Influence of genetics on tumoral pathologies: The example of the adenocarcinoma arising in Barrett's esophagus

Abstract

Barrett's esophagus (BE) refers to an abnormal change (metaplasia) in the cells of the inferior portion of the esophagus. About 10% of patients with symptomatic gastroesophageal reflux disease (GERD) have BE. In some cases, BE develops as an advanced stage of erosive esophagitis. The risk of esophageal cancer appears to be increased in patients with BE. The only way to diagnose BE is by endoscopy and histology. Some studies suggest that intensive treatment of Barrett's esophagus with effective acid suppression can reduce the amount of abnormal lining in the esophagus. It is not clear whether such treatment also prevents esophageal cancer. Generally, the cancer starts out as carcinoma of the esophagus on the surface, and then invades the surrounding tissue. Surgery offers the best chance of long-term survival. There are many events that occur in Barrett's esophagus that lead to the development of cancer and most of them appear to occur early, before high-grade dysplasia or cancer develops. No one knows what the late events are and how cells acquire the ability to leave their normal growth boundaries. It is now widely accepted that the development of most cancers is due to something called genomic or genetic instability. The aim of this review is to show BE pathology in its progression to cancer looking for new biomarkers to distinguish between BE -dysplasia (low grade and high grade)-adenocarcinoma (ADC) and to characterize the ADC, giving more hope for its treatment.

The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study

“…Without doubt, there is a strong need for a better approach to BE patients, especially from a pathologic point of view. In fact, since it is well known that Barrett's epithelium may progress to adenocarcinoma over a period of time (34,35), it is of paramount importance to detect the early phases of neoplastic transformation, that is, LGD. Since patients with BE usually enter a surveillance program (36), and the finding of dysplasia prompts repeated endoscopic and pathologic controls (37), thus raising the health costs (38), efforts should be made not to overemphasize the diagnosis of dysplasia in this setting.…”