Squamous dysplasia--the precursor lesion for esophageal squamous cell carcinoma

Abstract

Esophageal squamous cell carcinoma (ESCC) accounts for 80% of all esophageal cancers worldwide, and esophageal squamous dysplasia (ESD) is the only histopathology that predicts the development of ESCC. The prevalence of ESD parallels rates of invasive ESCC and is typically found in 25% or more of adults above the age of 35 years in populations in north central China, where risk for ESCC is among the highest in the world. Results of chemoprevention and early detection studies to prevent progression of ESD suggest that these approaches, coupled with emerging endoscopic therapies, offer promise for the prevention of esophageal cancer mortality in high-risk populations. Future research on ESD and ESCC should focus on finding additional modifiable risk factors and on identifying biomarkers to incorporate into early detection strategies.

Figures

Figure 1

Esophageal cancer incidence worldwide in 2008 (men)

Figure 2

ESCC precursor lesions: Cumulative incidences and relative risks for the development of ESCC over 13.5-years of follow-up by initial histology (N=670)

Figure 3

Histologic appearance of normal squamous epithelial and mild, moderate, and severe esophageal squamous dysplasia

Figure 4

Esophageal squamous dysplasia without and with Lugol’s iodine staining. An unstained lesion becomes readily apparent after topical application of Lugol’s iodine solution which can then be targeted for biopsy.