Esophagus Pathology

When your esophagus was biopsied with an endoscope, the samples were examined under a microscope by a pathologist, a qualified clinician with years of training. Your doctor receives a report from the pathologist that includes a diagnosis for each sample taken. This report's contents will be used to aid in the management of your care. The following questions and answers are intended to assist you in deciphering medical jargon found in the pathology report from your biopsy.

What if my report says adenocarcinoma?

Adenocarcinoma is a type of cancer that develops in gland cells. In the esophagus, adenocarcinoma can arise from the cells of Barretts esophagus.

What if my report says squamous carcinoma (squamous cell carcinoma)?

The mucosa is the term for the inside lining of the esophagus. Squamous cells make up the top layer of the mucosa in the majority of the esophagus. Squamous mucosa is the name for this type of mucosa. Squamous cells are flat cells that, when viewed under a microscope, resemble fish scales. The cancer squamous carcinoma of the esophagus develops from the squamous cells that lining the esophagus.

What does it mean if, in addition to cancer, my report also mentions Barretts, goblet cells, or intestinal metaplasia?

The intestines, not the esophagus, are lined by goblet cells. Intestinal metaplasia occurs when goblet cells appear in places where they aren't supposed to be, such as the esophagus. Metaplasia of the intestine can occur anywhere squamous mucosa is normally seen. Barrett's esophagus occurs when intestinal metaplasia replaces the esophageal squamous mucosa. Reflux of stomach contents into the esophagus, often known as gastroesophageal reflux disease or GERD, is the most prevalent cause of Barrett's esophagus.

What does it mean if I have Barretts esophagus and cancer is already present?

Barrett's esophagus is only significant since it increases your chances of developing esophageal cancer. Barrett's is of no consequence if you already have cancer.

What does invasive or infiltrating mean?

The term "invasive" or "infiltrating" refers to cancer cells that have spread beyond the mucosa (the inner lining of the esophagus). This indicates that it is real cancer rather than a precursor to cancer.

Does this mean that the tumor has invaded deeply and is associated with a poor prognosis?

No, all it means is that it is true cancer (and not a pre-cancer). On a biopsy, only a small sample of tissue is removed, and the pathologist usually cannot tell how deeply the tumor is invading the wall of the esophagus.

Some early, small cancers can be treated with a special procedure called an endoscopic mucosal resection (EMR), which removes only part of the inner lining of the esophagus. In other situations, an esophagectomy (removal of part or all of the esophagus) is needed, and the depth of invasion is measured when the entire tumor is removed at surgery.

What does differentiation mean?

Differentiation or grade of the cancer is based on how abnormal the cells and tissue look under the microscope. It is helpful in predicting how fast the cancer is likely to grow and spread. Esophageal cancer is usually divided into 3 grades:

• Well-differentiated (low grade)
• Moderately differentiated (intermediate grade)
• Poorly differentiated (high-grade)

Sometimes, it is just divided into 2 grades: well-moderately differentiated and poorly differentiated.

What is the significance of the grade of cancer?

One of the numerous elements that determine how probable a tumor is to grow and spread is its grade. Tumors that are poorly differentiated (high-grade) grow and spread more quickly, whereas cancers that are well-differentiated (low-grade) develop and spread more slowly. Other elements, though, are equally essential.

What does it mean if there is vascular, lymphatic, or lymphovascular (angiolymphatic) invasion?

These terms mean that cancer is present in the blood vessels and/or lymph vessels (lymphatics) of the esophagus. If cancer has grown into these vessels, there is an increased chance that it could have spread out of the esophagus. However, this doesn't mean that your cancer has spread. Discuss this finding with your doctor.

What if my report mentions HER2 (or HER2/neu) testing?

Some cancers have too much of a growth-promoting protein called HER2 (or HER2/neu). Tumors with increased levels of HER2 are referred to as HER2-positive.

Testing for HER2 tells your doctor whether drugs that target the HER2 protein might be helpful in treating your cancer.