Year: 1995
Type: editorial
Abstract: Esophageal cancer poses unique challenges in diagnosis and treatment that are related to its pathogenesis and epidemiology and to esophageal anatomy.Esophageal squamous cell carcinoma is linked closely to environmental influences.In Western countries, more than 90% of risk is related to alcohol and to combined alcohol and tobacco use.' Increased risk also is associated with squamous cell carcinoma of the head and neck.'By contrast, nutritional deficiencies and carcinogens derived from the soil are implicated in areas of Iran and northern China known as the "Asian esophageal cancer belt," where esophageal cancer incidence is as high as 140 per 100,000.3Incidence varies widely between geographic regions within countries and around the world.In the United States, it ranges from a low of 1.1 per 100,000 in white women to a high of 15.1 in African American men.4Much of our knowledge regarding esophageal cancer screening and early stages of carcinogenesis is derived froim geographic areas of high incidence where pathogenesis may differ from that in Western countries.The natural history and patterns of spread of esophageal cancer are related to esophageal and thoracic anatomy.Intraepithelial carcinoma often is preceded by dysplasia and by prolonged inflammation.Progression from carcinoma in situ (CIS) to invasive carcinoma was estimated to take 4-5 years in China where CIS can be i n d ~l e n t .~Studies from Japan suggest faster progression within less than 2 years.6Subsequent dissemination is rapid.The long submucosal lymphatics and lack of serosa favor distant longitudinal submucosal spread, extramural extension to mediastinal structures, and multifocal lyimph node metastases.Because luminal extension of tumor occurs late in the disease,
Source: Cancer
Authors: Gideon Steinbach, Waun Ki Hong
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2059084655