When your doctor examined your esophagus with the endoscope, he or she took biopsies. These biopsies were sent to a specialized doctor with many years of training called a pathologist, who examined them under the microscope. The pathology report tells your physician the diagnosis in each of your samples, and helps to manage your care. This FAQ sheet is designed to help you understand the medical language used in the pathology report.
1. What is my esophagus?
The esophagus is a tubular organ that connects the mouth to the stomach and allows food to pass from the mouth to the stomach. In the stomach, food is mixed with fluids that break up food so it can be absorbed into the body. The esophagus has a lining of tissue similar to skin, made up of layers of squamous cells. The outer part of the esophagus is muscle, which pushes food into the stomach.
2. What does "gastroesophageal junction" or "GEJ" mean?
" GEJ" means "Gastro-esophageal junction." The gastroesophageal junction is where the bottom of the esophagus meets the stomach. The words "gastric" and "gastro" are medical terms that mean stomach.
3. What does it mean if my report mentions the terms "Barrett's", "goblet cells", or "intestinal metaplasia"?
The lining of the esophagus and the stomach is known as the "mucosa." Most of the esophagus is lined by squamous cells, like the cells seen on the surface of the skin. The stomach is lined with columnar cells. Columnar cells are tall and skinny, like columns that hold up a porch on a house. In the stomach most of the columnar cells make fluids that mix with food and help digest it.
Goblet cells and absorption cells are types of columnar cells that are normally found in the small intestines, but not in the esophagus and stomach. Absorption cells take up food nutrients and pass them into the blood stream. Goblet cells make mucin, a lubricant that helps food pass through the small intestines. When goblet and absorption cells develop in a place where they are not supposed to be, such as the esophagus, it is called "intestinal metaplasia" or "goblet cell metaplasia."
When the lining of the esophagus changes from its normal lining (squamous cells) to goblet cells and absorptive columnar cells that are usually found in the intestines, we call this Barrett's esophagus or Barrett's mucosa.
4. What causes Barrett's esophagus?
The cause of Barrett's esophagus is not known. Barrett's esophagus can occur when chronic regurgitation of the stomach contents up into the esophagus (also known as reflux or heartburn) damages the normal lining of the esophagus. Because the injury is repeated many times, the squamous lining may change to instestinal type columnar cells and goblet that are more resistant to the injury caused by regurgitation. This is a process that usually takes many years to happen.
Most people who have chronic regurgitation or reflux do not develop Barrett's esophagus. Rarely, people who have no history of heartburn or regurgitation are found to have Barrett's esophagus. Treatment of the causes of chronic gastroesophageal reflux will reduce or eliminate the injury and inflammation in the esophagus and reduce the risk of Barrett's esophagus.
5. Is Barrett's esophagus associated with an increased risk of cancer?
Yes. Patients who have Barrett's esophagus are at increased risk to develop cancer of the esophagus. However, most people with Barrett's esophagus do not get cancer. Once a pathologist finds Barrett's esophagus, your doctor will probably increase the number of times s/he examines your esophagus and the number of biopsies s/he takes to look for cancer.
6. What if my report mentions Barrett's esophagus and dysplasia?
Dysplasia is a precancerous condition. Cells that are dysplastic have some changes that are present in cancer but dysplastic cells do not have the ability to invade the wall of the esophagus nor can they spread to other organs. Dysplasia can be treated to reduce the risk of developing cancer. Dysplasia can be patchy or focal. Dysplasia can also be masked by inflammation. There are different degrees of severity of dysplasia (see below).
7. What if my report says "negative for dysplasia"?
This means that you do not have any precancerous (ie. no premalignant) changes in your biopsies. Because dysplasia can be patchy, there is a chance that your biopsies may have missed a focus of dysplasia. The more biopsy samples that are ALL negative, the lower your chance of having dysplasia missed.
8. What does "indefinite for dysplasia" mean?
Your biopsy has Barrett's esophagus and also has some cells that are abnormal enough to have been noticed by the pathologist reviewing your biopsies but not abnormal enough to report as definitely precancerous. Often, people with these changes have a lot of heartburn or reflux which irritate the cells in the esophagus so that they look abnormal under the microscope. If the abnormal cells are reacting to the heartburn or reflux, treatment should clear up the changes.
9. If my report say that there are "changes indefinite for dysplasia" and Barrett's esophagus will I get cancer?
Five to 10 people out of 100 with "changes indefinite for dysplasia" are found to have esophagus cancer within 5 years. 10. What follow-up is necessary for "changes indefinite for dysplasia"? Usually if you have these findings, your doctor will ask you to return for more biopsies in 6 months to a year. However, your routine screening scheduleshould be discussed with your treating doctor as it may be individualized to your specific case.
11. If my report says that there is "low-grade dysplasia" in Barrett's esophagus, what does it mean?
Low grade dysplasia means that some of the cells in your esophagus have changes that increase your risk of developing esophagus cancer. These are precancerous cells but are an early form of precancer.
12. If my report says that there is "low-grade dysplasia" in Barrett's esophagus will I get cancer?
Up to 20 people out of 100 with low grade dysplasia in Barrett's esophagus are found to have esophagus cancer within 5 years.
13. What follow-up is necessary for "low-grade dysplasia" in Barrett's esophagus? Since dysplasia can be focal and not evenly distributed in the Barrett's esophagus, usuallly more biopsies are performed to ""map"" your esophagus and make sure you do not have something worse.
Some people with low-grade dysplasia are simply closely followed and have biopsies at time intervals set by their doctor. Other doctors may recommend treatment to remove the abnormal lining of their esophagus. You shoulddiscuss the various options with your treating doctor as any treatment must be individualized to your specific case.
14. If my report says that there is "high-grade dysplasia" in Barrett's esophagus, what does it mean?
High grade dysplasia means that areas of your esophagus sampled on your biopsy have changes that carry high risk for developing cancer. The cells of high grade dysplasia have most of the characteristics that pathologists find in cancer, with one exception. Cells of high grade dysplasia do not have the ability to spread all over your body. High grade dysplasia is an advanced precancer of the esophagus.
15. If my report says that there is "high-grade dysplasia" in Barrett's esophagus will I get cancer?
Between 30 and 60 people out of 100 with high grade dysplasia in Barrett's esophagus are found to have esophagus cancer within 5 years. Some people will already have cancer in another part of the Barrett's esophagus when high grade dysplasia is diagnosed. Therefore, it is very important to follow up with your doctor to determine what you should do next.
16. What follow-up is necessary for "high-grade dysplasia" in Barrett's esophagus?
You typically will need to have more biopsies to make sure you do not already have cancer, as your initial biopsies may have missed cancer elsewhere in the Barrett's esophagus. Your doctor may also recommend treatment to remove the abnormal part of the lining of your esophagus. You should discuss the various options with your treating doctor as you and s/he will individualize your treatment to your specific case.
17. What does it mean if my report says I also have inflammation?
Acid from the stomach, trauma from taking medications, or infections, can cause irritation in the esophagus leading to inflammation. Your treating doctor will work with you to find and treat the causes of the irritation, which can help prevent additional abnormalities from developing in your esophagus.