Chinese expert consensus on early diagnosis and treatment of esophageal cancer

Abstract

Although the incidence rate of esophageal cancer in China is on the decline, China is still a high-incidence country of esophageal cancer with great regional variation. In recent years, the five-year survival of esophageal cancer in China has improved significantly. However, due to the absence of typical symptoms in early stage, there still exists a large esophageal cancer diagnostic yield gap between China and developed countries. At present, there are no international guidelines defining the target population for esophageal squamous cell carcinoma (ESCC) screening. Exploring and implementing effective esophageal cancer screening together with early diagnosis and early treatment are the keys to reducing the mortality and improving the survival rate and life quality. Endoscopic therapies, such as endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and radiofrequency ablation (RFA), are used to treat early-stage esophageal cancer. If the tumor invasion is deep or lymph node metastasis is suspected, surgery is needed, meanwhile radiation therapy could also be an optional treatment. Regular follow-up and surveillance are required for any strategy above to deal with relapse and metachronous primary cancers. The Early Diagnosis and Treatment Group of the Chinese Medical Association Oncology Branch has reached an expert consensus on screening and diagnostic protocols for esophageal cancer, on endoscopic and surgical treatment of early esophageal cancer and precancerous lesions, as well as on postoperative monitoring and adjuvant therapy. This consensus follows the evidence-based medicine at both domestic and international levels, combines the current clinical practice and application experience in the treatment of esophageal cancer in China, is based on a multidisciplinary treatment model, and can be used as a reference for clinicians.