The therapeutic strategy for adenocarcinoma in Barrett's esophagus is discussed based on a comparison with squamous cell carcinoma. The pattern and range of lymph node metastasis of adenocarcinoma in Barrett's esophagus is similar to that of squamous cell carcinoma, as is the pattern of recurrence. Chemotherapy is less effective, except for some reports on paclitaxel, but chemoradiation therapy is comparable in effect. The general tendency of a better prognosis for patients with carcinoma in Barrett's esophagus is the result of several factors, such as earlier detection of the disease, lower probability of lymph node metastasis, and distal location which permits less radical curative surgical procedures without cervical and superior mediastinal lymph node dissection. In principal the therapeutic strategy for adenocarcinoma in Barrett's esophagus should be determined like that for squamous cell carcinoma, taking into account the location of the lesion and the depth of invasion.