Predisposing Factors/ Prevention

Dietary factors, which have been implicated in esophageal cancer, particularly squamous cell cancer, include nitrosamines and their precursors, and alcohol, particularly in association with tobacco use. Other factors associated with squamous cell cancer include low socio-economic status, race and geographic location. Squamous cell cancer may be associated with other disease processes, such as achalasia, caustic stricture and Plummer-Vinson's syndrome. The incidence of esophageal adenocarcinoma is increased in patients with Barrett's esophagus, with incidence rates of eventually developing adenocarcinoma in the order of 5-7%.

Screening/ Early Detection

There is as yet no suitable screening test for squamous cell cancer of the esophagus. Patients with Barrett's esophagus should undergo endoscopic surveillance at intervals of at least every 2 years. Dysplasia, if found, should be ablated or resected. Photodynamic therapy has been of value in treating in situ disease and high grade dysplasia, and this option, if available, should be considered. Dr. A. Weiss, in Vancouver, has experience with this modality.