What is High-Grade Dysplasia of the Esophagus?
High grade dysplasia (HGD) refers to precancerous changes in the cells of the esophagus. Gastroesophageal reflux disease (GERD) can be complicated by Barrett’s esophagus (BE), a change in the normal esophageal cells to intestinal-like cells. BE cells can become abnormal or dysplastic. Low grade and then high grade dysplasia can develop. HGD significantly increases a person’s risk for esophageal adenocarcinoma and in most cases will progress to cancer without any treatment. When someone is diagnosed with HGD, an intervention is advised including endoscopic resection and Barrx ablation or in some cases an esophagectomy is recommended for treatment.
Treatment of HGD requires an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.
What are the Symptoms of High-Grade Dysplasia?
You may not experience any symptoms, but they can include:
- A loss of your heartburn symptoms from GERD, can suggest Barrett’s esophagus has developed (although you can have heartburn and BE). HGD occurs in the setting of BE; thus, HGD would be found on an endoscopy for GERD or BE surveillance.
- If you have trouble swallowing, this suggests the dyplasia has progressed to cancer.
What are the Causes?
Dysplasia is a complication of gastroesophageal disease (GERD) and BE.
How is High-Grade Dysplasia Diagnosed?
Diagnosis is often difficult, as symptoms may be limited.
Endoscopy
You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.
How is High-Grade Dysplasia Treated?
There are a variety of ways we can treat your high-grade dysplasia. Your physician will work with you and your family to decide the most appropriate course of action. Your options include:
Endoscopic Mucosal Resection
Endoscopic mucosal resection, or EMR, is one of the newer, more minimally invasive techniques we offer for our esophageal cancer patients who have small tumors that have not spread outside of the esophagus. It may also be beneficial for patients with Barrett's esophagus. In this simple procedure, we are able to locate, remove, and examine cancerous or precancerous lesions of the esophagus. The mucosa is the innermost lining of the esophagus, and it extends down into your gastrointestinal tract. Cancers in this tract often originate in the mucosa, thus making visualization and access to it essential for diagnosis and treatment.
Radiofrequency Ablation with Barx ablation
Heat energy is applied to any areas of intestinal metaplasia to destroy the cells and allow replacement with normal appearing esophagus cells.
Esophagectomy
Esophagectomy is the surgical removal of the esophagus. Esophagectomy typically is recommended when the cancer has not spread to other parts of your body, and is potentially curable. In esophagectomy, most of your esophagus and nearby lymph nodes are removed, your stomach then moved up and attached to the remaining portion of your esophagus. There are several techniques for performing esophagectomy. Your surgeon will consider several factors such as overall condition, the size and location of the tumor, and the involvement of the tissue and organs near the tumor.
Photodynamic Therapy
Photodynamic therapy (PDT), also called photoradiation therapy, phototherapy, and photochemotherapy, has existed for about 100 years and is a type of cancer treatment that uses light to kill abnormal cells. A special drug called a photosensitizer or photosensitizing agent is circulated through the bloodstream.