| Esophageal adenocarcinoma has been increasing in Western countries as well as now Asian countries. Screening for this cancer involves identification of risk factors that will select a high risk groups such as male gender, age greater than 50, history of reflux symptoms, and obesity. Devices for screening currently range from endoscopy, the use of cytological screening tools, and using volatile organic compounds that can be detected by breath assays. The goal is to determine if these methods will be acceptable to the screening population and can be applied at low cost. Diagnosis of adenocarcinoma and its precursor Barrett's esophagus is dependent on biopsy but may shift to endoscopic microscopy techniques such as Volume Laser Endomicroscopy. Treatment of the precursor condition depends on the finding of high risk lesions such as high grade dysplasia or early cancer. Standard therapy currently for Barrett's esophagus is radiofrequency ablation (RFA) and for early cancer is endoscopic resection currently accomplished with EMR or ESD. Cryotherapy has been shown to be resistant to cases resistant to RFA. New treatments may combine these agents with medications to promote ablation effects. |
