[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-330803-105":59,"doc-detail-330803-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","endoscopic-diagnosis-and-management-of-superficial-esophageal-squamous-cell-carcinoma","Endoscopic diagnosis and management of superficial esophageal squamous cell carcinoma","","Review article detailing how superficial esophageal squamous cell carcinoma (ESCC) is diagnosed and managed, emphasizing the close relationship between invasion depth and initial treatment choice. It outlines risk factors such as tobacco, alcohol, and field cancerization, then focuses on pre-treatment assessment and endoscopic evaluation to avoid missed subtle mucosal changes. Techniques include high-definition white light endoscopy, Lugol chromoendoscopy with the pink-color sign, and electronic/optical chromoendoscopy, comparing sensitivity, specificity, and biopsy guidance using Lugol-void lesion patterns.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endoscopic-diagnosis-and-management-of-superficial-esophageal-squamous-cell-carcinoma/330803/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endoscopic-diagnosis-and-management-of-superficial-esophageal-squamous-cell-carcinoma/330803.png","ImageObject",300,407,{"name":92,"@type":93},"Violet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-26","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How is superficial ESCC defined and how does invasion depth affect management?","Question",{"text":113,"@type":114},"Superficial ESCC is defined as cancer invading up to the submucosa regardless of lymph node status (T1NxMx), while early ESCC is mucosal cancer (T1aNxMx). Survival rates and initial treatment choice are directly related to invasion depth.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why is endoscopic examination preparation important for detecting superficial ESCC?",{"text":118,"@type":114},"Mucosal changes in early cancers can be subtle and may be missed. Proper preparation includes removing mucus and bubbles using mucolytics and/or defoaming agents, ensuring appropriate sedation, and allowing sufficient time to evaluate the esophagus.",{"name":120,"@type":111,"acceptedAnswer":121},"What is the pink-color sign in Lugol chromoendoscopy and what is its clinical value?",{"text":122,"@type":114},"After iodine staining, a color change from yellow to pink 2–3 minutes later is the pink-color sign. It serves as a valuable indicator for diagnosing ESCC and improves specificity, including for HGIN and invasive cancer, and helps guide biopsy site selection in patients with multiple Lugol-void lesions.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},330803,1790470151,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908","REVIEW ARTICLE  \n[https://doi.org/10.1590/1806-9282.2024S133](https://doi.org/10.1590/1806-9282.2024S133)  \nEndoscopic diagnosis and management of superficial esophageal squamous cell carcinoma  \nRenata Nobre Moura1 , Fauze Maluf-Filho1*   \nBrazilian Society of Digestive Endoscopy  \nINTRODUCTION  \nEsophageal neoplasia ranks seventh in incidence and sixth in mortality among all cancers worldwide 1. Regarding histopathology, squamous cell carcinoma (SCC) accounts for up to 90% of cases and its distribution varies geographically, with a concentration in areas of greatest risk known as the “esophageal cancer belt,” which encompasses the region from northeast Iran, Central Asia, and northeast China2 (Figures 1 and 2) .  \nSmoking and alcohol consumption are major risk factors for esophageal squamous cell carcinoma (ESCC) . Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of developing a second primary tumor on the esophagus supporting the concept of field cancerization. Results ofa screening program in high-risk patients showed that the frequency of a second primary tumor in this population occurred in 8% of patients with HNSCC, mostly superficial lesions amenable to  \nendoscopic curative resection. In multivariate analysis, SCC of the oral cavity and oropharynx and the presence of esophageal low-grade dysplasia (LGD) were the predictive factors of ESCC3.  \nSurvival rates and choice of initial treatment are directly related to invasion depth. According to the Japanese Esophageal Society4, superficial ESCC is defined as a cancer invading up to the submucosa, regardless of linfonodal invasion (T1NxMx). On the contrary, early ESCC is the mucosal cancer (T1aNxMx) (Figure 3) .  \nManagement of ESCC has changed over the last few years, and endoscopic resection (ER) techniques have become increasingly important. Nevertheless, surgery continues to be the standard treatment, either alone or in combination with chemoradiotherapy. In addition to the tumor staging, the management of ESCC should be chosen according to patients’ preferences and the availability of surgical and endoscopic approaches.  \nFigure 1. Incidence of esophageal cancer worldwide. Data source: GLOBOCAN 2020. Graph production: IARC ([https://gco.iarc.fr/today](https://gco.iarc.fr/today)) World Health Organization.  \n1Universidade deSão Paulo, Cancer Institute of the State ofSão Paulo, São Paulo Medical School, Department of Gastroenterology –São Paulo (SP), Brazil.  \n*Corresponding author: [fauze.maluf@terra.com.br](fauze.maluf@terra.com.br)  \nConflicts of interest: the authors declare there is no conflicts of interest. Funding: none.  \nReceived on October 15, 2023. Accepted on October 16, 2023.  \n1  \nRev Assoc Med Bras. 2024;70(Suppl 1):e2024S133  \nFigure 2. Number of new cases and deaths. Data source: GLOBOCAN 2020.Graph production: IARC ([https://gco.iarc.fr/today](https://gco.iarc.fr/today)) World Health Organization.  \nFigure 3. Subclassification for superficial cancer.  \nAs the incidence of ESCC is increasing mainly because of improvements in endoscopic detection, this review will focus on the advances in diagnosis and endoscopic treatment strategies for superficial ESCC.  \nPRETREATMENT ASSESSMENT  \nENDOSCOPY  \nMost patients with superficial ESCC do not have signs or symptoms caused by the neoplasia. It means that the diagnosis  \nof superficial ESCC relies on endoscopy mostly indicated for unrelated gastrointestinal symptoms (e.g., dyspepsia) or in the context of screening programs5.  \nThe accurate evaluation of disease extent is crucial for the selection of the appropriate treatment strategy, and the endoscopic assessment of tumor depth is essential. Nevertheless,  \nmucosal changes associated with early cancers maybe subtle and missed. Therefore, the right preparation for an endoscopic examination is mandatory. The first step is to remove mucus and bubbles from the mucosal surface with mucolytics and/or defoaming agents. Adequate conscious sedatio","cbCaij3wnJWikHDt","https://ap.wps.com/l/cbCaij3wnJWikHDt","pdf",3005760,"English","# Introduction\n# Pretreatment Assessment\n## Endoscopy","[{\"question\":\"How is superficial ESCC defined and how does invasion depth affect management?\",\"answer\":\"Superficial ESCC is defined as cancer invading up to the submucosa regardless of lymph node status (T1NxMx), while early ESCC is mucosal cancer (T1aNxMx). Survival rates and initial treatment choice are directly related to invasion depth.\"},{\"question\":\"Why is endoscopic examination preparation important for detecting superficial ESCC?\",\"answer\":\"Mucosal changes in early cancers can be subtle and may be missed. Proper preparation includes removing mucus and bubbles using mucolytics and/or defoaming agents, ensuring appropriate sedation, and allowing sufficient time to evaluate the esophagus.\"},{\"question\":\"What is the pink-color sign in Lugol chromoendoscopy and what is its clinical value?\",\"answer\":\"After iodine staining, a color change from yellow to pink 2–3 minutes later is the pink-color sign. It serves as a valuable indicator for diagnosing ESCC and improves specificity, including for HGIN and invasive cancer, and helps guide biopsy site selection in patients with multiple Lugol-void lesions.\"}]","Endoscopic diagnosis and management of superficial esophageal squamous cell carcinoma | PDF",1789990214]