Siersema P D, Dees J, Tilanus H W, Kok T C, Hordijk M L, van Blankenstein M
Department of Internal Medicine, University Hospital Dijkzigt, Rotterdam, Netherlands.
Neth J Med. 1995 Aug;47(2):76-86. doi: 10.1016/0300-2977(95)00005-8.
Early oesophageal and gastric cancer are unique forms of oesophageal and gastric carcinoma with an excellent prognosis. Remarkable changes have taken place in the epidemiology of upper gastrointestinal malignancies. In particular, the incidence of adenocarcinoma of the distal oesophagus and the gastric cardia has risen over the past two decades. In the United States and Europe, early detection is dependent on a low threshold for upper gastrointestinal endoscopy with biopsy, because specific symptoms and physical findings are rarely present in patients with early oesophageal and gastric cancer. In addition to histology, the detection of possible markers of malignancy, such as aneuploidy (detected by flow cytometry) and the presence of oncogenes and tumour-suppressor genes, in biopsy material may be of value in the diagnosis of early cancers. For patients with early oesophageal or gastric cancer, surgery offers the best hope of cure. If patients are at high risk for surgery, an endoscopic resection may be an alternative option. This review discusses the definitions, the changes in epidemiology, the current options for diagnosis and treatment, and the value of screening programs for patients with early oesophageal or gastric cancer.
早期食管癌和胃癌是食管癌和胃癌的特殊形式，预后良好。上消化道恶性肿瘤的流行病学已发生显著变化。特别是，远端食管癌和贲门癌的发病率在过去二十年中有所上升。在美国和欧洲，早期检测依赖于对上消化道内镜检查及活检保持较低阈值，因为早期食管癌和胃癌患者很少出现特定症状和体征。除组织学检查外，在活检材料中检测可能的恶性标志物，如非整倍体（通过流式细胞术检测）以及癌基因和肿瘤抑制基因的存在，可能对早期癌症的诊断有价值。对于早期食管癌或胃癌患者，手术提供了治愈的最大希望。如果患者手术风险高，内镜切除可能是一种替代选择。本文综述了早期食管癌或胃癌患者的定义、流行病学变化、当前的诊断和治疗选择以及筛查项目的价值。
