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Abramson Cancer CenterNCI CANCERLIT® Search: Esophageal Neoplasms - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11967675
AU - Incarbone R; Bonavina L; Saino G; Bona D; Peracchia A
TI -
Outcome of esophageal adenocarcinoma detected during endoscopic biopsy
surveillance for Barrett's esophagus.
SO - Surg Endosc 2002 Feb;16(2):263-6
AD - Department of Surgical Sciences, University of Milan, Ospedale Maggiore
di Milano, IRCCS, Via F. Sforza 35, 20122 Milan, Italy.
BACKGROUND: In an attempt to reduce mortality from esophageal
adenocarcinoma, it has been recommended to enroll patients with
Barrett's esophagus in endoscopic surveillance programs in order to
detect malignant degeneration at an early and possibly curable stage.
The aim of this study was to assess the impact of endoscopic biopsy
surveillance on outcome of Barrett's adenocarcinoma. METHODS: Between
esophageal adenocarcinoma were referred to our department. Ninety-seven
of these patients had Barrett's adenocarcinoma. In 12 (12.2%) patients,
cancer was discovered during endoscopic surveillance for Barrett's
metaplasia. RESULTS: The prevalence of gastroesophageal reflux disease
in the Barrett's group was 38.8% versus 8% (p < 0.01) in non-Barrett's
patients. In the surveyed group, there were 9 (75%) early stage tumors
(Tis-1/N0) versus 9 (10.6%, p < 0.01) in the nonsurveyed patients. Three
of 5 surveyed patients operated on for high-grade dysplasia proved to
have invasive carcinoma in the esophagectomy specimen. All surveyed
patients were alive at a median follow-up of 48 months; the median
survival in the nonsurveyed group was 24 +/- 3 months (p < 0.01).
CONCLUSION: Endoscopic surveillance of Barrett's esophagus provides
early detection of malignant degeneration and a better long-term
survival than in nonsurveyed patients.
2
UI - 11967708
AU - Norberto L; Urso E; Angriman I; Ranzato R; Erroi F; Marino S; Tosato S;
TI -
Ruffolo C; D'Amico DF
Yttrium-aluminum-garnet laser therapy of esophageal granular cell tumor.
SO - Surg Endosc 2002 Feb;16(2):361-2
AD - Department of Surgical and Gastroenterological Sciences, Surgical
Endoscopy Unit, Clinica Chirurgica 1, University of Padua, Italy.
norberl@uxl.unipd.it
BACKGROUND: Granular cell tumor (GCT) is a rare lesion. Approximately 4%
to 6% of these tumors occur in the gastrointestinal tract, one-third of
them affecting the esophagus. Almost all GCTs are benign lesions.
Approximately 1% to 3% are malignant. Endoscopic ultrasonography (EUS)
is a diagnostic support. The best treatment for esophageal GCT is not
yet clear, whether surgical excision, periodic observation, endoscopic
excision, or yttrium-aluminum-garnet (YAG) laser therapy. METHODS: From
were observed. All the patients underwent EUS evaluation and endoscopic
YAG laser therapy of the esophageal neoplasm. At each session, a biopsy
at the tumor site was obtained. The treatment was continued until
endoscopic and histologic evidence of the tumor disappeared. RESULTS:
After the YAG laser therapy, no evidence of the tumor was found in any
of the four patients with esophageal GCT. At this writing, the patients
remain disease free after a mean follow-up period of 66 months. No
complication has been observed. Only four sessions for each patient were
necessary to eliminate the tumor. CONCLUSIONS: Therapy with YAG laser
was effective in all four patients with esophageal GCT, and complete
necrosis of the submucosal neoplastic cells was achieved. Endoscopic YAG
laser therapy appears to be a good compromise between esophageal
dissection and long-term observation without tumor excision. Esophageal
laser therapy is safe if correctly used, and previous EUS evaluation
increases treatment safety.
3
UI - 11764654
AU - Nutting CM; Bedford JL; Cosgrove VP; Tait DM; Dearnaley DP; Webb S
TI -
Intensity-modulated radiotherapy reduces lung irradiation in patients
with carcinoma of the oesophagus.
