Evaluation and treatment of superficial esophageal cancer.
BACKGROUND
Adenocarcinoma of the esophagus is the fastest increasing cancer in the USA, and an increasing number of patients are identified with early-stage disease. The evaluation and treatment of these superficial cancers differs from local and regionally advanced lesions.


METHODS
This paper is a review of the current methods to diagnose, stage, and treat superficial esophageal adenocarcinoma.


RESULTS
Intramucosal adenocarcinoma can be effectively treated with endoscopic resection techniques and with less morbid surgical options including a vagal-sparing esophagectomy. However, submucosal lesions are associated with a significant risk for lymph node metastases and are best treated with esophagectomy and lymphadenectomy.


CONCLUSIONS
There has been a major shift in the treatment for Barrett's high-grade dysplasia and superficial esophageal adenocarcinoma in the past 10 years. New therapies minimize the morbidity and mortality of traditional forms of esophagectomy and in some cases allow esophageal preservation. Individualization of therapy will allow maximization of successful outcome and quality of life with minimization of complications and recurrence of Barrett's or cancer.
DeMeester
Steven R
SR
Department of Cardiothoracic Surgery, The University of Southern California, Los Angeles, CA 90033, USA. sdemeester@surgery.usc.edu
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000628:therapy; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011788:Quality of Life