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Difference between revisions of "Esophageal adenocarcinoma"
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| LMDDx = [[high-grade columnar dysplasia of the esophagus]], [[squamous cell carcinoma of the esophagus]],[[gastric adenocarcinoma]] | | LMDDx = [[high-grade columnar dysplasia of the esophagus]], [[squamous cell carcinoma of the esophagus]],[[gastric adenocarcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = CK7 +ve, CK20 | | IHC = CK7 +ve, CK20 -ve, p63 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 15: | Line 15: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[esophagus]] | | Site = [[esophagus]] - classically distal esophagus | ||
| Assdx = [[Barrett's esophagus]], [[high-grade columnar dysplasia of the esophagus]] | | Assdx = [[Barrett's esophagus]], [[high-grade columnar dysplasia of the esophagus]] | ||
| Syndromes = | | Syndromes = | ||
| Line 28: | Line 28: | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = EMR (early), surgery - esophagectomy | | Tx = [[EMR]] (early), surgery - esophagectomy | ||
}} | }} | ||
'''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arises in the context of [[Barrett's esophagus]]. | '''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arises in the context of [[Barrett's esophagus]]. | ||
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===Treatment=== | ===Treatment=== | ||
*Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.<ref name=pmid19306943>{{Cite journal | last1 = Sampliner | first1 = RE. | title = Endoscopic therapy for Barrett's esophagus. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 7 | pages = 716-20 | month = Jul | year = 2009 | doi = 10.1016/j.cgh.2009.03.011 | PMID = 19306943 }}</ref> | *Adenocarcinoma in situ (AIS) - may be treated with [[endoscopic mucosal resection]] & follow-up.<ref name=pmid19306943>{{Cite journal | last1 = Sampliner | first1 = RE. | title = Endoscopic therapy for Barrett's esophagus. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 7 | pages = 716-20 | month = Jul | year = 2009 | doi = 10.1016/j.cgh.2009.03.011 | PMID = 19306943 }}</ref> | ||
*Surgery - esophagectomy. | *Surgery - esophagectomy. | ||
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====Staging==== | ====Staging==== | ||
Early esophageal adenocarcinoma has its own staging system:<ref>{{Cite journal | last1 = Pech | first1 = O. | last2 = May | first2 = A. | last3 = Rabenstein | first3 = T. | last4 = Ell | first4 = C. | title = Endoscopic resection of early oesophageal cancer. | journal = Gut | volume = 56 | issue = 11 | pages = 1625-34 | month = Nov | year = 2007 | doi = 10.1136/gut.2006.112110 | PMID = 17938435 | PMC = 2095648 }}</ref><ref>{{Cite journal | last1 = Thosani | first1 = N. | last2 = Singh | first2 = H. | last3 = Kapadia | first3 = A. | last4 = Ochi | first4 = N. | last5 = Lee | first5 = JH. | last6 = Ajani | first6 = J. | last7 = Swisher | first7 = SG. | last8 = Hofstetter | first8 = WL. | last9 = Guha | first9 = S. | title = Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. | journal = Gastrointest Endosc | volume = | issue = | pages = | month = Nov | year = 2011 | doi = 10.1016/j.gie.2011.09.016 | PMID = 22115605 | URL = http://www.sciencedirect.com/science/article/pii/S0016510711022048 }}</ref> | Early esophageal adenocarcinoma has its own staging system:<ref name=pmid17938435 >{{Cite journal | last1 = Pech | first1 = O. | last2 = May | first2 = A. | last3 = Rabenstein | first3 = T. | last4 = Ell | first4 = C. | title = Endoscopic resection of early oesophageal cancer. | journal = Gut | volume = 56 | issue = 11 | pages = 1625-34 | month = Nov | year = 2007 | doi = 10.1136/gut.2006.112110 | PMID = 17938435 | PMC = 2095648 }}</ref><ref name=pmid22115605>{{Cite journal | last1 = Thosani | first1 = N. | last2 = Singh | first2 = H. | last3 = Kapadia | first3 = A. | last4 = Ochi | first4 = N. | last5 = Lee | first5 = JH. | last6 = Ajani | first6 = J. | last7 = Swisher | first7 = SG. | last8 = Hofstetter | first8 = WL. | last9 = Guha | first9 = S. | title = Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. | journal = Gastrointest Endosc | volume = | issue = | pages = | month = Nov | year = 2011 | doi = 10.1016/j.gie.2011.09.016 | PMID = 22115605 | URL = http://www.sciencedirect.com/science/article/pii/S0016510711022048 }}</ref> | ||
*M1 = lamina propria. | *M1 = lamina propria. | ||
*M2 = superficial muscularis mucosae. | *M2 = superficial muscularis mucosae. | ||
*M3 = submucosa. | *M3 = submucosa. | ||
*M4 = muscularis propria. | *M4 = muscularis propria. | ||
<!-- | |||
Comment: | |||
