COMMENTARY
Oesophageal adenocarcinogenesis
Open questions in oesophageal adenocarcinogenesis
Correspondence to:
Correspondence to:
Dr C C Maley
Molecular and Cellular Oncogenesis Program, The Wistar Institute, 3601 Spruce Street, Philadelphia, PA 19104, USA; cmaley@wistar.org
Transition from GORD to Barretts oesophagus, and possibility of a reversal mechanism
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Barretts oesophagus develops as a complication of chronic gastro-oesophageal reflux disease (GORD), and is the only known precursor to oesophageal adenocarcinoma (EA). Barretts oesophagus is an ideal model for studying neoplastic progression, because it can be studied longitudinally in vivo, with protocols that allow for safe, reproducible sampling by endoscopy biopsies.1 Furthermore, the major genetic events that characterise progression in Barretts oesophagus are some of the most common genetic events across human neoplasms, including inactivation of the tumour suppressor genes p16 (CDKN2A/INK4A)2,3 and p53 (TP53),4,5 with the subsequent development of tetraploidy and aneuploidy.6,7,8,9,10
There are important open questions at all stages of progression from GORD to EA. Little is known about the transition from GORD to Barretts oesophagus. What is the cell of origin for Barretts oesophagus? And why do only a minority of patients with GORD undergo that transition? The presence of p16, p53 and ploidy lesions
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