Screening high‐risk populations for esophageal and gastric cancer

Abstract

Cancers of the esophagus and stomach remain important causes of mortality worldwide, in large part because they are most often diagnosed at advanced stages.Thus, it is imperative that we identify and treat these cancers in earlier stages. Due to significant heterogeneity in incidence and risk factors for these cancers, it has been challenging to develop standardized screening recommendations. This review summarizes the current recommendations for screening populations at high risk of developing esophagogastric cancers. K E Y W O R D SBarrett's esophagus, genetics, risk factors 1 | ESOPHAGEAL CANCER | IntroductionEsophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in its advanced stages. While EC is the 8th most common cancer in the world, it is the 6th most common cause of cancer-related deaths, with a 5-year survival rate of less than 20% despite advances in treatment. This poor prognosis is largely due to the often late detection of this cancer, owing primarily to the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis, 1 with greater than 30% of patients having metastatic disease at presentation. Certain countries around the world have addressed this with endoscopic screening programs for their high-risk populations, and with this many have seen a promising improvement in their survival rates.The screening of high-risk populations for EC differs for the two epidemiologically and biologically distinct subtypes of esophageal cancer. Esophageal adenocarcinoma (EAC) is the most common subtype in the United States, UK, and Western Europe and has been linked to gastroesophageal reflux disease (GERD) and obesity.Esophageal squamous cell carcinoma (ESCC) is the more common subtype worldwide, accounting for over 80% of EC cases. 2 ESCC is particularly prevalent in Asia, East Africa, and South America and is known to be associated with tobacco, alcohol, and consumption of nitrogenous foods. Rarely, other histological subtypes-sarcomas and small cell carcinomas-develop in the esophagus, comprising less than 1%-2% of all esophageal cancers. 3 Globally, the burden of disease is predominantly comprised of ESCC and EAC, and as distinct entities with both regional and epidemiologic differences, the methods and approaches to screening differ. 2 | ESOPHAGEAL ADENOCARCINOMA 2.1 | Epidemiology EAC is the predominant subtype of esophageal cancer in the United States, Europe, and Australia, with incidence rates that have risen by approximately 500% in the UK and 600% in the United States over the past four decades. Annual rates of increase range from 3.5% per year in Scotland to 8.1% per year in Hawaii, with a similar proportional increase in both men and women. 4 2.2 | Risk factors 2.2.1 | DemographicsThe risk of EAC is associated with older age, with the risk increasing by 3-to 4-fold in patients over the age of 50 years, 5 and male sex, with a 6-to 8-fold higher risk in males than females. 6 In the United States, the

LncRNA NEAT1 promotes gastric cancer progression via miR-1294/AKT1 axis

“…Gastric cancer (GC) is regarded as the third reason for death caused by tumors [25]. As a heterogeneous disease, the risk factors of GC cover different aspects, including age, Helicobacter pylori, familial syndromes, tobacco, alcohol, and diet [15]. Although some precancerous lesions can be screened by radiography, endoscopy, and serology [15], most patients with GC have been diagnosed at an advanced stage because of the unobservable symptoms.…”

Reactive Oxygen Species-Mediated Autophagy by Ursolic Acid Inhibits Growth and Metastasis of Esophageal Cancer Cells

“…The proven risk factors for ESCC are alcohol consumption and tobacco use [7]; however, acknowledged risk factors include low consumption of fruits and vegetables, zinc or vitamin E deficiency, and poor oral hygiene, which can be attributed to low socioeconomic status and living in a developing country [8,9]. ESCC is a heterogeneous disease with variable outcomes that are challenging to predict [10,11]. The best curative method for ESCC is surgery; however, complete surgical removal of ESCC is difficult in patients with late-stage ESCC [12,13], resulting in a high incidence of tumor recurrence.…”

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

“…The median time of ESD operations was 65.3 minutes (range 10-246), while the BEI patients required longer procedure time, which was 72.9 minutes (range 18-223) (P = 0.007). The average hospitalization time was 6.6 days (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Similarly, the EI and BEI patients stayed longer than the AI patients (P = 0.012).…”