Pathology of esophageal cancer and Barrett’s esophagus

Abstract

Esophageal cancer is a serious malignancy with high mortality. The two common distinctive pathologic subtypes of esophageal cancer are squamous cell carcinoma and adenocarcinoma. These differ with regards to etiology, ethnic distribution, pathogenesis, and location in the esophagus. The precursor lesions are also unique to each subtype. Squamous cell carcinoma is more common in East Asia, is linked to smoking and tobacco use, more commonly involves the middle esophagus, and the precursor lesion is squamous dysplasia.Adenocarcinoma is more common in the United States and certain European countries, associated with obesity and gastroesophageal reflux disease (GERD), more commonly involves the distal esophagus, and the precursor lesion is Barrett's esophagus. Endoscopic surveillance with biopsy evaluation is the standard of care in high-risk groups. Endoscopic ablative therapies for early cancers have lower morbidity than surgery. Despite increased awareness, identification of high-risk groups and endoscopic surveillance, a large proportion of patients present with advanced cancers. Surgery and chemoradiation, either in neo-adjuvant or adjuvant setting, is the usual treatment for patients with advanced but resectable esophageal cancers. The prognosis and further management largely depends upon the pathologic tumor-node-metastasis (TNM) staging provided by the American Joint Committee on Cancer (AJCC) and the International Union against Cancer. Currently, the 7th edition of TNM staging system is being applied for prognostication and this is more focused on pathologic evaluation. Eighth edition of AJCC/UICC TNM staging has been introduced and will be implemented for clinical use in 2018.

Pattern of lymph node metastasis in thoracic esophageal squamous cell carcinoma with poor differentiation

“…However, in pdESCC, the threshold of LNM rate that should be considered as the high-risk area may change, because the trend oflymphatic skip metastasis in pdESCC was stronger than in ESCC (21). It has been demonstrated that the average rate of LNM in all LN stations may be a reasonable threshold for metastasis risk in ESCC (22). Based on the result of the present study, the rates of LNM of stations 102 and 7 were higher than the average LNM rate in all LN stations in upper thoracic pdESCC (4.9 and 9.8 vs. 3.9%); the rates of LNM in station 101 and 105 were higher than that in middle thoracic pdESCC (5.0 and 5.0 vs. 3.9%); and the rate of LNM in station 100 was close to that in lower thoracic pdESCC (3.2 vs. 4.3%).…”

Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: A large cohort study in Guangzhou, China

“…All data were collected from medical records, and survival data were obtained from the Cancer Center's follow-up registry. The pathologic staging of tumors for patients was based on the 8th edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis classification 6 . In our study, all patient information was extracted from medical records.…”

“…The pathogenesis of EC is complex and not fully understood. Epidemiological studies have confirmed that smoking is an important risk factor of ESCC 6,7 . The Center for International Cancer Research categorizes tobacco and alcohol as Class I carcinogens with sufficient evidence to prove their carcinogenicity.…”

Ensemble of Deep Convolutional Neural Networks for Classification of Early Barrett’s Neoplasia Using Volumetric Laser Endomicroscopy

“…This GS feature comprises features for (1) texture analysis, (2) geometry analysis, as well as (3) VLE-specific information [15]. Both LH and GS capture characteristics in the VLE data that are indicative for dysplasia [7,26].…”