Oesophageal adenocarcinoma: from Barrett to invasive cancer
- Lesion
A gland-forming cancer of the lower oesophagus that grows out of Barrett mucosa, linked to reflux and obesity.
What it is
Oesophageal adenocarcinoma usually arises in Barrett oesophagus after years of reflux. Its incidence has climbed steeply in many Western countries in step with obesity-driven reflux. It shows strong male predominance and occurs most often in people of European descent. By the time it causes symptoms it has usually spread through the rich lymphatics of the oesophageal wall.
Structure
- Gross: begins as flat or raised patches in Barrett mucosa; grows into masses, or infiltrates and ulcerates.
- Micro: mucin-producing glands, usually intestinal-type; sometimes diffusely infiltrating signet-ring cells; rarely small-cell–like.
- Residual Barrett mucosa is often found next to the tumour.
Step by step
- Reflux causes Barrett metaplasia.
- TP53 and CDKN2A changes and aneuploidy appear in metaplastic epithelium.
- Low-grade, then high-grade dysplasia develops.
- Invasion into lamina propria (intramucosal), then submucosa and deeper.
- Spread through submucosal lymphatics to regional and distant nodes.
Clinical notes
- Most are detected only when swallowing becomes difficult, which is late.
- Cancers of the distal oesophagus and gastric cardia behave alike and are treated alike.
Test yourself
Think of the answer, then tap the question to see it.
Where in the oesophagus does adenocarcinoma usually arise?
In the distal third, often extending into the gastric cardia, on a background of Barrett oesophagus.
What are the two main risk factors for oesophageal adenocarcinoma?
Chronic reflux with Barrett oesophagus and obesity; tobacco also contributes.
Which common risk factor of squamous carcinoma does not raise adenocarcinoma risk?
Alcohol.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Esophageal Cancer (StatPearls (NCBI Bookshelf), 2025); Gastroesophageal Reflux Disease (GERD) (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.