Diagnosis and treatment of early esophageal carcinoma

It has become easier to find early esophageal carcinomas, which are localized in the mucosa or submucosal layer, by progress of X-ray technology. The term 'superficial esophageal carcinoma' is applied to tumours in which infiltration is limited to the submucosal layer. If there is no lymph node metastasis, we use the term "early carcinoma". In our hospital, we have resected 88 cases of superficial esophageal carcinoma including 55 early esophageal carcinoma cases. Five year-survival rate of early carcinoma is 61%. In contrast, 5 year-survival rate of superficial esophageal carcinoma with lymph node metastasis is only 13%. Therefore, from a prognostic point of view, it would be valuable to be able to detect the presence of lymph node metastasis in patients with superficial esophageal carcinoma. From X-ray findings, we divide superficial carcinoma into 5 types. In superficial flat type, there is no lymph node metastasis, but in other types there is no correlation between the types and lymph node metastasis. The condition of the surface of superficial esophageal carcinoma (smooth or irregular), however, has a close connection with lymph node metastasis or vascular invasion. To improve the prognosis of resected esophageal carcinoma cases, we should read X-ray films thoroughly before operation so that we can predict lymph node metastasis or vascular invasion and choose the most effective operative method.