Early cancer in achalasia

Esophagus achalasia is considered by many authors a preneoplasic disease and, for this reason, they propose a follow-up with endoscopies and brush cytology. For others, the possibility of cancer in achalasia is very low and the surveillance is not justified owing to its fallibility and high cost. Generally, cancer in achalasia has a late diagnosis as a consequence of megaesophagus and of many years of symptoms attributed to achalasia disease. The rate of resectability is low and 5-year survival is very poor. To define the patients who have a high disease. The rate of resectability is low and 5-year survival is very poor. To define the patients who have a high risk of cancer in achalasia and to perform an early diagnosis is the challenge to improve resectability and to increase survival. The search of cancer in achalasia with endoscopies and lugol vital staining was performed in 18 out of 76 patients with achalasia. The 18 patients had enlarged esophagus and more than 10 years of evolution. Lugol negative endoscopic areas were found in 10 out of 18 patients and four out of 10 were carcinomas. Two were circular superficial erosive lesions (Tis N0 M0 and T1 N0 M0), one was an elevated multifocal lesion of less than 1 cm diameter (T2 N0 M0) and the last one was a longitudinal central ulcer of less than 1 cm diameter (T1 N0 M0). In the remaining 6 out of 10 patients the diagnosis was esophagitis. In the other 58 patients, three carcinomas were diagnosed, two advanced tumors, with endoscopy and biopsy (T3 and T4 N1) and the third one (T1 N0 M0) was a pathological finding in a resected specimen for recurrent achalasia and megaesophagus. The global prevalence was of 9.21% (7/76). The prevalence in advanced stages of achalasia was of 18.92% (7/37). The resectability rate was of 85.71%.

Achalasia patients with more than 20 years of evolution, enlarged esophagus with 'knees' and with marked retention must be considered to be of high risk for developing cancer. In this group, the surveillance with endoscopy and lugol vital staining or brush cytology is justified. Other common risk factors of esophageal cancer that must be considered are patients aged over 60 years who are smokers and regular consumers of alcohol.