Role of Endoscopy in Screening and Treatment of Gastrointestinal Cancer

Abstract

Gastrointestinal cancer includes tumors of the proximal and distal stomach which are explored by upper GI endoscopy, using a flexible endoscope. It includes also tumors of the large bowel (colon and rectum), explored with flexible endoscopes by a complete colonoscopy or by a simple sigmoidoscopy. In 2008 the number of incident cases occurring in the World is estimated at 988 602 for gastric cancer and at 1 235 108 for colorectal cancer. A trigger role is played by Helicobacter pylori infection in gastric cancer, and by Diet, Nutrition and physical activity, in colorectal cancer. Gastric cancer is more frequent in developing countries of Asia and Latin America; colorectal cancer is more frequent in more developed countries of North America and Europe. For both tumors, endoscopic diagnosis is based on a 2 steps analysis, with detection followed by charaterization and prediction of histology, before decision of endoscopic resection. Techniques of endoscopic resection include polypectomy with a ligating snare, and modalities of resection called EMR and ESD. Endoscopic diagnosis with eventual treatment is the final step of all screening strategies, either in organized mass screening under the control of Health Authorities, or in Opportunistic screening in individual cases. In mass screening, endoscopy is performed only in persons with a positive filter test. In opportunistic screening endoscopy is a primary procedure. In secondary prevention of cancer, the early treatment of the tumor has a positive impact on survival and mortality. In the colorectum the treatment of premalignant adenomatous polyps has an impact on the reduction of incidence and could be considered as a primary prevention. Terminology and Definition of ScreeningIn clinical practice gastrointestinal cancer concerns tumors located in the stomach and in the large bowel, with colon and rectum. The occurrence of tumors in the long segment of the small intestine is relatively rare, and as a rule, these are considered separately. Gastric cancer is located in the distal stomach and antrum, or in the proximal stomach or cardia. The cardia includes the esophago-gastric junction, where tumors develop either from the squamous epithelium of the distal esophagus or from the gastric epithelium of the cardia. In synthesis for clinical practice, the term gastrointestinal cancer includes tumors of the distal esophagus and of the stomach, explored by upper GI endoscopy and tumors of the large bowel, explored by colonoscopy.In clinical practice persons complaining from appealing digestive symptoms consult their doctor; then an advanced cancer can be detected by radiology or endoscopy. On the other hand, at each tumor site, and in usually asymptomatic persons, screening corresponds to early detection of cancer at a completely curable stage, and will increase the overall 5 years survival from the disease, with a reduction in the mortality rate. In addition, the detection and treatment of premalignant neoplastic precursors will decrease the incidence rate of cance...

High-Resolution ENT Video Endoscope with Superior Image Quality Equivalent to that of Gastric Video Endoscopes

“…In particular, abnormal IPCLs have been reported as an early finding in esophageal and pharyngeal carcinomas [1][2][3][4]. Magnifying endoscopy coupled with NBI has been reported to be useful for detecting IPCLs [3,4].…”

“…At present, esophageal cancer can be detected at an early stage by observing characteristic vascular abnormalities such as abnormal Intraepithelial Papillary Capillary Loops (IPCLs) [1][2][3][4]. Pharyngeal carcinoma has been detected in the same manner, and carcinomas of the head and neck can be detected early with the use of video endoscopes in the upper gastrointestinal tract [5][6][7][8].…”