Superficial esophageal carcinoma: a report of 27 cases in Japan

Twenty-seven patients with superficial esophageal carcinoma were investigated to determine their clinical and pathological features. All 21 male patients were habitual drinkers, and 17 were heavy smokers. Histological examination showed that three tumors were intraepithelial, five were mucosal, and 19 were submucosal. Fifteen of the 27 patients were asymptomatic, including seven of the eight with intraepithelial or mucosal carcinoma. Twelve of the 13 patients with polypoid tumors had submucosal invasion, whereas two patients with flat tumors and four of the seven with erosive tumors had either intraepithelial or mucosal carcinoma. Six of the eight patients with intraepithelial or mucosal carcinoma had normal routine radiological studies. All these eight patients had no lymph node involvement, whereas four of the 19 with submucosal carcinoma had lymph node metastases. An aggressive approach to endoscopy in asymptomatic high-risk individuals (middle-aged male drinkers and smokers) may increase the detection of early esophageal carcinoma, although the cost-effectiveness should be evaluated further. In addition, in the interest of prevention, our results show that encouraging people to stop smoking and limit their alcohol intake to an occasional drink might be an important factor in lessening the risk for esophageal carcinoma.