Task Specific Project 4

食管腺癌是发病率和死亡率的重要来源，其发病率 在白人男性中增加了350%，现在是与癌症相关的死亡的第七大原因，97‘98 年龄调整后的年发病率为2.5/100,000。 然而，柱状上皮取代了正常的食管鳞状黏膜 与食管腺癌有关。Barrett化生的患者估计有30-40倍 罹患腺癌的风险比普通人群更大。这种情况的恶性潜能是 某些细胞从巴雷特化生到低级异型增生、高级别异型增生的进展证明 不典型增生，最后发展为浸润性腺癌。因此，患有巴雷特化生的患者 参加旨在检测高度不典型增生或早期癌症的内窥镜监测计划 在侵袭和转移之前。 胃食道反流病(GERD)是Barrett化生的主要危险因素 这在肥胖个体中往往会增加，而且在西方国家肥胖正在迅速增加。穿着那些 患有GERD的患者，首次内窥镜检查时，Barrett‘s粘膜的发病率高达10%-12%。101’102家族 食管腺癌103和GERD 104的发生也可能与多种因素有关 手术技术和多模式治疗的进展食道癌的5年生存率 5%-15%令人沮丧。105‘106最初诊断时疾病的晚期和高发病率 局部区域和远处转移性疾病的复发直接导致本病5年生存率低 癌症。这凸显了开发和完善癌症早期检测方法的重要性。 有GERD和Barrett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.