Diagnosis and treatment of superficial esophageal cancer

Abstract

Endoscopy allows for the screening, early diagnosis, treatment and follow up of superficial esophageal cancer. Endoscopic submucosal dissection has become the gold standard for the resection of superficial squamous cell neoplasia. Combinations of endoscopic mucosal resection and radiofrequency ablation are the mainstay of the management of Barrett’s associated neoplasia. However, protruded, non-lifting or large lesions may be better managed by endoscopic submucosal dissection. Novel ablation tools, such as argon plasma coagulation with submucosal lifting and cryoablation balloons, are being developed for the treatment of residual Barrett’s esophagus, since iatrogenic strictures still hamper the development of extensive circumferential resections in the esophagus. Optimal surveillance modalities after endoscopic resection are still to be determined. The assessment of the risk of lymph-node metastases, as well as of the need for additional treatments based on qualitative and quantitative histological criteria, balanced to the patient’s condition, requires a dedicated multidisciplinary team decision process. The need for trained endoscopists, expert pathologists and surgeons, and specialized multidisciplinary meetings underlines the role of expert centers in the management of superficial esophageal cancer.

Accuracy and Pitfalls in the Assessment of Early Gastrointestinal Lesions

“…Oesophageal cancer is the eighth most common cancer and sixth most common according to mortality [17,18]. In Asia, the most common histological type is SCC, while in Northern Europe and America adenocarcinoma predominates [17,19].…”

“…In Asia, the most common histological type is SCC, while in Northern Europe and America adenocarcinoma predominates [17,19].…”

“…Superficial carcinoma of the oesophagus is classified into the T1 group according to the TNM classification [17]. If the oesophageal carcinoma infiltrates the submucosa, it is classified as T2 class, which includes T2bsm 1, 2 or 3, depending on which segment of the submucosa is infiltrated [17].…”

“…If the oesophageal carcinoma infiltrates the submucosa, it is classified as T2 class, which includes T2bsm 1, 2 or 3, depending on which segment of the submucosa is infiltrated [17]. Intraepithelial carcinoma or lamina propria involvement has a negligible risk for nodal metastasis, whereas tumours involving the muscularis mucosa, superficial or deep submucosa and beyond have a metastatic frequency of 8-54% [19].…”

“…Superficial oesophageal neoplasia is most often detected as discrete flat lesions [17]. During endoscopy, special attention must be paid to the right lateral wall, and to the cervical narrowing of the oesophagus [19].…”