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List of key points of China's guidelines for esophageal cancer screening and early diagnosis and early treatment (2022, Beijing).

 Last Update: 2022-11-15
 Source: Internet
 Author: User

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Esophageal cancer is one of the common malignant tumors of the digestive tract in China, which seriously threatens the life and health of
Chinese residents.
Screening, early diagnosis and early treatment of people at high risk of esophageal cancer can effectively reduce the incidence and mortality of esophageal cancer.

The formulation of guidelines for esophageal cancer screening and early diagnosis and early treatment in line with China's national conditions will promote the homogeneity and standardization of esophageal cancer screening in China and improve the effect
of esophageal cancer screening 。 China's guidelines for esophageal cancer screening and early diagnosis and early treatment are entrusted and guided by the National Health Commission Bureau of Disease Control and Prevention, initiated by the National Cancer Center, and jointly with multidisciplinary experts, integrating domestic and foreign research progress in the field of esophageal cancer screening and early diagnosis and early treatment, while considering China's national conditions and the actual experience of esophageal cancer screening, according to the guidelines recommended by the World Health Organization, the principles and methods are formulated, and evidence-based recommendations are given for the screening population, technology and process in the process of esophageal cancer screening It aims to ensure the effect of esophageal cancer screening and early diagnosis and treatment, and to provide a scientific basis for the prevention and control of esophageal cancer in China.

01 The incidence and mortality of esophageal cancer in China (A) The burden of esophageal cancer in China is serious and is one of the main causes of death from malignant tumors (B) The incidence of esophageal cancer in China shows gender, age and regional differences (C) The mortality rate of esophageal cancer in China shows gender, age and regional differences 02 The survival rate of esophageal cancer patients in China (A) Esophageal cancer in China 5 The annual relative survival rate has improved in recent years (B) The 5-year relative survival rate of esophageal cancer in China shows regional and sex differences03 Risk factors and protective factors related to the incidence of esophageal cancer (A) The burden of esophageal cancer in China is serious and is one of the main causes of death from malignant tumors (B) The incidence of esophageal cancer in China shows gender, age and regional differences (C) China's esophageal cancer mortality showed gender, age and regional differences04 Pathological classification and pathological staging of esophageal tumor lesions related to screening (A) Esophageal cancer histological classification includes squamous cell carcinoma (non-special type), adenocarcinoma (non-special type), adenosquamous cell carcinoma, small cell carcinoma, etc
(B) According to the American Joint Committee on Cancer (AJCC) TNM staging system (8th edition), the pathological stages of esophageal cancer are divided into stage 0, stage I.
, stage II.
, stage III.
and stage IV.
05 Definition of early esophageal cancer and precancerous lesions

(A) Early esophageal cancer refers to invasive carcinoma of the esophagus whose lesions are confined to the mucosal layer, regardless of regional lymph node metastasis

(B) Esophageal precancerous lesions include esophageal squamous epithelial cell dysplasia and Barrett esophageal dysplasia

06Adverse outcome event indicators for esophageal cancer screening

(A) The harm of esophageal cancer screening refers to any negative effect of an individual's or group's participation in the screening process compared to no screening

(B) Overdiagnosis refers to a situation in which an individual is diagnosed with a malignant tumor by participating in screening, but if the individual is not screened, the malignant tumor will not be detected for life

07Definition of high incidence area of esophageal cancer

(A) It is recommended to define the high incidence of esophageal cancer by county-level administrative regions (strong recommendation, evidence classification: medium)

(B) The areas with an age-standardized incidence of esophageal cancer > 15/100,000 are areas with a high incidence of esophageal cancer, and the areas with an age-standardized incidence rate of > 50/100,000 are areas with a very high incidence of esophageal cancer (strong recommendation, evidence grading: medium)

08Definition of high-risk groups for esophageal cancer

Age≥ 45 years old and one of the following:

(A) Long-term residence in an area with a high incidence of esophageal cancer (strong recommendation, evidence classification: medium)

(B) History of esophageal cancer in first-degree relatives (strongly recommended, evidence grading: medium)

(D) Have smoking, drinking, hot diet and other living and eating habits (strongly recommended, evidence grading: medium)

09Recommended starting and ending age for screening of people at high risk of esophageal cancer

Esophageal cancer screening is recommended for high-risk people to start at 45 years and end screening at 75 years or when life expectancy < 5 years (strongly recommended, evidence graded: medium)

10 Effectiveness of novel esophageal cell collectors for screening for esophageal cancer

(A) The use of traditional balloon dragnet cytology for early screening of esophageal cancer is not recommended (weak recommendation, evidence classification: medium)

Barrett's esophageal screening with a novel esophageal cell collector is recommended (weak recommendation, evidence grading: medium)

(C) Recommended for initial screening of endoscopic esophageal cancer using a novel esophageal cell collector (strongly recommended, evidence grading: medium).

11Biomarker screening for esophageal cancer

Biomarker testing is not recommended for esophageal cancer screening (strongly recommended, evidence grade: very low)

12Esophageal cancer screening population and screening interval

(A) It is recommended that people at high risk of esophageal cancer in China undergo endoscopy every 5 years (strong recommendation, evidence classification: medium)

(B) It is recommended that patients with low-grade intraepithelial neoplasia undergo endoscopy every 1~3 years (strong recommendation, evidence grading: medium)

(C) It is recommended that patients with low-grade intraepithelial neoplasia combined with endoscopic high-risk factors or lesions with a length and diameter of > 1 cm undergo endoscopy once a year for 5 years (strongly recommended, evidence grading: medium)

(D) Barrett esophageal patients without dysplasia are recommended to undergo endoscopy every 3~5 years (weak recommendation, evidence grade: low)

(E) Barrett esophageal patients with low-grade intraepithelial neoplasia are recommended to undergo endoscopy every 1~3 years (weak recommendation, evidence grade: low)

Choice of type of esophageal endoscopy

(A) Lugol's liquid staining endoscopy or narrow band imaging (NBI) endoscopy is recommended as the first choice for esophageal cancer screening, and ordinary white light endoscopes can be selected for those with insufficient conditions, and magnifying endoscopes can be used in combination with those with conditions (strong recommendation, evidence grading: medium).

