Paper

Tylosis associated with carcinoma of the oesophagus and oral leukoplakia in a large Liverpool family—A review of six generations

The chapter provides historical context and biological understanding of precancerous changes, and describes disorders that predispose to squamous carcinoma. It discusses grading systems for use at different head and neck sites, with no single grading system being applicable to all, and those developed for cervix, colon, and other sites being inappropriate. Oral lesions are more diverse than laryngeal lesions, with a different approach required for dysplasia grading at the two sites because of the restricted opportunities for intervention in the larynx. The current World Health Organization classifications are included, together with newly described conditions such as human papillomavirus–associated dysplasia in the mouth. Terminology is updated and the normal microscopic anatomy of the sites reviewed.

Esophageal squamous cell cancer (ESCC) is one of the most common cancers worldwide. There is considerable geographic variability in the prevalence of ESCC. The high mortality rates observed for ESCC reflect the fact that most patients diagnosed with ESCC have advanced disease at the time of diagnosis. The goal of ESCC screening is to prevent cancer-related death by detecting ESCC and precursor lesions when in an early, asymptomatic stage, thereby permitting the opportunity for curative intervention. Both endoscopic and nonendoscopic techniques for ESCC screening have been developed and investigated, and these techniques and supporting data will be discussed in this chapter.

Currently curative treatment for esophageal squamous cell cancer (ESCC) is possible only in patients with early-stage, usually asymptomatic disease. In Western countries, where the incidence of ESCC is relatively low, a screening of asymptomatic, average-risk population is untenable. In order to detect early-stage ESCC or its precursor lesions it is important to identify high-risk patients and consider endoscopic surveillance in these groups. These high-risk groups include patients after curative treatment for head and neck cancer, previous endoscopic resection of ESCC, caustic injury, and patients with tylosis or achalasia. This paper discuss the evidence and proposed method of endoscopy surveillance of these high-risk patients.