Esophageal squamous cell carcinoma - precursor lesions and early diagnosis

Abstract

Squamous cell carcinoma of the esophagus (SCCE) carries a poor prognosis due to late diagnosis. Early detection is highly desirable, since surgical and endoscopic resection offers the only possible cure for esophageal cancer. Population screening should be undertaken in high risk areas, and in low or moderate risk areas for people with risk factors (alcoholics, smokers, mate drinkers, history of head and neck cancer, achalasia and lye stricture of the esophagus). Esophageal balloon cytology is an easy and inexpensive sampling technique, but the current methods are insufficient for primary screening due to sampling errors. Conventional endoscopy with biopsy remains the standard procedure for the identification of pre-malignant and early malignant changes in esophageal mucosa and endoscopic detection. It may be enhanced by several techniques such as dye and optic chromoendoscopy, magnifying endoscopy, and optical-based spectroscopic and imaging modalities. Since more than 80% of SCCE deaths occur in developing countries, where expensive techniques such as narrow band imaging (NBI) and autofluorescence imaging are unavailable, the most cost-effective tool for targeting biopsies may be Lugol dye chromoendoscopy, since it is easy, accurate, inexpensive and available worldwide. In ideal conditions, or in developed countries, is it reasonable to think that optimal detection will require a combination of techniques, such as the combination of Lugol's chromoendoscopy and NBI to identify esophageal areas that require further characterization by a high resolution technique. The efficacy and cost-effectiveness will determine whether these modalities will become part of standard endoscopy practice.

Current advances in esophageal cancer proteomics

“…The most sensitive tool for the early detection of EC is chromoendoscopy with Lugol's dye [33]. During the 1990s, multiple reports demonstrated that endoscopy provided an easy, inexpensive, and sensitive means of detecting early and late squamous cell neoplasia.…”

Effect of Routine Esophageal Screening in Patients With Head and Neck Cancer

“…However, many patients in the routine screening group had advanced ESCC, with the primary survey identifying tumor invasion of other adjacent structures or regional lymph node metastases (and even distant metastases). The introduction of techniques such as narrow band imaging 15,16 and Lugol dye spray chromoendoscopy 17 or shortening the interval between examinations to 3 months may be helpful in these patients to diagnose earlier ESCC.…”

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study

“…It was not detected preoperatively, probably due to lack of adequate preparation for endoscopy. Although our series of cases is very limited, it reproduces the well known risk factors for esophageal squamous cell carcinoma 1,3,6 .…”

“…Therefore, the best strategy to improve the chances of long-term survival is the identification of lesions at early stage 5,6 .…”