title: [Update on Barrett esophagus and Barrett carcinoma].
abstract: The definition of Barrett esophagus is currently under discussion. It is now suggested that a distal esophagus coated with cylinder epithelium with cardia-fundus mucosa should also be classified as Barrett esophagus because the risk of cancer is significantly increased even without histological evidence of intestinal metaplasia with goblet cells. The results of recent epidemiological investigations imply that the cancer risk of cylinder cell metaplasia and low grade intraepithelial neoplasia in Barrett esophagus has previously been overestimated. The histological detection of dysplasia still remains the best biomarker for estimation of the risk of cancer of Barrett esophagus. Exact determination of invasion depth in the mucosa, respective submucosa is now established as prognostic marker for overall survival in Patients with early carcinomas and this classification is useful for therapy decisions (endoscopic versus surgical removal). In advanced Barrett carcinoma following neoadjuvant therapy the lymph node status (ypN) is a better prognostic factor than the ypT category. In metastasized tumors therapies targeting HER2/new, EGFR or c-Met have been investigated explicitly in Barrett carcinoma only in phase I/II studies, whereby the predictive value of appropriate molecular pathology investigations is not yet reliably established.
authors.affiliation: Institut für Pathologie, Universitätsklinikum Freiburg, Breisacher Str. 115a, 79106 Freiburg. direktion-pathologie@uniklinik-freiburg.de
authors.forename: M
authors.initials: M
authors.lastname: Werner
authors.forename: S
authors.initials: S
authors.lastname: Laßmann
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D002299:Cardia / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D016503:Drug Delivery Systems; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics; D004938:Esophageal Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D005748:Gastric Fundus / Q000473:pathology / Q000601:surgery; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D019859:Proto-Oncogene Proteins c-met / Q000037:antagonists & inhibitors / Q000235:genetics; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000235:genetics; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D019859:Proto-Oncogene Proteins c-met; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C512478:EGFR protein, human; C508053:ERBB2 protein, human