Endoscopic Findings of 100 Early-Stage Esophageal Cancers

The morphologic analysis of 100 early squamous cell carcinomas of the esophagus has shown that the barely visible or invisible forms (erythroplakias and occult forms) are predominant. This explains the poor yield of upper gastrointestinal (GI) endoscopies in detecting early cancers, at least in Western countries. Leucoerythroplakias correspond to the most advanced form of early cancers (submucosal invasion in approximately 38% of cases). Pure erythroplakias and occult forms correspond to in situ or intramucosal cancers in over 90% of the cases. Accurate endoscopic staging is possible using morphologic criteria, superficial spread, and rigidity of the wall as parameters. In a prospective study, we show that the degree of accuracy of this staging system reaches 95% for an experienced endoscopist. T(1a)N(0) cancers can benefit from an endoscopic treatment (mucosectomy or photodynamic therapy), because the risk of lymph node metastasis is low (6%). In T(1b)N(0) cancers, the best treatment option is an esophageal resection with extensive mediastinal lymph node dissection for good surgical candidates; PDT combined with adjuvant radiotherapy is a reasonable option for inoperable patients.