Pathology of Early Invasive Adenocarcinoma of the Esophagus or Esophagogastric Junction -- Implications for Therapeutic Decision Making

Reviewers: Li Liu, MD
Source: Cancer, Volume 88:2429-2437, (June) 2000

Précis: Esophagectomy remains the preferred treatment for early esophageal cancer

Introduction

The treatment of esophageal cancer remains a challenge. Controversy persists regarding the optimal surgical approach to this disease. Tumors confined to the mucosa and submucosa, without metastases to the regional lymph nodes, both esophagectomy and endoscopic ablation are used for cure. In this report, the researchers evaluated the pathologic features of early adenocarcinoma of esophagus in an attempt to rationalize therapeutic decision making.

Method

Pathology reports and slides of 173 patients who had esophagectomies for invasive adenocarcinoma were reviewed.

Results

• 19% of patients had early stage cancer.
• 7% of patients had tumor invasion limited to the mucosa. Of them, no lymph node metastases were found.
• 12% had tumor that invaded the submucosa. Lymph node metastases were present in 30% of them.
• Intestinal metaplasia was present in all the cases.
• The 3-year cause-specific survival for patients with intramucosal cancer was 100% and survival was 82% for patients with submucosa cancer.

Discussion

Because staging techniques are inaccurate, the differences between the early stages of esophageal cancer remain unclear. Therefore, endoscopic treatment for clinically staged early esophageal cancer should be used with caution. For patients with submocosal extension, esophagectomy is preferred because of the relatively high incidence of lymph node metastasis.