Barrett’s esophagus and esophageal cancer: An overview

Abstract

Although esophageal cancer (EC) is the eighth most common cancer in several European countries, it is one of deadliest worldwide. The most frequent predisposing factor implicated in its development is Barrett's esophagus (BE), an acquired metaplastic transformation of the esophageal lining cells from normal squamous epithelium into specialised or intestinal-like columnar epithelium. The major risk factor for BE is gastroesophageal reflux disease. Although BE is in itself a benign and often asymptomatic disorder, its clinical importance stems from the recognition that it represents the main precursor lesion for the development of esophageal adenocarcinoma (AC), a tumor that is rapidly increasing especially in developed countries and is associated with a low survival rate. This paper provides an overview of the epidemiology and natural history of BE as well as of the possible pathogenetic mechanisms underlying the development of BE and its progressive transition to AC. New diagnostic tests are described, recommendations for screening and surveillance are provided and surgical and ablative procedures to treat dysplastic lesions and early neoplasia are discussed. Claimed chemopreventive agents and biomarkers that in the near future may help identify people with a higher risk of EC are also considered.

Gastric Cancer: An Epidemiological Overview

“…These findings are supported by the results of a Meta-analysis stating the relative risk of cancer of stomach to be 0.65 after HP eradication [12].…”

“…The risk of gastric adenocarcinoma and MALT lymphoma increases by 3 to 6 folds in HP infected patients than in those who are uninfected [12]. This association is mainly observed in distal and intestinal-type of gastric cancer.…”

DNA polymerase iota (Pol ι) promotes invasion and metastasis of esophageal squamous cell carcinoma

“…Esophageal squamous cell carcinoma (ESCC) is the major histological type of esophageal cancer (>90%) in China and accounts for 60-70% of esophageal cancer cases worldwide [2, 3]. Despite the improvement of diagnosis and treatment throughout the past decades, the management of ESCC remains a challenge due to its rapid progression and metastasis [4].…”

Epidemiology of esophageal cancer

“…Most adenocarcinomas, however, tend to arise in the distal esophagus from columnar-lined metaplastic epithelium, commonly known as Barrett's esophagus [15,16] , which replaces the squamous epithelium during the healing reflux esophagitis and may progress to dysplasia. Gastroesophageal reflux disease (GERD), or just reflux [17][18][19] can damage the lining of esophagus which causes Barrett' s esophagus [17] , characterized by abnormal "tongues" of salmon-colored mucosa extending proximally from the gastroesophageal junction into the normal pale esophageal mucosa, develops in approximately 5 to 8 percent of patients with gastroesophageal reflux disease.…”