When your esophagus was biopsied with an endoscope, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your biopsy.
The esophagus is a tubular organ that connects the mouth to the stomach. The place where the esophagus meets the stomach is called the gastro-esophageal junction, or GEJ.
The inner lining of the esophagus is known as the mucosa. It is called squamous mucosa when the top layer is made up of squamous cells. Squamous cells are flat cells that look similar to fish scales when viewed under the microscope. Most of the esophagus is lined by squamous mucosa.
Goblet cells normally line the intestines, not the esophagus. When goblet cells are found in a place where they are not supposed to be, like the lining of the esophagus, it is called intestinal metaplasia. Intestinal metaplasia can develop any place where squamous mucosa is normally found. When intestinal metaplasia replaces the squamous mucosa of the esophagus, it is called Barrett's esophagus.
Barrett’s esophagus occurs when chronic or long-term reflux (regurgitation) of the stomach contents up into the esophagus damages the normal inner lining of the esophagus. This process usually takes many years to happen. (Reflux of the stomach contents into the esophagus is sometimes called gastro-esophageal reflux disease or GERD. It can cause heartburn.)
Yes. Patients who have Barrett’s esophagus have a higher risk of cancer of the esophagus. However, most people with Barrett’s esophagus do not get cancer.
Sometimes the cells of Barrett’s esophagus become more abnormal. This is called dysplasia. Dysplasia is a pre-cancer. Although the cells are abnormal, they do not have the ability to spread to other sites. This condition can be treated. Dysplasia is often divided into 2 grades based on how abnormal the cells appear under the microscope: low-grade and high-grade. (This is discussed in more detail later on.)
This means that you do not have any pre-cancerous (premalignant) changes in your biopsies.
It means that your biopsy showed Barrett’s esophagus that contains some cells that are abnormal, but not abnormal enough to consider them dysplasia. Often, people with these changes have a lot of reflux, which irritates the cells in the esophagus so that the cells look abnormal under the microscope.
People who have Barrett’s esophagus with changes indefinite for dysplasia have a small increase in their risk of esophagus cancer, but most do not go on to get this cancer.
If you have these findings, your doctor may ask you to return for another endoscopy and more biopsies within 3 to 6 months, after increasing your medication to treat your reflux. Follow-up schedules can vary, though, so you should discuss what is best for you with your doctor.
Low-grade dysplasia means that some of the cells look abnormal when seen under the microscope. These cells may look a lot like cancer cells in some ways, but unlike cancer, they do not have the ability to spread all over your body. This is a very early form of pre-cancer of the esophagus.
People with low-grade dysplasia in Barrett’s esophagus do have an increased risk of esophagus cancer, but most do not go on to get this cancer.
Your doctor might want to do another endoscopy to obtain more biopsies of your esophagus to make sure you do not have something worse. In addition, your doctor may ask that your samples be sent to an expert to review them under the microscope
Your doctor will probably recommend some sort of treatment to remove the abnormal area (usually to remove both the area of Barrett’s esophagus and the dysplasia). You should discuss your treatment options with your doctor.
High-grade dysplasia means that some of the cells contained in the area of Barrett’s esophagus look very abnormal under the microscope. This is a more advanced pre-cancer of the esophagus than low-grade dysplasia.
People with high-grade dysplasia in Barrett’s esophagus have a high risk of getting esophagus cancer.
Your doctor might want to repeat the endoscopy to do more biopsies to make sure you do not already have cancer that wasn’t seen the first time. Your doctor may ask that your biopsy slides be sent to another pathologist for a second opinion concerning the cells on your slides.
Since high-grade dysplasia is strongly linked to cancer, your doctor will recommend some sort of treatment for the dysplasia. Different patients may be treated in different ways, so discuss your treatment options with your doctor. Most of the treatments can be done without removing your esophagus.
A number of different things can irritate the esophagus and lead to inflammation, including stomach acid, trauma from taking medicines, and infections. Your doctor will work with you to find the cause of the irritation and treat it. This can help prevent more serious problems.
This series of Frequently Asked Questions (FAQs) was developed by the Association of Directors of Anatomic and Surgical Pathology to help patients and their families better understand what their pathology report means. These FAQs have been endorsed by the College of American Pathologists (CAP) and reviewed by the American Cancer Society.
Last Revised: March 6, 2017
Copyright 2017 Association of Directors of Anatomic and Surgical Pathology, adapted with permission by the American Cancer Society.