Resumen de Barrett's oesophagus and oesophageal adenocarcinoma

Nadeera De Silva, Rebecca Fitzgerald

• Oesophageal adenocarcinoma has increased rapidly in the Western world over the past 20 years. It usually presents de novo but is always preceded by replacement of the distal squamous epithelium by columnar lined epithelium (Barrett's oesophagus). The risk of progression from Barrett's oesophagus to adenocarcinoma is 0.2–0.4% per year. Surveillance (or monitoring) is generally recommended, despite the limitations of current methods, in order to detect high-grade dysplasia and intramucosal carcinoma lesions at an early curative stage, as symptomatic adenocarcinoma has a poor prognosis. Endoscopic diagnostic and therapeutic technologies for detecting and treating early lesions are advancing rapidly. Screening for Barrett's oesophagus is also being more seriously considered, following the realization that it is a common condition and that most cases are undiagnosed. Oesophageal adenocarcinoma is staged using a combination of PET-CT and EUS, and staging informs management. Management still mainly involves cytotoxic chemotherapy, increasingly combined with radiotherapy, and oesophagectomy for cases deemed suitable for a curative pathway. Surgery is centralized for this condition and surgical techniques are becoming more minimally invasive to reduce morbidity. Molecular targeted therapies, such as ErbB2 inhibitors, are beginning to be applied but progress has lagged behind that in other cancers because oesophageal adenocarcinoma displays molecular heterogeneity. Curative and palliative treatment involves close liaison between members of the multidisciplinary team.