From the Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington.
South Med J. 2021 Mar;114(3):161-168. doi: 10.14423/SMJ.0000000000001226.
The incidence of esophageal cancer (EC) is on the rise. With the distinct subtypes of adenocarcinoma and squamous cell carcinoma comes specific risk factors, and as a result, people of certain regions of the world can be more prone to a subtype. For example, squamous cell carcinoma of the esophagus has the highest incidence in eastern Africa and eastern Asia, with smoking being a major risk factor, whereas adenocarcinoma is more prevalent in North America and western Europe, with gastroesophageal reflux disease being a leading risk factor. With that being said, adenocarcinoma and squamous cell carcinoma have similar and unfortunately poor survival rates, partly because EC is prone to early metastasis given that the esophagus does not have a serosa, as well as the superficial nature of its lymphatics compared with the rest of the gastrointestinal tract. This makes early detection of the utmost importance, and certain patients have been shown to have the benefit of screening/surveillance endoscopies, including those with Barrett's esophagus, lye-induced/caustic strictures, tylosis, and Peutz-Jeghers syndrome. Until treatments significantly improve, identifying EC at the earliest stage will have the best success for patient outcomes, and further elucidation of its pathogenesis and risk factors may lead to identifying other high-risk groups that should be screened.
食管癌（EC）的发病率正在上升。腺癌和鳞状细胞癌有明显的亚型，随之而来的是特定的危险因素，因此，世界上某些地区的人更容易患某一特定亚型。例如，食管鳞状细胞癌在东非和东亚的发病率最高，吸烟是主要的危险因素，而腺癌在北美和西欧更为普遍，胃食管反流病是主要的危险因素。话虽如此，腺癌和鳞状细胞癌的生存率相似，而且不幸的是都很差，部分原因是由于食管没有浆膜，其淋巴管的浅表性与胃肠道的其他部位相比，食管癌容易早期转移。这使得早期检测变得至关重要，某些患者已经受益于筛查/监测内镜检查，包括 Barrett 食管、碱性/腐蚀性狭窄、tylosis 和 Peutz-Jeghers 综合征患者。在治疗显著改善之前，在最早阶段发现 EC 将为患者的预后带来最大的成功，进一步阐明其发病机制和危险因素可能会发现其他需要筛查的高危人群。
