Esophageal cancer: The precursors (Part II)

The epidemiology of esophageal cancer has been considered in part I of this review [ 1 ]. Squamous cell carcinoma (SCC), accounts for the majority of cases, which tend to occur in low-resource countries, particularly in certain regions of Asia, where the age-standardized rate (ASR) incidence can be higher than 100/100 000). Adenocarcinoma (ADC) is less frequent and develops from a metaplastic epithelium. The ASR incidence of ADC is higher in Caucasians and in men, but is still low at less than 5 in men and 1 in women; however it is increasing rapidly in the USA, Australia, and northern Europe, and may have a significant impact in the near future. There is frequent confusion in determining whether the site of ADC is on the esophageal or gastric side of the esophagogastric junction. The question arises of whether a preneoplastic alteration of the epithelium is the first step in the sequence leading from chronic inflammation to neoplasia.