Dysplasia and Cancer Screening and Treatment

Dysplasia and Cancer Screening

Periodic endoscopic examinations to look for early warning signs of cancer are generally recommended for people who have Barrett's esophagus. This approach is called surveillance. When people who have Barrett's esophagus develop cancer, the process seems to go through an intermediate stage in which pre-cancerous cells appear in the Barrett's tissue. This condition is called dysplasia and can be seen only in biopsies of tissue examined under a microscope. The process is patchy and cannot be seen directly through the endoscope, so multiple biopsies must be taken. Even then, cancer cells can be missed.

The process of change from Barrett's to cancer seems to happen in only a few patients, less than 1 percent per year, and over a relatively long period of time. Most physicians recommend that patients with Barrett's esophagus undergo periodic surveillance endoscopy to have biopsies. The recommended interval between endoscopies varies depending on specific circumstances, and the ideal interval has not been determined.

Treatment for Dysplasia or Cancer

If a person with Barrett's esophagus is found to have high-grade dysplasia or cancer, the doctor will discuss treatment options. These options include:

• Surgery: This is usually recommended for those in good health with high-grade dysplasia or early stage cancer. The type of surgery may vary, but it usually involves removing most of the esophagus and pulling the stomach up into the chest to attach it to what remains of the esophagus. Many patients with Barrett's esophagus and high-grade dysplasia or cancer are elderly or have medical conditions that make surgery unwise.
• Endoscopic ablation: In these techniques, the Barrett's lining is destroyed and healthy tissue is allowed to grow in its place. These treatments are given during upper endoscopy, and no surgery is required.
• Photodynamic therapy (PDT): a light-sensitizing drug and laser are used to destroy the abnormal tissue. Extensive data is available on the success and risks of PDT. The drawbacks of PDT include pain after the procedure, risk of stricture (esophageal scarring), and need to avoid direct sunlight for 4-6 weeks.
• Cryotherapy: the tissue is destroyed by exposing the cells to extreme cold using liquid nitrogen. Early results from this technique show similar success rates to PDT for removal of the abnormal tissue with significantly less side effects.
• Radiofrequency ablation: is a very localized treatment that kills the abnormal cells with heat. Doctors at the University of Maryland are using the HALO Ablation System, which consists of a catheter with a balloon at the tip for delivering short bursts of energy to the treatment area.

For patient inquiries, call 1-800-492-5538 or If you prefer, you may call the division directly at 410-328-5780.