食道癌の初期病巣と発育進展―内視鏡の立場から

The Growth and Development of Escophageal Cancer: From the Standpoint of the Endoscopy

要旨　食道癌の初期病巣とその発育進展をみるために，まず，深達度と内視鏡像から初期発育形式を検討した．続いて，その発育形式と発育速度をみるために，初回治療時に全食道を精査した内視鏡的粘膜切除術(EMR)施行例で，経過観察中に異時性多発癌を発見した27例と，さらに，手術拒否などで経過観察しえた食道癌16例について検討した．食道癌は粘膜上皮の基底層付近から発生し，0-IIb基底層型から0-IIb全層型，0-IIc m1あるいは0-IIc m2となり，0-IIc m3から0-IIc smとなって，0-1型，0-III型あるいは進行癌へと発育するものが多いと推定された．粘膜癌である期間は4年ぐらいはありそうであるが，一度粘膜下層へ浸潤すると1年以内に進行癌になるものと推測された．

　The relation between depth of invasion and endoscopic findings of early stage of esophageal cancer was examined to investigate the early developing of esophageal cancer. Fathermore, follow up cases who had been treated for early esophageal cancer with endoscopic mucosal resection, after that second primary carcinoma was detected in their esophagus, and the patients who refused surgical treatment and chemo radiotherapy, and who could be followed up their course retrospectively were also examined in dietal.

　As the results, esophageal cancer is developed from basal cell layer as 0-IIb type, then developes to the full layer of epithelium, and growes up to 0-IIc type of m2 and 0-IIc m3. After that, the lesion invades to submucosal layer and growes up 0-IIc sm, 0-I and 0-III.

　It is necessary almost 4 and more years for early esophageal cancer to grow up from mucosal cancer to submucosal one. Though, if the tumor invades to submucosal layer once, it may grow up to advanced cancer within a year.