Cancers in the distal esophagus are more likely to represent advanced-stage gastroesophageal reflux-related adenocarcinoma than a distinct tumor type of different origin, according to an article in the June issue of the Archives of Surgery.

The relationship of gastroesophageal reflux disease and adenocarcinoma of the esophagus is clear for tumors located along the tubular portion of the esophagus, regardless of whether Barrett mucosa is found, according to background information in the article. But there is controversy about the origin of tumors located at the far end of the esophagus where it connects to the stomach. Two distinct cancer types arise there. One type is associated with Barrett mucosa and that it is caused by reflux is widely accepted, the authors write, but the second type has no associated Barrett mucosa and it has been proposed that these tumors originate differently. The major evidence in support of this position has been that the second type of tumor has a worse prognosis.

Guiseppe Portale, MD, and his American colleagues compared demographic information, clinical features, and tumor characteristics in 215 patients who underwent surgery for cancer of the distal esophagus from January 1992 to December 2002. Pathology reports were reviewed to determine whether there was adjacent Barrett mucosa and whether these tumors represented distinct tumor types.

The researchers found that patients with Barrett mucosa had tumors that were diagnosed earlier, were smaller in size, earlier in stage, with fewer node metastases, and had a better five-year survival.

"Although overall survival in the two groups was significantly different, survival by tumor stage was similar," the authors wrote. "This suggests that adenocarcinomas without detectable Barrett epithelium may not be a different type of tumor but rather a more advanced stage of the same disease. It is likely that these larger more aggressive tumors have overgrown the Barrett epithelium in which they arose."

Based on cancer registry data, the authors suggested that this conclusion would double the number of cases of loss of life due to malignancy related to gastroesophageal reflux disease.