Screening strategy of esophageal cancer in high-risk areas of China
| Population | 40–69 years old high risk population |
| Method | Endoscopy + iodine staining+ indicative biopsy |
| Pathologic diagnostic criteria | |
| Mild dysplasia | Atypical cells are distributed mainly in the basement membrane, less than 1/3 of the epithelium |
| Moderate dysplasia | Atypical cells are involved in the top layer of epithelium or less than 2/3 of the epithelium |
| SD/CIS | Precursor lesions involve the epithelium without invading the basement membrane; atypical cells are fully or almost fully distributed in the epithelium with a clear structure of the basement membrane |
| Intramucosal carcinoma | Lamina propria is invaded and restricted to the mucosa layer; the rate of lymph node metastasis rate ranges from 1% to 5% |
| Submucosal carcinoma | Submucosa is invaded; muscular layer of esophagus is not invaded; the rate of lymph node metastasis ranges from 10% to 50% |
| Treatment and follow-up | |
| Mild dysplasia/moderate dysplasia | Interventions such as nutrition or medication can be taken, affecting their differentiation in its reversal Follow-up for these patients should be conducted every 3-5 years |
| SD/CIS and intramucosal carcinoma | These patients should receive the treatment of EMR/APC. Follow-up should also be conducted annually |
| Submucosal carcinoma | These patients should receive the Esophagectomy. Esophagectomy should also be conducted for patients with SD/CIS or intramucosal carcinoma and the lesion is large than 3 cm in diameter or invasion of esophageal circumference 3/4 |
| In advanced esophageal cancer | Standard treatments, such as surgery, radiotherapy and chemotherapy should be used according to the conditions of patients |
SD: sever dysplasia; CIS: carcinoma in situ; EMA: endoscopic mucosal resection; APC: argon plasma coagulation.