食道癌の発育・進展―prospective and retrospective study

Prospective and Retrospective Study on Natural Progression of Esophageal Cancer

要旨　食道癌11例のprospectiveおよびretrospective studyから次のようなことが推定された．①臨床的に診断しうるm癌の存在期間はかなり長く，数年を要する．②smあるいはそれ以上に進行した癌の発育・進展は急速である．sm癌を疑ったならば，できるだけ早く外科的処置を行うべきである．③X線診断からみると，一見急速に発育・進展するようにみえるが，早期の段階での発育経過を予側することは難しい．④m癌，特にep癌周辺の生検診断からみた発育・進展の分析には，dysplasiaあるいは食道炎との鑑別が難しいため慎重でなければならない．

　Eleven cases of esophageal cancer were analysed prospectively and retrospectively. In nine of these cases, cancer was confirmed retrospectively either by patient death during follow-up treatment on during surgical operation. In the other two cases there had been follow-up for periods of 5 years 5 months, and 2 years 6 months respectively. The follow-up began prospec-tively as soon as a diagnosis of squamous-cell cancer was made at the initial biopsy.

　Based on an analysis of these 11 cases, the following deductions were made concerning the natural progression of esophageal cancer.

　(1) Progression of mucosal cancer discerned by endoscopy is slow, presumably a few years.

　(2) Progression of esophageal cancer of which depth invasion reaches sm and deeper is rapid. Once sm cacer is suspected, the earliest possible steps including surgical operation and other treatments should be taken.

　(3) Esophageal cancers detected by x-ray were more likely to show rapid growth, but actually, this is not the case with esophageal cancer previous to detection by x-ray. It is a mistake to define the progression of mucosal cancer in terms of follow-up after x-ray.

　(4) Generally defferential diagnosis of mucosal (especially ep) cancer, dysplasia, and esophagitis is difficult. This fact should be taken into account in estimating the natural progression rate by basing analysis on esophageal cancers diagnosed by biopsy and followed-up.