EARLY DETECTION AND TREATMENT OF ESOPHAGEAL AND GASTRIC-CANCER

Early oesophageal and gastric cancer are unique forms of oesophageal a nd gastric carcinoma with an excellent prognosis. Remarkable changes h ave taken place in the epidemiology of upper gastrointestinal malignan cies. In particular, the incidence of adenocarcinoma of the distal oes ophagus and the gastric cardia has risen over the past two decades. In the United States and Europe, early detection is dependent on a low t hreshold for upper gastrointestinal endoscopy with biopsy, because spe cific symptoms and physical findings are rarely present in patients wi th early oesophageal and gastric cancer. In addition to histology, the detection of possible markers of malignancy, such as aneuploidy (dete cted by flow cytometry) and the presence of oncogenes and tumour-suppr essor genes, in biopsy material may be of value in the diagnosis of ea rly cancers. For patients with early oesophageal or gastric cancer, su rgery offers the best hope of cure. If patients are at high risk for s urgery, an endoscopic resection may be an alternative option. This rev iew discusses the definitions, the changes in epidemiology, the curren t options for diagnosis and treatment, and the value of screening prog rams for patients with early oesophageal or gastric cancer.