Prevention and management of early esophageal cancer

Abstract

Early esophageal cancer is defined by its limitation to the esophageal mucosa and submucosa. It has become a curable malignant disease, in sharp contrast to the dismal prognosis of esophageal cancer at advanced stages, which still represents the majority of patients. Understanding the risk factors, establishing surveillance programs for patients at risk, and developing preventative interventions such as dietary and lifestyle changes or pharmacologic interventions hold the potential of reducing the incidence of the disease and of shifting the stage distribution toward early cancer. Endoscopic ultrasound examination is pivotal for distinguishing early from advanced stages of the disease because it allows for accurate assessment of tumor infiltration and regional lymph node involvement. The therapeutic mainstay for early esophageal cancer remains surgery. New, less invasive surgical techniques are being tested that are associated with less morbidity and mortality than standard radical esophagectomies. For patients who are not candidates for surgery, definitive chemoradiation is a viable alternative. New endoscopic ablation techniques, such as endoscopic mucosa resection and photodynamic therapy, are potential alternatives to surgery in patients with cancers limited to the mucosa. For patients with adenocarcinoma of the gastroesophageal junction with submucosal involvement, adjuvant chemoradiation should be considered because of its potential to increase survival.

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

“…Patients with submucosal tumor (pT1b) have a high risk of lymph node metastases, in our series 18.2% (27 of 148), which makes them unsuitable for endoscopic treatment. Therefore, endoscopic resection is limited to patients with high-grade dysplasia or mucosal tumors (Korn, 2004), especially for patients with high-grade dysplasia, as no lymph node metastases and systemic disease reported. Most of the previous studies confirmed that lymph node metastases were rare in patients with mucosal tumor (Endo et al, 2000;Fujita et al, 2001;DeMeester, 2010;Bogoevski et al, 2011), but some studies reported a rate of higher than ten percent for lymph node metastases in mucosal tumor (Matsubara et al, 1999).…”

The Importance of Concurrent Chemotherapy for T1 Esophageal Cancer: Role of FDG-PET/CT for Local Control

“…Although the majority of patients with esophageal cancer (EC) presented with locally advanced disease in historical series, more recent series show that with increased surveillance endoscopy, many patients (18-33%) are being diagnosed with early-stage lesions (1,2). T1 EC is defined as a malignant tumor that is limited to the lamina propria mucosa or muscularis mucosa (stage T1a), or submucosa (stage T1b) in the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control TNM staging system (3).…”