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The esophageal-gastric junction adenocarcinoma (AEG) is neither completely equivalent to esophageal squamous carcinoma, but also different from the distal gastric adenocarcinoma. This article begins from the concept and classification of AEG, reviews the diagnosis and treatment status of advanced AEG, and explores the molecular classification of gastric adenocarcinoma and AEG, and looks ahead the future of diagnosis and treatment of AEG according to molecular classification.
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Objective To explore the clinical and histopathological features of Barrett esophagus and its related adenocarcinoma as well as the relationship between them.Methods From January 2002 to January 2012,the clinical data of 35 patients with Barrett esophagus,850 patients with esophagus cancer and 218 patients with esophageal-gastric junction cancer were collected,and the histopathological features of all the patients and the follow-up in patients with Barrett esophagus were retrospectively analyzed.Results Among 35 patients with Barrett esophagus,six cases(17.1 ％) had specialized intestinal metaplasia and all of them did not develop into esophageal adenocarcinoma or Siewert type Ⅰ esophageal-gastric junction cancer.Among 850 patients with esophageal cancer,794 cases (93.4％) were squamous carcinoma,19 cases (2.2％) were small cell carcinoma,seven cases (0.8％) were adenocarcinoma.And besides,there were adenosquamous carcinoma,basaloid squamous carcinoma,carcinosarcoma,and neuroendocrine carcinoma.Among 218 patients with esophageal gastric junction cancer,nine cases (4.1％) were Siewert type Ⅰ,150 cases (68.8％) were Siewert type Ⅱ,59 cases (27.1％) were Siewert type Ⅲ.A total of 180 cases (82.6％) were adenocarcinoma and others were signet ring cell carcinoma,mucous adenocarcinoma,squamous carcinoma,adenosquamous carcinoma,small cell carcinoma,neuroendocrine carcinoma,carcinoid and spindle cell carcinoma.Conclusions Specialized intestinal metaplasia is rare in patients with Barrett esophagus in China,and the probability of Barrett esophagus developing into adenocarcinoma is low.Barrett esophagus related adenocarcinoma such as esophageal adenocarcinoma and Siewert type Ⅰ esophageal-gastric junction cancer is rare.
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Objective: Epithelial dysplasia of the esophagus and gastric cardia is precancerous lesion, including mild, moderate and severe levels. In 2000 year, WHO recommended to replace dysplasia with intraepithelial neoplasia. Mild and moderate dysplasia were classified as low-grade intraepithelial neoplasia (LIN). Cardia adenocarcinoma was suggested to be called esophageal-gastric junction adenocarcinoma. The risk of cancer development and the rule of time evolution were detected in esophagus and esophageal-gastdc junction LIN in high incidence area of esophageal cancer in Northern China, in an effort to provide scientific data for the prevention of esophageal cancer. Methods: Between October 2001 and October 2002, two townships of Cixian were chosen to carry out endoscopic iodine staining screening cohort study. The total population aged 0-85 was 22,016, of which 6,596 aged 40-69 (3257 males and 3339 females). Except for thoese with contraindications and those who refused to join the study, 3,506 cases were finally recruited in the study, and the screening rate was 53.2%. According to WHO criteria of the pathological diagnosis, the esophageal squamous epithelium with mild and moderate dysplasia and esophageal-gastric junction with mild dysplasia were classified into LIN groups (including 616 cases). The control group contained a total of 2,478 cases without precancerous lesions and free of cancer in endoscopic screening. Results: From June to September in 2008, the cohort was followed up and 174 cases were lost, with a follow-up rate of 95.0%. Follow-up was 3,970.7 person- years in the LIN group and 16,120.0 person-years in the control group.Carcinomous conversion rates were 251.7 and 68.2/per 100,000 person- years respectively in the LIN group and the control group. The median time in the two groups was 38 and 47 months, respectively. Compared with that of the normal population, the relative risk (RR) of LIN was 3.69 (95% CI=1.57-8.69, P=0.001). Conclusion: Population with LIN are at high-risk for esophageal cancer and endoscopic examination every year is absolutely necessary.