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Adenocarcinoma of the Esophagus and Gastric Cardia: Is There Progress in the Face of Increasing Cancer Incidence?
From the late 1970s to the mid-1980s, the incidence of adenocarcinoma of the esophagus and gastric cardia increased more rapidly than that of any other cancer in the United States (1). Adenocarcinoma of the esophagus has continued to increase in frequency in the early 1990s. An estimated 25 000 people die every year of these cancers in the United States, and a similar trend has been noted in western Europe (2).
Adenocarcinoma of the esophagus itself usually occurs in patients who have Barrett esophagus (3). Adenocarcinoma of the gastric cardia and esophagogastric junction is associated with Barrett esophagus about 40% of the time (4). Unfortunately, the terminology for defining adenocarcinoma of the proximal stomach is not standardized. The International Classification of Diseases for oncology lumps together cancers of the cardia and the gastroesophageal junction. For example, the origin of a tumor may be described as the gastric cardia “when the epicenter is at the gastroesophageal junction” (4) or the esophagogastric junction “when the vertical midpoint of the tumor was ≥ 2 cm above or below the esophagogastric junction” (5).
Barrett esophagus is, in turn, a complication of gastroesophageal reflux disease (GERD). Most patients with Barrett esophagus have severe GERD, as judged by predisposing pathophysiologic factors: weak lower-esophageal sphincter pressure, decreased amplitude of contractions in the distal esophagus, increased acid exposure, increased bile acid exposure, and presence of a hiatal hernia.
Recognition of Barrett esophagus has increased with the widespread application of flexible upper endoscopy, the most sensitive method of detecting Barrett esophagus (6). Most investigators would agree that intestinal metaplasia documented on directed biopsy specimens obtained from an abnormal-appearing esophageal lining is also necessary for the diagnosis of Barrett …
