Background

Adenocarcinomas constitute 2.5% to 8% of primary esophageal cancers, although this frequency is increasing dramatically in the United States at a rate surpassing that of any other cancer. It is suggested that these carcinomas develop from an increased incidence of Barrett's esophagus (BE). BE is metaplastic change of the normal squamous epithelium to an intestinal columnar type secondary to gastrointestinal reflux. The incidences of BE is 22/100000.

Patients with a columnar-lined lower esophagus (Barrett's metaplasia) are 40 times more likely to develop adenocarcinoma than the general population. Although the true incidence of Barrett's esophagus in the general population is unknown, it has been estimated that adenocarcinoma arises in 8% to 15% of patients with a columnar-lined esophagus. Patients with adenocarcinoma of the distal esophagus are discovered to have intestinal columnar metaplasia in 80% of cases. virtually synonymous with carcinoma in situ and being an indication for resectional therapy.

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