Review of Studies on Early Esophageal Cancer in “Stomach and Intestine” from 1966 to 2013 Misao Yoshida 1 1Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: early esophageal cancer , X-ray diagnosis , endoscopy , pathology , macroscopic classification pp.11-26
Published Date 2015/1/25
DOI https://doi.org/10.11477/mf.1403200127
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 In order to follow the development of studies on early esophageal cancer in Japan, every paper in “Stomach and Intestine” dealing with endoscopy, X-ray study, pathology and others in this field from 1966 to 2013 were reviewed. Studies on early esophageal cancer had started following the first case report of early esophageal cancer in Japan in “Stomach and Intestine” 1966. Most of early esophageal cancer was submucosal cancer in 1960's and 1970's. X-ray study and endoscopy cooperated in detection and evaluation of “early esophageal cancer”. Development of the fiberscope allowed us to identify very slight mucosal changes of the esophagus such as coarseness, redness, discoloring, slight elevation and slight depression. Chromoendoscopy such as iodine staining or staining made it easy and accurate to detect squamous cell carcinoma confined to the esophageal mucosa in the second half of 1970's. The pan-endoscope for upper GI endoscopy was established in the early 1980's and it gave us frequent occasions of endoscopic observation of esophageal mucosa. Numbers of mucosal cancer cases had been accumulated as the iodine staining prevailed in Japan. Large number of studies on endoscopy, X-ray study, pathology and biological behavior of mucosal cancer of the esophagus revealed difference between mucosal cancer and submucosal cancer. Lymph node metastasis is rare among mucosal cancers but it was frequent among submucosal cancers. Those facts resulted excellent prognosis of mucosal cancer after esophagectomy and poor in case of submucosal cancer. Macroscopic findings of mucosal cancers were different from that of submucosal cancers. The new macroscopic classification of esophageal cancer reflecting those studies allowed us to identify mucosal cancers as type 0-II (IIa, IIb and IIc) lesions other than type 0-I or type 0-III cancers that strongly suggestive of cancer invasion into the submucosa. Three endoscopic mucosal resection techniques such as the 2-channel method (Momma), the tube method (Makuuchi) and the cap method (Inoue) had established in early 1990's. Endoscopy became the mainstay in diagnosis and treatment of mucosal cancer of the esophagus. Further studies on mucosal cancer of the esophagus asked us to make the subclassification of the depth of cancer invasion such as m1 (intraepithelial cancer), m2 (cancer invasion into the lamina propria mucosae) and m3 (cancer invasion into the muscularis mucosa). The cancer invasion into the submucosa was divided into three categories such as sm1 (invasion into the superficial 1/3 of the submucosa), sm2 (invasion into the middle third of the submucosa) and sm3 (invasion into the deeper 1/3). Macroscopic, microscopic findings and biological behavior of the m3 and sm1 cancers were studied to establish the function preserving treatment for them. Clinico-pathological studies on resected specimens by EMR revealed a lymphatic permeation, diffuse cancer infiltration or poor differentiation closely related to frequent lymph node metastasis. Additional treatments including radical esophagectomy, chemotherapy and chemoradiation were recommended for patients at risk. Early in the 2000's, the Japan Esophageal Society revised the Japanese classification of esophageal cancer. They decided the definition of early esophageal cancer as “cancers with invasion confined to the mucosa”. Some new challenges on early esophageal cancer have started such as the NBI (narrow band imaging), magnify observation made endoscopic cancer detection easier and estimation of depth of invasion accurate. ESD (endoscopic submucosal dissection) allowed us to remove large mucosal cancer in one resected specimen. Nowadays, we are challenging to establish an advanced endoscopic diagnosis and treatment of Barrett's cancer applying new endoscopic measures and clinic-pathological studies on gastric cancer in Japan. Some genetic abnormalities are strongly suggestive of patients with high risk for esophageal cancer and it probably allow us to built up a new endoscopic surveillance system for esophageal cancer. We may expect additional developments in the field of early esophageal cancer in Japan.

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