Gastric cardia cancer and precursor lesions- current dilemmas

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Report (EN)

2007 (EN)
Gastric cardia cancer and precursor lesions- current dilemmas (EN)

Jovanovic I.,
Mouzas I.,

SUMMARY Over the last two decades a marked increase in the incidence of adenocarcinoma of the gastroesophageal junction has been observed. This carcinoma can develop, either from short segment Barrett’s esophagus or metaplastic gastric epithelium in the cardia. Much confusion exists regarding the malignant potential of such short segments of intestinal metaplasia, at or above the esophagogastric junction. Furthermore, it is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus, represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a different pathogenesis. Such a difference may not be crucial since all patients with cancer would undergo surgical procedure, but the identification of precursor lesions is merited since different therapeutic and surveillance protocol can be established. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett’s esophagus or whether it is related to a generalized atrophic process of the stomach. Epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia of the gastric cardia. Results from recent studies still leave us with a dilemma concerning the role of reflux disease and Helicobacter pylori infection in the development of carditis and consecutive intestinal metaplasia. It appears that such discrepancies often originate from different biopsy sampling protocols. At present, there are no accepted criteria concerning the position of gastric cardia. Anatomic and histological landmarks do not always coincide. A promising tool for future investigation may be the different expression of cytokeratins in metaplastic epithelium arising from the esophageal, as opposed to the gastric mucosa. This article reviews the results of the recent studies and presents dilemmas relating to the burning issue of gastric cardia cancer. (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 14, No 4 (2001) (EN)

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