Gastroesophageal reflux disease (GERD) may be associated with more cases of cancers than previously thought, according to a study in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
The relationship of GERD and adenocarcinoma (type of cancer) of the esophagus is clear for tumors located along the tubular portion of the esophagus, regardless of whether Barrett mucosa (a condition where the cellular lining of the esophagus has been changed, often caused by gastric reflux) is found, according to background information in the article. But there is controversy about the origin of tumors located at the far end of the esophagus where it connects to the stomach. Two distinct cancer types arise there. One type is associated with Barrett mucosa and that it is caused by reflux is widely accepted, the authors write, but the second type has no associated Barrett mucosa and it has been proposed that these tumors originate differently. The major evidence in support of this position has been that the second type of tumor has a worse prognosis.
Guiseppe Portale, M.D., of the University of Southern California, Los Angeles, and colleagues compared demographic information, clinical features and tumor characteristics in 215 patients who underwent surgery for cancer of the lining of the far end of the esophagus from January 1992 to December 2002. Pathology reports were reviewed to determine whether there was adjacent Barrett mucosa and whether these tumors represented distinct tumor types.