sign of esophageal cancer (Source: [5]) [5] Chronic coughing or hoarseness can occur as the tumor grows (Source: [6])

Diagnostic Tests for Esophageal Adenocarcinoma

Esophageal adenocarcinoma, a type of cancer that affects the esophagus, can be diagnosed using various tests and procedures. Here are some of the diagnostic tests used to detect this condition:

• Endoscopy with Biopsy: This is a procedure where a thin, flexible tube with a camera (endoscope) is inserted through the mouth or nose and down the throat to visualize the esophagus. A biopsy sample may be taken from the affected area for lab testing.
• Barium Swallow Study: This test uses X-rays to look at the digestive system, including the esophagus. A liquid containing barium is swallowed, and then a series of X-rays are taken to visualize the esophagus.
• Endoscopic Ultrasound (EUS): This procedure uses an endoscope with a built-in ultrasound device to take images of the esophagus and surrounding tissues. It can help identify the extent of cancer spread.
• Fine Needle Aspiration (FNA): During EUS, a small needle may be used to collect cell samples from the affected area for lab testing.

Other Diagnostic Tests

In addition to these procedures, other tests may be ordered to confirm the diagnosis and determine the stage of esophageal adenocarcinoma. These include:

• Blood Chemistry Studies: To evaluate liver function and detect any abnormalities.
• Complete Blood Count (CBC): To check for anemia or infection.
• Imaging Tests: Such as CT scans, PET scans, or MRI to visualize the cancer spread.

Early Detection

Early detection of esophageal adenocarcinoma is crucial for effective treatment. If you experience symptoms such as difficulty swallowing, weight loss, or chest pain, consult a doctor promptly.

References:

• [1] (4) - Biopsy and lab tests for cancer of the esophagus
• [5] (5) - A procedure to look inside the esophagus to check for abnormal areas.
• [7] (7) - Upper Endoscopy with Biopsy​​ To diagnose esophageal cancer, doctors insert an endoscope, a thin flexible tube with a camera and light on the end, through the mouth or nose and down the throat to visualize the esophagus. A biopsy sample may be taken from the affected area for lab testing.
• [9] (10) - Laboratory tests play a crucial role in the diagnosis of esophageal cancer.
• [11] (11) - Learn about finding esophageal cancer early, tests to diagnose it, & how the process of staging is important for treatment options and outlook.

Treatment Options for Esophageal Adenocarcinoma

Esophageal adenocarcinoma, a type of cancer that affects the esophagus, can be treated with various drug therapies. Here are some common treatment options:

• Ramucirumab: This medication is used to treat advanced esophageal cancers that start at the gastroesophageal (GE) junction [2]. It works by blocking a protein that helps cancer cells grow.
• Lonsurf (trifluridine/tipiracil): This drug may be used to treat recurrent or metastatic adenocarcinoma tumors at the GE junction. It is typically used after other treatments have failed [5].
• Chemotherapy: Chemotherapy involves using strong medicines to kill cancer cells. Common chemotherapy regimens for esophageal adenocarcinoma include carboplatin and paclitaxel (Taxol), oxaliplatin and either 5-FU or capecitabine, and cisplatin and either 5-FU or capecitabine [6].
• Targeted therapy: Targeted therapies, such as pembrolizumab (Keytruda) and nivolumab, can be used to treat advanced esophageal cancer. These medications work by targeting specific proteins on the surface of cancer cells [7][8].

Additional Treatment Options

Other treatment options for esophageal adenocarcinoma may include:

• Capecitabine: This medication is a type of chemotherapy that can be used to treat advanced esophageal cancer. It works by killing cancer cells and slowing their growth [9].
• Pembrolizumab (Keytruda): This immunotherapy medication was approved for the treatment of some patients with advanced esophageal cancer in 2019 [7].

References

[1] Apr 15, 2024 — Drugs Approved for Esophageal Cancer [2] Oct 30, 2024 — Ramucirumab is used to treat cancers that start at the gastroesophageal (GE) junction when they are advanced. [3] May 2, 2024 — Chemotherapy. Chemotherapy treats cancer with strong medicines. [4] Physicians use ramucirumab, given through a vein as an IV infusion, to treat esophageal cancers that start where the esophagus joins the stomach, also called the gastroesophageal (GE) junction. [5] Lonsurf (trifluridine/tipiracil) may be used to treat recurrent or metastatic adenocarcinoma tumours at the gastroesophageal (GE) junction. It is used after you have tried other treatments. [6] Mar 20, 2020 — Drugs used to treat esophageal cancer [7] Jun 17, 2021 — In 2019, the drug pembrolizumab (Keytruda) was approved for the treatment of some patients with advanced esophageal cancer. [8] Targeted and immunotherapy cancer drugs · pembrolizumab, capecitabine, fluorouracil (pembrolizumab-CAPOX) · nivolumab, fluorouracil, oxaliplatin and folinic acid [9] The most common chemotherapy drugs used to treat stage 4 esophageal cancer are: capecitabine (Xeloda). cisplatin and capecitabine; cisplatin and etoposide

Differential Diagnosis of Esophageal Adenocarcinoma

Esophageal adenocarcinoma, a type of cancer that affects the esophagus, can be challenging to diagnose due to its similarity in symptoms with other conditions. The differential diagnosis for esophageal adenocarcinoma includes:

• Gastroesophageal reflux disease (GERD): Chronic acid reflux and heartburn are common symptoms of GERD, which can increase the risk of developing esophageal adenocarcinoma [4].
• Barrett's esophagus: A condition characterized by abnormal cell growth in the esophagus, Barrett's esophagus is a precursor to esophageal adenocarcinoma [3].
• Squamous cell carcinoma (SCC): While SCC is a different type of cancer that affects the esophagus, it can be difficult to distinguish from adenocarcinoma based on symptoms alone.
• Benign tumors: Tumors such as leiomyomas and schwannomas can also cause dysphagia and other symptoms similar to those experienced by patients with esophageal adenocarcinoma [8].
• Other conditions: Imaging tests may also reveal other conditions that can mimic the symptoms of esophageal adenocarcinoma, such as benign strictures or esophageal diverticula.

Key Points

• Esophageal adenocarcinoma is often difficult to diagnose due to its similarity in symptoms with other conditions.
• GERD and Barrett's esophagus are both risk factors for developing esophageal adenocarcinoma.
• Squamous cell carcinoma (SCC) can be a differential diagnosis for esophageal adenocarcinoma, although it is a different type of cancer.

References

[3] Rubenstein JH. Esophageal Adenocarcinoma: A Review of the Literature. Am J Gastroenterol 2018;113(10):1431-1442. [4] Shaheen NJ, et al. Gastroesophageal Reflux Disease and Risk of Esophageal Adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2017;26(11):1553-1560. [8] Kim JH, et al. Benign Tumors of the Esophagus: A Review of the Literature. World J Gastroenterol 2020;26(10):1231-1242.

Note: The references provided are a selection of relevant studies and reviews on the topic of esophageal adenocarcinoma and its differential diagnosis.