Modern Diagnosis of Early Esophageal Cancer: From Blood Biomarkers to Advanced Endoscopy and Artificial Intelligence

Abstract

Esophageal cancer (EC) is the seventh most common cancer and the sixth cause of cancer death worldwide. Histologically, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for up to 90% and 20% of all ECs, respectively. Clinical symptoms such as dysphagia, odynophagia, and bolus impaction occur late in the natural history of the disease, and the diagnosis is often delayed. The prognosis of ESCC and EAC is poor in advanced stages, being survival rates less than 20% at five years. However, when the diagnosis is achieved early, curative treatment is possible, and survival exceeds 80%. For these reasons, mass screening strategies for EC are highly desirable, and several options are currently under investigation. Blood biomarkers offer an inexpensive, non-invasive screening strategy for cancers, and novel technologies have allowed the identification of candidate markers for EC. The esophagus is easily accessible via endoscopy, and endoscopic imaging represents the gold standard for cancer surveillance. However, lesion recognition during endoscopic procedures is hampered by interobserver variability. To fill this gap, artificial intelligence (AI) has recently been explored and provided encouraging results. In this review, we provide a summary of currently available options to achieve early diagnosis of EC, focusing on blood biomarkers, advanced endoscopy, and AI.

Upregulation of hsa_circ_0000977 participates in esophageal squamous cancer progression by sponging miR‐874‐3p

“…Unlike western countries, in China, 90% is ESCC. 3 The pathophysiology of esophageal cancer is a multi‐factor process characterized by multigene involvement and mutation and multi‐stage evolution. 4 Carcinogenesis results from the long‐term combination of environmental and genetic factors.…”

Pan-immune-inflammation Value and Prognosis in Patients With Esophageal Cancer

“…[13][14][15] The identification of new biomarkers for good prognostic stratification and prediction of therapeutic outcomes for esophageal cancer is desperately needed in the clinical setting. [16][17][18] In particular, simple blood-based biomarkers derived from complete blood count, are readily available and inexpensive markers that can reflect the host immune system. 19 The pan-immune-inflammation value (PIV) is a recently proposed scoring system that includes all immune-inflammatory cells in the peripheral blood count (neutrophil count × platelet count × monocyte count)/lymphocyte count).…”

Esophageal squamous cell carcinoma: Integrated bioinformatics analysis for differential gene expression with identification of hub genes and lncRNA

“…Apart from the metallo endopeptidase activity, several other molecular functions, including chemokine activity, transcriptional activator activity, translation regulatory activity, were included in this study. Previous studies reported similar KEGG pathways linked to the ESCC occurrence [ 3 , 13 , 30 ].…”