Adenocarcinoma

Adenocarcinomas account for less than 15% of esophageal cancers, but their incidence is rising sharply. They may arise from ectopic gastric mucosa or columnar-lined esophagus, or they may result from the contiguous spread of a cardia malignancy.

Endoscopic diagnostic criteria (Figs. 3.66, 3.67)

► Highly variable endoscopic appearance

- Superficial mucosal alteration, discoloration

- Nodular or depressed mucosa

- Erythema, erosion, or ulceration

- Mucosa is friable, bleeds easily on examination and biopsy

- Exophytic, polypoid mass (most common form)

- Fungiform, clefted surface, sometimes with central excavation

- Erythema, erosion, ulceration

- Pale gray, sometimes reddish discoloration

- May be sharply or poorly demarcated from the surrounding mucosa

Additional Studies

► Biopsy with generous margins

► Endosonography

► Radiographic contrast examination

► Usual staging work-up

Fig. 3.66 Esophageal carcinoma

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