25. Precancerous disorders in the oral cavity, pharynx, larynx and oesophagus

Oral leukoplakia and erythroplakia

Leukoplakia is an unbrushable white lesion, while the erythoplakias are fiery red. They are associated with increased risk of cancer and have normally no symptoms. The risk factors for leuko- and erythroplakias are smoking, chewing tobacco and excessive alcohol intake.

The risks of progression into invasive squamous cell carcinoma is 3-25% with leukoplakia, and more than 50% with erythroplakia. It’s important to distinguish them from benign oral lesions like oral candidiasis.

These precancerous lesions should be surgically removed, or alternatively, regularly surveyed. Avoiding risk factors is important to prevent recurrence or progression.

Barrett oesophagus

Barrett oesophagus is a consequence of chronic GERD where the chronic acid exposure of the oesophageal mucosa causes intestinal metaplasia (Barrett metaplasia). On histology goblet cells can be seen in the mucosa. It occurs in up to 15% of patients with GERD.

Barrett oesophagus is a precancerous lesion which must be treated or at the very least frequently monitored. It may progress into adenocarcinoma.

Barrett oesophagus is asymptomatic and is often discovered when a patient is being evaluated endoscopically for GERD. The diagnosis is based on biopsy and histology.

All patients with Barrett oesophagus should be on PPI.

Barrett oesophagus with high-grade dysplasia is treated with mucosectomy (endoscopic resection) or endoscopic ablation, same as T1A oesophageal cancer. No dysplasia or low-grade dysplasia may be managed either with regular surveillance or endoscopic removal.