How to detect early carcinoma of the esophagus

In order to identify the most effective approaches for detecting early carcinoma of the esophagus, 46 patients with such lesions, including three epithelial, 13 mucosal and 30 submucosal carcinomas, were studied. Among 16 patients with epithelial and mucosal carcinomas, five (31%) were symptomatic, and in 15 (94%), the lesions were detected by endoscopy. Among 30 submucosal carcinomas, 17 (57%) were associated with symptoms such as mild dysphagia and a sharp pain, and 22 (73%) were detected by endoscopy. With respect to the gross appearance of early esophageal carcinoma, a protruded type frequently caused symptoms (70%) and was often detected by radiology (50%). Although endoscopy always permitted a correct diagnosis of the lesion (100%), radiology often failed to detect it (47%), especially when the lesion was of the superficial type. In asymptomatic patients, most early esophageal carcinomas were detected during the follow-up of gastric diseases, mass-screening or medical examination for gastric cancer, and in connection with abdominal pain due to other diseases. These results indicate that, in order to detect early carcinoma of the esophagus, it is important to perform Lugol-combined endoscopy with biopsy rather than radiology.