Natural history and significance of esophageal squamous cell dysplasia

Article Abstract:

Balloon-mesh cytology for the early detection of esophageal cancer is widely used in China, Iran, and South Africa, where this type of cancer has a particularly high incidence. The technique is easy and safe, and patients with esophageal cancer detected at an early stage by this technique have a five-year survival rate of 90 percent. This contrasts with a five to seven percent overall survival in the United States. The technique involves an inflatable balloon which is covered with nylon mesh for increased abrasiveness. The balloon is inserted into the stomach through the esophagus where it is inflated. The inflated balloon is withdrawn back through the esophagus, scraping off some cells as it goes. These cells are then examined for signs of cancerous transformation. Esophageal cancer is common in China, and accounts for 22 percent of all cancer deaths, making positive balloon-mesh cytology test results just cause for further examination. However, the same may not be true in the US. To determine the effectiveness of this technique for the early screening for esophageal cancer among Americans, 255 veterans regarded as high-risk patients, due to smoking or alcohol abuse, were examined. Thirty-seven patients had squamous cell dysplasia. Dysplasia means that abnormalities are present in a tissue, but they are not necessarily cancerous changes. During follow-up evaluation, 57 percent of the patients still tested normal. Dysplasia persisted in seven percent, and 29 percent had changes indicating inflammation. Two patients (seven percent) developed cancer; one developed esophageal cancer, the other developed cancer of the larynx. The results indicate that among high-risk patients in the United States, a positive finding by balloon-mesh cytology is more likely to be caused by inflammation than cancer, and that this technique is not suitable for mass early-screening programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Medical examination, Development and progression, Cytology, Esophagus, Cytodiagnosis

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Endoscopic screening of early esophageal cancer with the lugol dye method in patients with head and neck cancers

Article Abstract:

Esophageal cancer has a poor prognosis. Nevertheless, cases of esophageal cancer that have not metastasized to the lymph nodes at the time of surgery have a good prognosis; this suggests that patients with esophageal cancer are likely to benefit greatly from early detection. Barium radiology and endoscopic examination are two methods by which early detection might be accomplished, but many early stage esophageal cancers cannot be accurately diagnosed using these methods. There has been some suggestion that the use of Lugol's solution might improve the visibility of esophageal lesions to endoscopic examination; this technique was used to examine 178 patients with head and neck cancer who were regarded as being at high risk for esophageal cancer. Lugol's solution is a caustic strong solution of iodine; although some lesions may stain more darkly than surrounding normal tissue, most cancerous lesions remain unstained in contrast to the surrounding greenish brown normal tissue. The solution was applied through a polyethylene tube under direct vision of the endoscope to coat the entire esophagus. Unstained lesions were observed in 69 patients, and biopsy revealed cancer in nine. Of the nine patients with cancer, only four had lesions that were visible without the use of the Lugol method. In eight of the nine patients, the esophageal cancer had not yet spread, and thus the technique may well contribute to greater survival among these cases. Although Lugol's solution in combination with endoscopy is not suitable for mass screening for cancer, the method is potentially life-saving for individuals who are known to be at high risk for esophageal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Iodine, Iodine (Chemical element), Endoscopy, Esophagoscopy

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Flat early cancers of the large intestine

Article Abstract:

Research was conducted to detect and assess the pathological characteristics of flat early cancers of the large intestine. Most flat early cancers were not accompanied by adenoma (benign epithelial tumors) and were considered to have fully developed de novo. Flat cancer formation tended to infiltrate deeper mucosal layers of the colon as a small diameter cancer and at earlier stages than polyp-type cancers in adenoma. The use of colonoscopy is the preferred diagnostic method for detecting small flat lesions in the colon. Treatment is accomplished by surgical removal of the small lesions. Preoperative diagnosis of the depth of invasion is possible and necessary in order to accomplish a complete removal of the cancer. Surgical methods (polypectomy) used to remove polyp-type tissue from the large intestine is contraindicated. The widespread use and perfection of colonoscopic techniques will promote better screening for colonic cancers.

Colorectal cancer, Colonoscopy, Intestinal polyps

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