Esophageal Adenocarcinoma Methods and Protocols

2

rise in incidence of esophageal adenocarcinoma is very rapid in the

Western populations. In Asian populations, there is also a small

rise of esophageal adenocarcinoma in some studies [ 3 ].

2 Predisposing Lesions

Esophageal and esophagogastric adenocarcinoma is more common

in the Western populations and male gender. The strong male pre-

dominance remains unexplained, but hormonal influence might

play an important role.

The most important etiological factor for this group of adeno-

carcinoma is gastro-esophageal reflux (GORD) and related factors

[ 2 – 4 ]. GORD induces gastric and intestinal metaplasia of the squa-

mous epithelium of the lower esophagus (Barrett esophagus) (see

Chapter 8 ) (Fig. 1 ). The prevalence of Barrett esophagus varies

with the populations and is higher with increasing age, male sex,

and the presence of risk factors. It is more common in developed

countries, affecting 1–3% of the population depending on the dif-

ferent factors in the population [ 5 ]. The metaplasia could progress

Fig. 1 Effect of GORD: tongues of tan color gastric mucosa replace macroscopic

appearance showing the whitish mucosa of the lower esophagus

Alfred K. Lam