Diagnosis of Esophagogastric Tumors

Introduction

Esophagogastric cancer includes esophageal squamous-cell cancer and adenocarcinoma in the esophagus, at the esophagogastric junction, and in the stomach (noncardia) cancer. Other benign tumors or malignant diseases (such as lymphomas and submucosal tumors) will not be examined in this review. In recent years, time trends in the worldwide incidence and mortality from esophagogastric cancer have suggested stable age-standardized rates for squamous-cell cancer, increased rates for adenocarcinoma, and decreased rates for noncardia gastric cancer. However, the crude numbers of cancer cases are still increasing in most countries in relation to the increased risk in aging populations. In the West, the 5-year survival from esophagogastric cancer in tumor registries is low, at just around 10 % for esophageal cancer and 20 % for gastric cancer. This contrasts with the higher survival for colorectal cancer, and is explained by the poor prognosis of advanced esophagogastric cancer, while the proportion of cases detected early is still small. In Japan, the 5-year survival from gastric cancer reaches higher figures (40 - 50 %). A national screening policy has been in operation in Japan since 1968, and the proportion of early cases detected is in the range of 40 - 45 %. However, intramucosal neoplastic lesions with a good prognosis, which would be termed dysplasia in the West, are classified as cancer in Japan. The key factor for preventing esophagogastric cancer is a policy of early diagnosis, as confirmed by the good results obtained in small surgical series in which early cases are frequent.

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