Lightdale C J, Winawer S J
Semin Oncol. 1984 Jun;11(2):101-12.
In geographic areas where there is a high risk of esophageal cancer, analysis of cells obtained from the esophagus has been used effectively to detect early lesions. This has been demonstrated on a large scale in studies from China. Using abrasive balloon cytology techniques, 75% of the cancers detected were early lesions, where the 5-year survival after resection was in the range of 90%. Endoscopic followup studies indicate that dysplastic changes in the esophageal mucosa are a common precursor to malignancy. In many cases, the time course from dysplasia to carcinoma in situ to early invasive cancer may take place over many years, allowing a reasonable amount of time for screening. In low-incidence areas, such as the United States, most esophageal cancers are related to the excessive use of tobacco and alcohol. These factors are too common and the incidence of the disease too low, however, to justify screening on this basis. There are smaller groups at higher risk where selective screening by endoscopy with cytology and biopsy is recommended, usually every 1 to 3 years. These include patients with longstanding achalasia, lye strictures, and Plummer- Vinson syndrome. Patients with cancers of the head and neck region and patients with celiac disease may also be considered to be at increased risk. Tylosis is a rare inherited disease with a very high risk of esophageal cancer. There is an increased incidence of adenocarcinoma of the esophagus with Barrett's epithelium, and once identified such patients should be kept under endoscopic surveillance. The finding of severe dysplasia in any of these groups would indicate a shorter screening interval. Most patients with symptoms referable to the esophagus are first tested by barium esophagram. If negative, with persistent symptoms or if a suspicious lesion is identified, endoscopy with cytology and biopsy is recommended. Staging of the cancer is based on the size of the cancer both longitudinally and circumferentially and the presence of extraesophageal spread. At the present time, CT is the best noninvasive method for judging the extent of the cancer. Performance and nutritional status are also determinants of prognosis and should be considered in planning treatment.
在食管癌高发地区，对取自食管的细胞进行分析已被有效地用于检测早期病变。这在中国的大规模研究中得到了证实。采用磨砂气囊细胞学技术，检测出的癌症中有75%为早期病变，切除术后的5年生存率在90%左右。内镜随访研究表明，食管黏膜发育异常改变是恶性肿瘤的常见先兆。在许多情况下，从发育异常到原位癌再到早期浸润癌的病程可能会持续多年，这为筛查留出了合理的时间。在低发地区，如美国，大多数食管癌与过度吸烟和饮酒有关。然而，这些因素过于普遍，而该病的发病率又过低，因此无法据此进行筛查。有较小一部分高危人群，建议通过内镜检查结合细胞学检查和活检进行选择性筛查，通常每1至3年进行一次。这些人群包括患有长期贲门失弛缓症、碱液性狭窄和普卢默-文森综合征的患者。头颈部癌症患者和乳糜泻患者也可能被认为风险增加。掌跖角化症是一种罕见的遗传性疾病，患食管癌的风险非常高。食管巴雷特上皮化生患者患食管腺癌的几率增加，一旦确诊，这些患者应接受内镜监测。在这些人群中发现严重发育异常表明筛查间隔应缩短。大多数有食管相关症状的患者首先接受食管钡餐造影检查。如果结果为阴性，但症状持续存在或发现可疑病变，则建议进行内镜检查并取细胞和组织进行活检。癌症分期基于癌症在纵向和周向上的大小以及食管外扩散情况。目前，CT是判断癌症范围的最佳无创方法。身体状况和营养状况也是预后的决定因素，在制定治疗方案时应予以考虑。
