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. If your doctor says that you have cancer in your esophagus, it means that a pathologist, looking at the tissue samples your doctor took, found cancer in the tissue. A cancer diagnosis means that you have a tumor that is able to spread to other parts of your body.
1. What if my report says "adenocarcinoma"?
Adenocarcinoma of the esophagus is a cancer (tumor) that can occur in Barrett's Esophagus (see FAQ #3) or can be a stomach cancer that started at the junction of the esophagus and the stomach and grew into the esophagus. Adenocarcinoma of the esophagus and adenocarcinoma of the stomach near the gastroesophageal junction are the same type of cancer. They look alike and generally will behave the same.
2. What if my report says "squamous carcinoma" ("squamous cell carcinoma")?
Squamous carcinoma of the esophagus is a type of cancer (tumor) whose cells resemble the cells that make up the normal lining of the esophagus (see FAQ#3). Squamous carcinoma usually arises in a setting of smoking, prior injury to the esophagus from radiation, chemical ulceration, or alcohol abuse. Squamous carcinoma is not associated with Barrett's esophagus.
3. What does it mean if in addition to cancer, my report also mentions "Barrett's", "goblet cells", "intestinal metaplasia", or "squamous"?
The lining of the esophagus and stomach is known as the "mucosa." Most of the esophagus is lined by a tough covering called "squamous mucosa." Squamous mucosa is made up of many layers of flat cells that are similar to skin cells, but are on the inside of the esophagus. Goblet cells make up part of the normal lining in the intestines, but not in the esophagus. When goblet cells develop in a place where they are not supposed to be, this is called "intestinal metaplasia." When intestinal metaplasia occurs in the esophagus, it is called "Barrett's esophagus" Adenocarcinomas can start in Barrett's Esophagus or they can start in the part of the stomach just next to the esophagus. Squamous carcinomas arise from the squamous lining (mucosa) of the esophagus. In most cases of squamous carcinoma, the squamous lining is abnormal where the cancer starts.
4. What is the significance of Barrett's Esophagus if cancer is already present?
There is no significance. The presence of Barrett's esophagus does not affect the behavior of the cancer.
5. What does "invasive" or "infiltrating" mean?
"Invasive" or" infiltrating" means the cancer has broken through or "invaded" the mucosa (lining) of the esophagus and is present in the muscle tissue that makes up the wall of the esophagus.
6. Is it important that the cancer is invasive?
How far a tumor has invaded the wall of the esophagus is one way that pathologists predict how likely a cancer can be cured or whether you need additional treatment. If a cancer has invaded deeply, most patients will have cancer spread to other organs outside the esophagus and will need treatment to prevent the cancer outside the esophagus from growing.
7. Can the pathologist tell how deeply a cancer has invaded on a biopsy?
A biopsy only samples the mucosa (lining) of the esophagus and sometimes a little bit of the tissue underneath the mucosa. The pathologist can usually only determine that a cancer has invaded the mucosa and perhaps the tissue underneath. Because a biopsy does not take a piece of the whole wall, the pathologist cannot tell how far the tumor has gone and consequently cannot determine the prognosis. The pathologist must wait for removal of the entire tumor before s/he can measure how far a cancer has invaded the wall of the esophagus.
8. What does "differentiation", "differentiated" or grade refer to?
Cancers have features under the microscope that show how they will behave. When cancer cells look almost normal, the cancer tends to grow slower and tends not to "seed" other organs as often. When cancer cells don't look like normal tissue, the cancer tends to grow quickly, invade deeply, and seed other organs.
Differentiation is one of the words pathologists use to describe how closely cancer cells resemble normal tissue. If a tumor is "well differentiated" it has features that more closely resemble normal tissue. A "poorly differentiated" cancer is a cancer that does not resemble normal tissue and tends to behave aggressively.
Grade is another way of telling differentiation of the cancer. Esophageal cancer is usually divided into three grades. Grade 1 is the same as well differentiated, grade 2 means moderately differentiated, and grade 3 means poorly differentiated. Some pathologists use two grades. Low grade means well to moderately differentiated and high grade means poorly differentiated.
9. What is the significance of the grade of the cancer?
Grade is one of the many factors that helps determine how aggressive a given cancer is. Poorly differentiated cancers tend to be more aggressive. However, other factors in addition to grade, such as how far the cancer has spread (which cannot be determined on the biopsy) also affect the prognosis (how likely a person will survive the cancer).
10. What does it mean if there is vascular, lymphatic, or lymphovascular invasion?
These terms mean that cancer is present in the vessels (arteries, veins, and/or lymphatics) of theesophagus and that there is an increased chance that cancer could spread out of the esophagus. However, your cancer could still be curable,depending on other factors.
11. What is a metastasis?
When "seeding" of other organs by a cancer results in new tumor growths in other organs, the new tumor growths are called metastases. Metastases to organs like the brain and liver interfere with their function and can lead to organ failure. The pathologist looks for metastases in the tumor resection and in biopsies of other organs your physician may take. X-rays or other studies can also detect lesions that might be metastases.