Understanding Your Pathology Report: Esophagus Carcinoma (With or Without Barrett’s)

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.

What if my report says adenocarcinoma?

Adenocarcinoma is a type of cancer that develops in gland cells. In the esophagus, adenocarcinoma can arise from the cells of Barrett’s esophagus.

What if my report says squamous carcinoma (squamous cell carcinoma)?

The lining of the esophagus is known as the mucosa. In most of the esophagus the top layer of the mucosa is made up of squamous cells. This is called squamous mucosa. Squamous cells are flat cells that look similar to fish scales when viewed under the microscope. They are also found on the surface of the skin. Squamous carcinoma of the esophagus is a type of cancer that arises from the squamous cells that line the esophagus.

What does it mean if in addition to cancer, my report also mentions Barrett’s, goblet cells, intestinal metaplasia, or squamous?

Goblet cells normally line the intestines, not the esophagus. When goblet cells develop in a place where they are not supposed to be, like the esophagus, it is called intestinal metaplasia. Intestinal metaplasia can develop any place where squamous mucosa is normally found. When intestinal metaplasia occurs in the squamous mucosa of the esophagus it is called Barrett's esophagus. The most common cause of Barrett’s esophagus is reflux of the stomach contents into the esophagus, which is often called gastro-esophageal reflux disease or GERD.

What does it mean if I have Barrett’s esophagus and cancer is already present?

Barrett’s esophagus is only important because it raises your risk of cancer. If you already have cancer, having Barrett’s is not important.

What does invasive or infiltrating mean?

Invasive or infiltrating means that cancer cells have grown beyond the mucosa (the inner lining of the esophagus). This means that it is a true cancer and not a pre-cancer.

Does this mean that the tumor has invaded deeply and is associated with a poor prognosis?

No, all it means is that it is a true cancer (and not a pre-cancer).

On a biopsy, only a small sample of tissue is removed, and the pathologist usually cannot tell how deeply the tumor is invading. The depth of invasion will be measured when the entire tumor is removed at surgery.

What does differentiation mean?

Differentiation or grade of the cancer is based on how abnormal the cells and tissue look under the microscope. It is helpful in predicting how aggressive a cancer is (how fast it may grow and spread). Esophageal cancer is usually divided into 3 grades:

  • Well differentiated (or low-grade)
  • Moderately differentiated (or intermediate-grade)
  • Poorly differentiated (or high-grade)

Sometimes, it is just divided into 2 grades: well-moderately differentiated and poorly differentiated.

What is the significance of the grade of the cancer?

Grade is one of the many factors that helps determine how aggressive a cancer is. Poorly differentiated cancers tend to be more aggressive− they tend to grow and spread more quickly−while well differentiated cancers tend to grow more slowly. However, other factors are also important.

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 the esophagus. If the cancer has grown into these vessels, there is an increased chance that it could have spread out of the esophagus. You should discuss this finding with your doctor.

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.

Learn more about the FAQ Initiative

Last Medical Review: October 14, 2014 Last Revised: October 14, 2014

Copyright 2011 Association of Directors of Anatomic and Surgical Pathology, adapted with permission by the American Cancer Society.