Early detection of esophageal cancer

A review of recently published articles on the risk factors and early detection of esophageal cancer.

Last year, while researching a book in Latin America, I had the good fortune to meet Dr. Fabian Emura.  Unlike most physicians profiled here at Cirugia de Torax.org, Dr. Emura is not a thoracic surgeon.  Dr. Emura is a gastroenterologist specializing in the early detection of digestive cancers, including esophageal cancer.  Dr. Emura, and other doctors like him, use a diagnostic technique called chromoendoscopy to identify early gastric, esophageal and colonic lesions in high risk patients.  This is particularly important in gastric cancers such as esophageal and stomach cancers.  These cancers are usually not detected until late stage disease when the patients develop symptoms such as dysphagia (inability to eat), anorexia, weight loss, nausea, early satiety or a feeling of abdominal fullness.

However, the development of chromoendoscopy, which is a fairly inexpensive technique that involves using a dye (Lugol’s) to detect abnormal cells in esophageal (and gastric mucosa.)  The areas of abnormality will fail to change color when dye is applied.  This technique, combined with narrow band imaging and other diagnostic modalities can aid in the early diagnosis of esophageal cancers.

Who should get tested?

As we discussed in a previous post, the incidence of adenocarcinoma based esophageal cancers is rising dramatically.  Unlike esophageal cancer from squamous cell carcinoma, the risk factors for squamous cell type vary from the traditional risk factors of smoking, alcohol ingestion, history of Barrett’s esophagus and geographic factors.

Hippisley – Cox and Copeland attempt to address and identify these risk factors with an algorithm created to assist primary care providers in identifying at- risk patients. An study by Jessri et al. looked at the risks of esophageal cancer related to dietary malnutrition. Jessri found that a plant rich or vegetarian diet may lower the risk of esophageal cancer.

In comparison, a study by Yu et. al. found that contrary to common belief, coffee did not contribute to the development of esophageal (and other cancers) and this meta-analysis of over 500 published studies showed that coffee may actually be beneficial.

Dawsey et al. in their investigation of 109 cases of esophageal cancer in patients under the age of 30, found that family history of esophageal cancer was one of the biggest risk factors.

Anyone with the above mentioned risk factors of smoking, heavy alcohol ingestion, frequent or uncontrolled gerd (acid reflux), or a family history of esophageal cancer should consider additional testing.  Anyone with unexplained weight loss, loss of appetite, dysphagia (difficulty eating or swallowing), or abdominal pain should seek prompt medical attention.

Neither this article or any information of this site should be used in lieu of medical attention/ evaluation or advice from a licensed medical provider.


Antonio Barros Lopes and  Renato Borges Fagundes.  Esophageal squamous cell carcinoma – precursor lesions and early diagnosis.  World J Gastrointest Endosc. 2012 January 16; 4(1): 9–16.

Ide E, Maluf-Filho F, Chaves DM, Matuguma SE, Sakai P.  Narrow-band imaging without magnification for detecting early esophageal squamous cell carcinoma.  World J Gastroenterol. 2011 Oct 21;17(39):4408-13.  Comparison between diagnostic techniques.

Only TIME will tell: Esophagectomy

There is a new trial on the horizon that sounds promising; the Traditional Invasive versus Minimally Invasive Esophagectomy (TIME). It’s a timely study indeed as the rates of esophageal cancer in western countries continues to increase, due to GERD and obesity.

I really don’t like the ‘cutesy’ way research trials have been named for the last ten years or so – but in this case – I will just have to look past it.  There is a new trial on the horizon that sounds promising; the Traditional Invasive versus Minimally Invasive Esophagectomy (TIME) trial based in the Netherlands.  It is a multi-center trial taking place at six hospitals in Europe.  This trial will compare both morbidity and mortality in patients undergoing traditional esophagectomy (Ivor Lewis) and patients undergoing minimally – invasive (thoracoscopy combined with laparoscopy) after both sets of patients receive adjuvant chemotherapy.  (This approach differs from the transhiatal esophagectomy developed at the University of Michigan in the 1970’s).

The researchers are planning for a five-year follow-up to compare both immediate post-operative complications / mortality with long-term effects (QoL) and cancer recurrence.

The full article is detailed on Medscape. (Also published in BMC Surgery. 2011;11 ).   This couldn’t come at a more appropriate time, with recent data showing an abrupt rise in the incidence of esophageal cancer.

In an article (Chustecka) dated from September 2010, British researchers at Cancer Research UK reported a 50% increase in diagnoses of esophageal cancer in the last 25 years, particularly in men in their 50’s. (with an incidence of 14.4 men per 100,000, to put it into perspective, up from 9.9 in 1983.)

More concerning, is the fact that the prevalence of the types of cancer are changing.  Previously, the majority of esophageal cancers were caused by squamous cell carcinoma which is linked to smoking and alcohol use.  This study, along with an American study, shows an increasing incidence of adenocarcinoma, which is more commonly attributable to gastroesophageal reflux (Barrett’s esophagus). Researchers  (Dr. Mark Orringer) estimate that the incidence of adenocarcinoma of the esophagus has increased by 350% in the last thirty years – and is directly related to huge increases in obesity.  It now accounts for over 85% of esophageal cancers in the USA.

We’ll bring you more as the trial continues, and preliminary results are reported.

(Dr. Mark Orringer, who was quoted in the original medscape article from 2007 is one of several pioneering surgeons in thoracic surgery.  He invented two of the surgical techniques in use today; the aforementioned transhiatal esophagectomy and the Collis -Nissen hiatal hernia repair.)