Task Specific Project 4

食管腺癌是食管癌发病和死亡的重要来源，其发病率 在白色男性中增加了350%以上，现在是癌症相关死亡的第七大原因97 '98， 年龄调整后的年发病率为2.5/10万。“Barrett化生的存在， 正常食管鳞状上皮被柱状上皮所取代， 与食管腺癌相关。巴雷特化生患者估计有30-40倍 腺癌的风险高于一般人群。100这种情况的恶性潜力是 通过某些细胞从巴雷特化生发展到低度异型增生、高度异型增生和高度异型增生来证明， 不典型增生，最后发展为浸润性腺癌。因此，巴雷特化生患者 参加内窥镜监测计划，目的是检测高度异型增生或早期癌症 在侵袭和转移之前。 一个主要的危险因素的发展巴雷特化生是胃食管反流病（GERD） 其在肥胖个体中经常增加，并且肥胖在西方国家迅速增加。在这些 在GERD患者中，初次内镜检查时发现高达10-12%的Barrett粘膜。101 '102家族性 因素也可能参与食管腺癌103和GERD的发展。 随着外科技术和多模式治疗的进步，食管癌的5年生存率仍然是 105 - 106初次诊断时疾病处于晚期， 局部区域和远处转移性疾病的复发直接导致这种低5年生存率。 癌这突出了开发和改进早期癌症检测方法的重要性， 患有GERD和巴雷特化生的患者。

Esophageal adenocarcinoma is a significant source of morbidity and mortality and its incidence rate has increased over 350% among white males and is now the 7th leading cause of cancer-related deaths97'98 with an annual age adjusted incidence of 2.5 per 100,000." The presence of Barrett's metaplasia, a condition in which the normal esophageal squamous mucosa is replaced by columnar epithelium is however, strongly associated with esophageal adenocarcinoma. Patients with Barrett's metaplasia have an estimated 30-40 fold greater risk.of adenocarcinoma than the general population.100 The malignant potential of this condition is evidenced by the progression of certain cells from Barrett's metaplasia to low-grade dysplasia, high-grade dysplasia, and finally to invasive adenocarcinoma. For this reason, patients with Barrett's metaplasia are enrolled in endoscopic surveillance programs with the intent of detecting high-grade dysplasia or early cancers prior to invasion and metastasis. A major risk factor for the development of Barrett's metaplasia is gastroesophageal reflux disease (GERD) which is often increased in obese individuals and obesity is rapidly increasing in Western countries. In those patients with GERD, Barrett's mucosa is found in up to 10-12% at the time of initial endoscopy.101'102 Familial factors may also be involved in the development of esophageal adenocarcinoma103 and GERD.104 Despite advances in surgical technique and multimodal therapy, the 5-year survival rate for esophageal cancer remains dismal at 5-15%.105'106 The advanced stage of disease at the time of initial diagnosis and the high rates of recurrence of local-regional and distant metastatic disease directly contribute to the low 5-year survival of this cancer. This highlights the importance of developing and refining methods for early cancer detection in patients who have GERD and Barrett's metaplasia.