(B) Recommend hospitals with conditions to try to use artificial intelligence microendoscopy (weak recommendation, evidence grading: low)

(C) Recommend that patients who cannot tolerate conventional channel endoscopy try nasal endoscopy (weak recommendation, evidence grade: low)

During esophageal endoscopy

(A) Systematic observation of the entire esophageal mucosa under esophageal endoscopy is recommended, and adequate and reasonable examination time is required (strongly recommended, evidence grade: low)

(B) Endoscopy duration at least 7 minutes and esophageal observation time of not less than 3 minutes (weak recommendation, evidence classification: medium)

(C) The use of mucus extractants and defoamers is recommended to improve the visibility of the esophageal endoscopic mucosa, and patients should be required to fast for more than 6 h and water for more than 2 h before endoscopic screening (strongly recommended, evidence grading: very low)

Effectiveness of PET-CT in screening for esophageal cancer

(A) Early screening for esophageal cancer using 18 F-FDG PET-CT is not recommended (weak recommendation, evidence classification: medium).

(B) PET-CT is not recommended for early screening of esophageal cancer (weak recommendation, evidence grade: low)

Early treatment of esophageal cancer

(A) It is recommended to evaluate the extent, stage and depth of invasion of lesions through endoscopy before endoscopic treatment of early esophageal cancer (strongly recommended, evidence grading: medium).
(B) For patients with early-stage esophageal cancer who meet the absolute and relative indications for endoscopic resection, endoscopic resection (ESD) is recommended, and endoscopic submucosal dissection (ESD) is preferred; When the length and diameter of the lesion ≤ 10 mm, if the whole piece can be guaranteed, endoscopic mucosal resection (EMR) treatment can also be considered (strongly recommended, evidence grade: high) (C) For patients with early esophageal adenocarcinoma after EMR resection, ablation therapy after EMR resection is recommended to improve the cure rate and reduce the incidence of esophageal stricture and perforation (weak recommendation, evidence grade: high).
(D) Endoscopic radio frequency ablation (RFA) can be used to treat esophageal squamous cell carcinoma confined to the lamina propria of the mucosa
.
Endoscopic RFA (weak recommendation, evidence grading: medium) (E) can be considered when the ≥>lesion is too long, the near annular circumference, etc.
, or the patient does not tolerate endoscopic resection

Early treatment of precancerous lesions of the esophagus

(A) Pathology shows low-grade intraepithelial neoplasia of esophageal squamous epithelium, but endoscopic high-grade lesion manifestations or risk factors for pathological escalation can be endoscopic resection, and those who have not been resected should re-examine endoscopy and re-biopsy within 3~6 months; RFA may be considered when the lesion is too long, proximal circumferential, or the patient does not tolerate endoscopic resection (strongly recommended, graded evidence: medium)

(B) Endoscopic resection of the whole block is recommended for pathological high-grade intraepithelial neoplasia of squamous epithelium and no submucosal infiltration and lymph node metastasis after endoscopic or imaging evaluation; RFA may be considered when the lesion is too long, proximal circumferential, or the patient does not tolerate endoscopic resection (weak recommendation, evidence classification: medium)

(C) Patients with Barrett's esophagus with low-grade dysplasia (LGD) of the mucous membrane are recommended for endoscopic radiofrequency ablation therapy, and those who have not been treated are followed up once every 6~12 months; Barrett's esophagus with HGD, with RFA followed by endoscopic resection preferred (strongly recommended, evidence grade: high)

Post-treatment management of patients with esophageal cancer and precancerous lesions

(A) Esophageal stricture should be actively prevented after endoscopic resection for esophageal cancer and precancerous lesions with lesions exceeding 3/4 of the circumferential diameter of the esophagus, and local injection of steroids, oral steroids and balloon dilation is recommended (strongly recommended, evidence grade: high)

(B) Early esophageal squamous cell carcinoma and precancerous lesions should be reviewed every 3~6 months in the first year after endoscopic treatment, including upper gastrointestinal endoscopy and other corresponding examinations, if there is no obvious abnormality, reexamination can be performed once a year from the second year (weak recommendation, evidence grading: low)

(C) Regular endoscopic follow-up is recommended after endoscopic resection or ablation for Barrett's esophageal-associated LGD, HGD, or early adenocarcinoma (strongly recommended, evidence grade: high)

Competencies of physicians conducting esophageal cancer screenings

Esophageal cancer screening endoscopists should have a clear understanding of the anatomical features of the esophagus, have the ability of general endoscopy, carry out endoscopic diagnosis and treatment for at least 5 years, and obtain the qualifications of attending physician and above for professional and technical positions; Each endoscopist has personal experience with at least 300 esophageal endoscopic procedures; Endoscopists meet training criteria for endoscopic screening for esophageal cancer (strongly recommended, evidence grade: low)

Esophageal cancer screening quality control

It is recommended that the early diagnosis rate of esophageal cancer and the use rate of chromatoendoscopy be used as quality control indicators for esophageal cancer screening (strongly recommended, evidence grading: low)

The above content is extracted from: Guidelines for Screening, Early Diagnosis and Treatment of Esophageal Cancer in China (2022, Beijing) Click to read the full text of the guidelines

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