Superficial and early cancers of the esophagus

Abstract

The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the evolution of Barrett's dysplasia to early cancer; the early detection of esophageal cancer in China; new technologies of treatment for dysplasia; the prognostic value of molecular markers expression in esophageal squamous cell carcinoma; the follow-up schedule after ablation of high-grade dysplasia; intramucosal cancers; and tubular widespread endoscopic esophageal submucosal dissection with high-dose steroid stricture prevention.

A suggested framework for conducting esophageal cancer screening in China

“…However, conducting screening programs in high‐risk areas in China has exhibited significant benefit and a decrease in incidence and mortality . Though global screening guidelines had not been established until recently, national and regional screening strategies were in place for decades before the introduction of global screening guidelines …”

“…In 2006, a national early detection and treatment guideline for EC was introduced, which stated that screening was to be performed by endoscopy accompanied with iodine staining and indicative biopsy among 40‐ to 69‐year‐old individuals in high‐incidence rural areas in China. Initially, the screening program was conducted in eight high‐incidence rural areas only, resulting in 412 641 individuals who were screened between 2006 and 2012 . Subsequently, this screening and treatment program was extended to urban areas, including screening for lung, breast, colorectal, upper gastrointestinal, and liver cancers .…”

“…20 Though global screening guidelines had not been established until recently, national and regional screening strategies were in place for decades before the introduction of global screening guidelines. [21][22][23] In China, the first cancer screening programs were implemented in 2001 in high-risk rural areas that first focused on three types of cancers, including cancers of the stomach, breast, and cervix. Screening programs for colorectal and liver cancers were later introduced in 2005.…”

“…Initially, the screening program was conducted in eight high-incidence rural areas only, resulting in 412 641 individuals who were screened between 2006 and 2012. 22 Subsequently, this screening and treatment program was extended to urban areas, including screening for lung, breast, colorectal, upper gastrointestinal, and liver cancers. 26 "Chinese Cancer Prevention and Control Three-year Action Plan (2015-2017)" proposed an expansion of this screening and treatment program for cancers with high diagnostic sensitivity, including EC and cervical carcinoma, to cover about 50% of the high-incidence areas.…”

Comparison of two major staging systems of esophageal cancer—toward more practical common scale for tumor staging

“…T1a and T1b in UICC classification are both subclassified into three levels, i.e., T1a to T1a-EP, T1a-LPM, and T1a-MM, and T1b to T1b-SM1, T1b-SM2, and T1b-SM3. This meticulous subclassification in JES system is based on the large data of superficial cancer treatments in Japan (8,9), T1a-EP and T1a-LPM are usually handled in one group and regarded as good candidates of local treatment such as endoscopic submucosal dissection (ESD) because almost no lymph node metastases have been experienced in these patients (10). T1b-SM2 and T1b-SM3 are associated with 40% or more frequent nodal involvement, and radical surgery similar to T2 or more advanced tumors is recommended.…”