ESOPHAGEAL CANCER, EARLY DISEASE - DIAGNOSIS AND CURRENT TREATMENT

Most esophageal canters are at a fairly advanced stage at the time of diagnosis, and curative therapy is not possible. For those that are detected early, cure may be possible, particularly if there is no lymphatic spread. Radical therapeutic approaches result in increased treatment-related mortality, high treatment-induced morbidity, and reduced quality of life. Therefore It is one of the major targets in the treatment of esophageal cancers to classify the tumor and to perform adequate stage-related therapy. The modern diagnostic procedures, such as endoscopy, endoluminal sonography, computed tomograpby (CT) scanning, and endoscopic biopsy, have led to major advances in preoperative staging. Endoluminal sonography is able to predict the depth of tumor infiltration in the esophageal wall and the existence of local lymph node metastasis, whereas CT scanning demonstrates distant metastasis. Histologic classification of the tumor together with genetic and cell biologic characteristics can predict the prognosis. Currently, the best prospect for cure of early esophageal cancer is surgical resection through the abdominothoracic approach, although less radical surgical procedures such as transhiatal resection without extensive lymph node dissection seem to achieve the same results. Even less traumatic is the use of minimal invasive techniques, which certainly will be used more often in the future. For early esophageal cancers limited to the epithelium and the lamina propria, local destruction of the tumor leads to long term survival and cure. Techniques such as endoscopic resection, laser coagulation, photodynamic laser activation, and argon beam exposure have been described and seem to achieve similar results. Another conservative method for treating early esophageal tumors is radiotherapy, although it has been shown in several studies that radiochemotherapy is superior to radiotherapy alone, at least in more advanced eases. In future, treating local early esophageal tumors will consist In exact preoperative staging followed by a surgical therapy that includes local excision of tumors limited to epithelium or a more aggressive approach if advanced infiltration of the esophageal wall has been proved. In these cases combined radiochemotherapy plus surgery is promising. In cases with increased operative risk the combination of local tumor destruction plus radiochemotherapy may improve the results.