WESTPORT, Jun 05 (Reuters Health) - Although endoscopic treatment for early esophageal cancer is being explored, this approach should be used with caution, according to researchers in the Netherlands. Their report notes that, because staging techniques are inaccurate, defining the difference between the early stages of esophageal cancer remains questionable.
Dr. Johanna W. van Sandick and colleagues from the University of Amsterdam reviewed the clinical records, pathology reports and slides of 173 patients who had esophagectomies for invasive adenocarcinoma.
Of these, 19% (32) had early stage cancer. "In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa," Dr. van Sandick's group writes in their article in the June 1st issue of Cancer. They also say that intestinal metaplasia was present in all the cases. "Areas of high-grade dysplasia accompanied 27 of the 32 cancers (84%)."
The researchers found that while intramucosal cancer "had no lymph node metastasis," 42% of the cases presented with multifocal disease, and in 17%, cancer "extended under preexisting squamous mucosa." Lymph node metastasis was present in 30% of the patients who had submucosal cancer. The 3-year survival for patients with intramucosal cancer was 100% and survival was 82% for patients with submucosal cancer, according to the investigators.
The researchers say that endoscopic treatment needs to be used with caution because of the "local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction." They note that because lymph node metastasis is often present with submucosal carcinoma, esophageal resectioning should be the treatment of choice. Esophagectomy, they say, has a favorable outcome in both of the early stages of esophageal cancer.
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