In this paper, the most important publication of 1993 with respect to all facets of esophageal cancer are summarized and put in perspective with the current state of knowledge. Columnar metaplasia and esophageal surgery, chemotherapy, and radiotherapy will not be covered as they are the subject of separate chapters. Undoubtedly, a major emphasis was given to the further unraveling at the molecular level of the complex genetic aberrations that ultimately lead to esophageal carcinogenesis. Understanding these molecular abnormalities becomes increasingly complex for the clinician. However, clinicians should be aware, albeit superficially, of these new insights because they may lead to clinically useful diagnostic and prognostic elements. It has become clear that there is an increasing need for a better subclassification of the superficial or early esophageal cancers. Currently, these cancers encompass epithelial, mucosal, and submucosal tumors. As there is already a high percentage of lymph node metastasis for submucosal tumors, true progress can only be made if malignancies are detected at the stage of epithelial or mucosal cancer. In the future, this may require an adaptation of the T system, as T1 now equals mucosal and submucosal cancer. As new techniques are being developed to treat malignancy at the level of the mucosa by nonsurgical means, it will become essential to accurately detect tumors with high-frequency endoluminal ultrasound.
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