Kim James A, Shah Pari M
Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.
Chin Clin Oncol. 2017 Oct;6(5):50. doi: 10.21037/cco.2017.09.05.
Esophageal cancer is the 8th most common cancer worldwide and the 6th most common cause of cancer-related death. Its two main subtypes, esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), have varying incidences globally, but recent decades have seen a demonstrated rise of EAC in Western countries whereas ESCC remains highly prevalent in Eastern Africa, Central Asia, and China. Screening interventions have focused on using endoscopy to identify Barrett's esophagus (BE) as a precursor to EAC, and squamous cell dysplasia prior to onset of ESCC. However, additional cost-effective screening interventions that can be applied to larger populations at risk for esophageal cancer are needed. Advances in endoscopic ablative techniques and endoscopic resection via endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have proven to be effective in eradicating dysplasia and early stage cancer. Preventive strategies involving reduction in tobacco and alcohol consumption as well as regular use of proton pump inhibitors and nonsteroidal anti-inflammatory drugs are aimed at reducing the incidence of dysplasia and esophageal cancer, but require further study before being recommended for widespread use.
食管癌是全球第8大常见癌症，也是癌症相关死亡的第6大常见原因。其两种主要亚型，即食管腺癌（EAC）和食管鳞状细胞癌（ESCC），在全球的发病率各不相同，但近几十年来，西方国家的EAC呈上升趋势，而ESCC在东非、中亚和中国仍然非常普遍。筛查干预措施主要集中在内镜检查以识别作为EAC前驱病变的巴雷特食管（BE）以及ESCC发病前的鳞状细胞发育异常。然而，需要额外的具有成本效益的筛查干预措施，以便应用于更多有食管癌风险的人群。内镜消融技术以及通过内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）进行的内镜切除的进展已被证明在根除发育异常和早期癌症方面是有效的。涉及减少烟草和酒精消费以及定期使用质子泵抑制剂和非甾体抗炎药的预防策略旨在降低发育异常和食管癌的发病率，但在被推荐广泛使用之前还需要进一步研究。
