Barrett’s esophagus is associated with an increased risk of which type of esophageal cancer?

• A. Adenocarcinoma
• B. Squamous cell carcinoma
• C. Small cell carcinoma
• D. Leiomyosarcoma

Answer: (A)

Barrett’s esophagus involves intestinal metaplasia of the distal esophageal mucosa due to chronic acid exposure from gastroesophageal reflux. This metaplastic, goblet-cell–containing epithelium is more prone to accumulating genetic changes that drive progression from metaplasia to dysplasia and then to adenocarcinoma, particularly at the gastroesophageal junction. That’s why esophageal adenocarcinoma is the cancer most associated with Barrett’s. In contrast, squamous cell carcinoma comes from the native squamous lining and is linked to risk factors like smoking and alcohol; it occurs more often in the mid to upper esophagus. Small cell carcinoma and leiomyosarcoma are distinct histologies not driven by Barrett’s.