Role of endoscopic therapy in early esophageal cancer

Abstract

Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.

Study on incidence of oesophageal carcinoma in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital

“…Endoscopic mucosal resection and endoscopic submucosal dissection are endoscopic techniques that permit targeted removal of superficial tissue of the GI tract. 11 Ablation techniques include photodynamic therapy, cryotherapy, argon plasma coagulation, heater probe treatment, and radiofrequency ablation. 11 In patients with tumours of stage 2 and 3 -multimodality treatment is beneficial since surgery alone have relatively poor results.…”

“…11 Ablation techniques include photodynamic therapy, cryotherapy, argon plasma coagulation, heater probe treatment, and radiofrequency ablation. 11 In patients with tumours of stage 2 and 3 -multimodality treatment is beneficial since surgery alone have relatively poor results. Chemo radiotherapy has been used as adjuvant, neoadjuvant and as definitive therapy according to the stage of the disease and the response of the tumour 12…”

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

“…[74][75][76] Modern improved endoscopic diagnostic techniques have reduced the risk of occult carcinoma, with a more recent study finding a rate of 12.7%. 77,78 The alternative approach to surgery was frequent surveillance endoscopy with biopsy to monitor for progression of disease in order to avoid the morbidity and mortality associated with surgery. 75,79 Patients undergoing EET for BE with dysplasia, however, still require frequent and usually lifelong surveillance with biopsies to closely monitor disease.…”

Increased Risk of Esophageal Cancers Among Men in Taiwan

“…The latter tumors require more extensive management, including chemotherapy and/or radiotherapy. Tumor removal may not be effective, as many patients experience postoperative complications [3]. The high mortality rates in these patients may be due to the methods used to manage this disease or the disease itself [4].…”