*Different staging systems exist; confusingly, they use the same terms (M1, M2, M3).<ref name=pmid15557945>{{Cite journal | last1 = Buskens | first1 = CJ. | last2 = Westerterp | first2 = M. | last3 = Lagarde | first3 = SM. | last4 = Bergman | first4 = JJ. | last5 = ten Kate | first5 = FJ. | last6 = van Lanschot | first6 = JJ. | title = Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. | journal = Gastrointest Endosc | volume = 60 | issue = 5 | pages = 703-10 | month = Nov | year = 2004 | doi = | PMID = 15557945 }}</ref> --> | |||
==IHC== | ==IHC== | ||
*CK7 +ve. | Features:<ref name=pmid14631371>{{cite journal |authors=Driessen A, Nafteux P, Lerut T, Van Raemdonck D, De Leyn P, Filez L, Penninckx F, Geboes K, Ectors N |title=Identical cytokeratin expression pattern CK7+/CK20- in esophageal and cardiac cancer: etiopathological and clinical implications |journal=Mod Pathol |volume=17 |issue=1 |pages=49–55 |date=January 2004 |pmid=14631371 |doi=10.1038/modpathol.3800011 |url=}}</ref> | ||
*CK20 +ve. | *CK7 +ve (54 of 66 cases). | ||
*CK20 -ve (14 of 66 cases). | |||
Note: | |||
*CK7 +ve and CK20 -ve is seen in ~67% cases (44/66).<ref name=pmid14631371/> | |||
To rule-out SCC: | To rule-out SCC: | ||
*p63 -ve. | *p63 -ve. | ||
*HWMK -ve. | *HWMK -ve. | ||
Others:<ref name=pmid17650224>{{Cite journal | last1 = Liu | first1 = YS. | last2 = Yu | first2 = CH. | last3 = Li | first3 = L. | last4 = Zhang | first4 = BF. | last5 = Fang | first5 = J. | last6 = Zhou | first6 = Q. | last7 = Hu | first7 = Y. | last8 = Li | first8 = YM. | last9 = Jun Gao | first9 = H. | title = Expression of p53, p16 and cyclooxygenase-2 in esophageal cancer with tissue microarray. | journal = J Dig Dis | volume = 8 | issue = 3 | pages = 133-8 | month = Aug | year = 2007 | doi = 10.1111/j.1443-9573.2007.00299.x | PMID = 17650224 }}</ref> | |||
*p53 +ve. | |||
*COX-2 +ve. | |||
*p16 +ve - but not that useful as it's frequently positive in the precursors.<ref name=pmid15617840>{{Cite journal | last1 = Hardie | first1 = LJ. | last2 = Darnton | first2 = SJ. | last3 = Wallis | first3 = YL. | last4 = Chauhan | first4 = A. | last5 = Hainaut | first5 = P. | last6 = Wild | first6 = CP. | last7 = Casson | first7 = AG. | title = p16 expression in Barrett's esophagus and esophageal adenocarcinoma: association with genetic and epigenetic alterations. | journal = Cancer Lett | volume = 217 | issue = 2 | pages = 221-30 | month = Jan | year = 2005 | doi = 10.1016/j.canlet.2004.06.025 | PMID = 15617840 }}</ref> | |||
==Staging== | |||
*The number of lymph nodes is important for [[staging]], as a small number may lead to stage migration (Will Rogers phenomenon). | |||
*There is no established standard for esophageal cancer (as per UICC/AJCC staging - based on Li ''et al.''<ref name=pmid23124992>{{Cite journal | last1 = Li | first1 = Q. | last2 = Wu | first2 = SG. | last3 = Gao | first3 = JM. | last4 = Xu | first4 = JJ. | last5 = Hu | first5 = LY. | last6 = Xu | first6 = T. | title = Impact of esophageal cancer staging on overall survival and disease-free survival based on the 2010 AJCC classification by lymph nodes. | journal = J Radiat Res | volume = 54 | issue = 2 | pages = 307-14 | month = Mar | year = 2013 | doi = 10.1093/jrr/rrs096 | PMID = 23124992 }}</ref>), several studies give different numbers (18 lymph nodes Greenstein ''et al.'',<ref name=pmid18224663>{{Cite journal | last1 = Greenstein | first1 = AJ. | last2 = Litle | first2 = VR. | last3 = Swanson | first3 = SJ. | last4 = Divino | first4 = CM. | last5 = Packer | first5 = S. | last6 = Wisnivesky | first6 = JP. | title = Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. | journal = Cancer | volume = 112 | issue = 6 | pages = 1239-46 | month = Mar | year = 2008 | doi = 10.1002/cncr.23309 | PMID = 18224663 }}</ref> 23 lymph nodes Peyre ''et al.''<ref name=pmid18936567>{{Cite journal | last1 = Peyre | first1 = CG. | last2 = Hagen | first2 = JA. | last3 = DeMeester | first3 = SR. | last4 = Altorki | first4 = NK. | last5 = Ancona | first5 = E. | last6 = Griffin | first6 = SM. | last7 = Hölscher | first7 = A. | last8 = Lerut | first8 = T. | last9 = Law | first9 = S. | title = The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. | journal = Ann Surg | volume = 248 | issue = 4 | pages = 549-56 | month = Oct | year = 2008 | doi = 10.1097/SLA.0b013e318188c474 | PMID = 18936567 }}</ref>). | |||
==Sign out== | ==Sign out== | ||
===Biopsy=== | |||
<pre> | |||
Esophagus, Biopsy: | |||
- INVASIVE ADENOCARCINOMA, poorly differentiated. | |||
Comment: | |||
Pending IHC (CK7, CK20) and HER2 testing; results of these will be reported in an addendum. | |||
</pre> | |||
===Resection=== | |||
<pre> | <pre> | ||
GASTROESOPHAGEAL JUNCTION, RESECTION: | GASTROESOPHAGEAL JUNCTION, RESECTION: | ||
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==See also== | ==See also== | ||
*[[Esophagus]]. | *[[Esophagus]]. | ||
*[[Esophageal cancer]]. | |||
*[[Adenocarcinoma]]. | *[[Adenocarcinoma]]. | ||
*[[Siewert classification]]. | |||
==References== | ==References== | ||