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Endoscopic Evaluation of Intraepithelial or Mucosal Cancer of the Esophagus Misao Yoshida 1 1Department of Surgery, Tokyo Metropolitan Koma-gome Hospital Keyword: 食道m癌 , 食道sm癌 , 早期食道癌 , 早期癌類似進行型 , 食道癌内視鏡分類 pp.1059-1066
Published Date 1990/9/25
DOI https://doi.org/10.11477/mf.1403111405
  • Abstract
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 Superficial cancer which used to be defined as cancer remaining within the submucosa (sm) was an early indication of esophageal cancer. Studies made on 26 cases with submucosal cancer of the esophagus revealed that there were frequent lymph node metastases (48%) and recurrence. 64% of such cases had a five year survival rate. On the other hand, lymph node metastasis was rare in intraepithelial cancer (ep) (0%) and in mucosal cancer (mm) (0%) and their prognosis was excellent (100%). Recently, a new endoscopic classification of esophageal cancer was proposed by the Japanese Society for Esophageal Diseases.

 The new classification recognizes 5 types;-

(1) Type 0―Superficial type

    0-Ⅰ―Superficial and protruding type

    0-Ⅱ―Superficial flat type

     0-Ⅱa―Superficial flat and slightly elevated type

     0-Ⅱb―Superficial flat type

     0-Ⅱc―Superficial flat and slightly depressed type

    0-Ⅲ―Superficial and excavated type

(2) Type 1, 2, 3 and 4―Advanced type

(3) Type 5―Miscellaneous type

 Clinical application of this classification for 40 of our superficial cancer cases allowed us to diagnose 0-Ⅱ type lesions as (ep) or (mm) cancer with an accuracy rate of 93.5%, and 0-Ⅰ or 0-Ⅲ lesions other than 0-Ⅱ type as (sm) cancer with an accuracy rate of 92.3%. Excellent prognosis of 0-Ⅱ lesions following conventional esophagectomy suggests that 0-Ⅱ leson is really “early esophageal cancer”. Results of this study suggest that (ep) and (mm) cancer of the esophagus can be identified as 0-Ⅱ type lesions by endoscopy, and they rarely have lymph node metastasis. Hence, 0-Ⅱ type lesions should be considered as early cancer of the esophagus. However, clinically speaking, 1) 0-Ⅰ lesions of submucosal cancer should be regarded as advanced cancer type Ⅰ, and, 0-Ⅲ lesion should be regarded as type-2 or 3 advanced cancer, 2) submucosal cancer that resembles mucosal cancer should be called “early cancer-like-advanced type”, 3) an early cancer that looks like an advanced cancer should be called “advanced cancer-like-early type”.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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