Esophageal cancer screening
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Esophageal cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Esophageal cancer screening On the Web |
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American Roentgen Ray Society Images of Esophageal cancer screening |
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Risk calculators and risk factors for Esophageal cancer screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Screening may be effective in reducing the incidence of esophageal cancer, especially with Barrett's esophagus-associated adenocarcinoma, however, not very cost effective.
Screening
Adenocarcinoma screening
- The predominant type of esophageal cancer in the United States is adenocarcinoma.
- Under current guidelines, random endoscopic biopsies are taken in all 4 quadrants with a high resolution endoscope.
- Dysplasia within lesions of Barrett's esophagus indicates a marked increase in cancer risk.
- It should be noted that those who presented with adenocarcinoma demonstrated no prior Barrett's esophagus in 80 - 90% of the time.
- Most dysplastic changes were found in 50 year old white men.
- In one study, the authors concluded that the only cost-effective strategy was once in a lifetime screening of 50-year-old white men with GERD, followed by surveillance of those with dysplasia only.[1]
Squamous cell carcinoma screening
- Since this histological type of esophageal cancer exists in the more underdeveloped countries, there is no reliable data to suggest that screening programs are effective when implemented.
- However, in China, esophageal cancer is the sixth most common cancer and the fourth most common cause of death from cancer, the incidence of which is about 287,000 new cases and 211,000 deaths in 2012. A screening program has been put into effect where those with mild to moderate dysplasia are examined via endoscopy every 3 years, whilst those with severe dysplasia are screened once per year. Therefore, high risk populations may be of benefit in reducing the incidence of esophageal cancer.
- In 1983, a study was carried out in Hishun village, China.
- Due to different dietary factors, the incidence of esophageal cancer amongst these people was particularly high.
- 6758 subjects were examined by esophageal exfoliative cytology, 1729 had marked dysplasia and 2411 had mild dysplasia of esophageal epithelium.
- Those with marked dysplasia were randomly divided into 3 groups and given: antitumor B (Chinese herbs); retinamide (4-Ethoxycarbophenylretinamide) and placebo.
- The subjects with mild dysplasia were randomly divided into 2 groups for treatment with riboflavin and placebo.
- They took their respective treatments for 3 years and were then reexamined using cytology.
- The incidence of esophageal cancer in the antitumor B group was reduced by 53% as compared with that of the placebo group (8.3%).
- The incidence of esophageal cancer in retinamide and riboflavin groups were reduced by 33.7% and 19% as compared with those of the control groups.
- These results demonstrated that the secondary prevention of esophageal cancer is effective in the prevention of esophageal cancer.[2]
References
- ↑ Domper Arnal MJ, Ferrández Arenas Á, Lanas Arbeloa Á (2015). "Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries". World J. Gastroenterol. 21 (26): 7933–43. doi:10.3748/wjg.v21.i26.7933. PMC 4499337. PMID 26185366.
- ↑ Lin PZ, Zhang JS, Cao SG, Rong ZP, Gao RQ, Han R, Shu SP (1988). "[Secondary prevention of esophageal cancer--intervention on precancerous lesions of the esophagus]". Zhonghua Zhong Liu Za Zhi (in Chinese). 10 (3): 161–6. PMID 3219974.