Endoscopic treatment of early esophageal cancer

03/2020

Doc. MUDr. Jan Martínek, MD, Ph.D., AGAF

Klinika hepatogastroenterologie IKEM, Praha

SUMMARY

There are two main types of esophageal cancer - adenocarcinoma and more aggressive squamous cell carcinoma. While squamous cell carcinoma was previously more frequently diagnosed, now the incidence of both types is comparable in developed countries, in some cases the incidence of adenocarcinoma is even more frequent. In the past, most esophageal cancers were indicated for surgery if it was a surgically solvable finding and the patient was not an unsuitable candidate for resection, e.g. due to comorbidities. Due to the fact that esophagectomy, compared to other procedures, represents an operation with a considerable risk of morbidity and mortality, a considerable number of operated patients died or were treated for a long time due to complications. Medicine has also undergone a fundamental change in this area - early carcinomas (defined as tumors with infiltration of the mucosa and submucosa) can be treated endoscopically, often radically and therefore curatively. Mortality from endoscopic treatment is practically zero and morbidity is minimal. The quality of life after endoscopic treatment is excellent thanks to the preserved organ. As a result, the established practice is beginning to change, when patients with early esophageal cancer used to be sent for surgery, nowadays these patients are increasingly referred to the assessment of endoscopic treatment. However, not every patient is resolved endoscopically, some still have to undergo surgery or possibly oncological treatment. Therefore, the treatment of early esophageal carcinomas should be discussed in a multidisciplinary team.

Key words

esophageal cancer, Barrett's esophagus, endoscopic resection, endoscopic submucosal dissection