SO - Front Radiat Ther Oncol 2002;37():128-31
AD - Academic Department of Radiotherapy, Institute of Cancer Research, Royal
Marsden NHS Trust, Sutton, UK. chrisnutting@cs.com
4
UI - 11910473
AU - Koliopanos A; Friess H; di Mola FF; Tang WH; Kubulus D; Brigstock D;
TI -
Zimmermann A; Buchler MW
Connective tissue growth factor gene expression alters tumor progression
in esophageal cancer.
SO - World J Surg 2002 Apr;26(4):420-7
AD - Department of Visceral and Transplantation Surgery, University of Bern,
Inselspital, CH-3010 Bern, Switzerland.
The ability of cancer cells to initiate specific fibroblast reactions
may subsequently determine tumor evolution. In the present study we
examined the coordinated expression of transforming growth factor-beta-1
(TGF-beta1), its signaling receptors, and its downstream
mediator-connective tissue growth factor (CTGF)--and their impact on
tumor progression and fibrogenesis in esophageal carcinomas. Messenger
ribonucleic acid (mRNA) expression of TGF-beta1, CTGF, TGF-beta receptor
subtype I ALK5 (TbetaR-IALK5), and TGF-beta receptor type II (TbetaR-II)
was studied by Northern blot analysis in esophageal cancer and the
normal esophagus. By means of immunohistochemistry and Western blot
analysis, the respective proteins were localized in the tissue samples
and the protein content was quantitated. Northern blot analysis revealed
3-fold and 4-fold increases (p < 0.05) in TGF-beta1 and CTGF mRNA
levels, respectively, in esophageal cancer in comparison with normal
controls, whereas TbetaR-I mRNA levels were significantly decreased and
TbetaR-II mRNA levels were unchanged in the cancer samples.
Immunostaining revealed results similar to those seen on the RNA level.
TGF-beta1 and CTGF immunoreactivity were increased, TbetaR-II was
unchanged, and TbetaR-IALK5 immunoreactivity was decreased. CTGF
immunoreactivity was mainly present in the stroma surrounding the cancer
cells but was also present in the cancer cells. The degree of fibrosis
was different in squamous and adenocarcinomas and was significantly
related to CTGF mRNA expression levels. The presence of CTGF in squamous
cell carcinomas was associated with longer survival, whereas in
adenocarcinomas it influenced survival negatively. The findings indicate
that TGF-beta signaling is disturbed in esophageal cancer. CTGF, a
downstream effector of TGF-beta action, differentially influences the
composition of tumor microenvironment and distinct cell-matrix
interactions in the two histological types of esophageal carcinoma,
resulting in differences in tumor progression and patient survival.
5
UI - 11819737
AU - Wang SJ; Wen DG; Zhang J; Man X; Liu H
TI -
Intensify standardized therapy for esophageal and stomach cancer in
tumor hospitals.
SO - World J Gastroenterol 2001 Feb;7(1):80-2
AD - Hebei Tumor Hospital, 5 Jiankanglu, Shijiazhuang 050011, Hebei Province,
China.
6
UI - 11986424
AU - Scherubl H; Scherer H; Hoffmeister B
TI -
Head and neck cancer.
SO - N Engl J Med 2002 May 2;346(18):1416-7
7
UI - 11916346
AU - Conio M; Filiberti R; Blanchi S; Giacosa A
TI -
Carditis, intestinal metaplasia and adenocarcinoma of oesophagogastric
junction.
SO - Eur J Cancer Prev 2001 Dec;10(6):483-7
AD - Department of Gastroenterology and Clinical Nutrition, National Cancer
Research Institute, Genova, Italy.
Barrett's oesophagus is a precancerous condition in which the normal
squamous epithelium is replaced by intestinal metaplasia (IM). IM can
then progress through increasingly severe dysplasia to oesophageal
adenocarcinoma (EAC). In the gastric cardia the normal gastric mucosa,
when inflamed (carditis), can be replaced by IM and can then progress to
gastric adenocarcinoma (GAC). The same histopathological sequence can
take place on either side of the oesophagogastric junction. Since the
location of that junction can be uncertain this can result in confused
diagnosis between EAC and GAC. In this review, the diagnostic criteria,
incidence and risk factors for Barrett's oesophagus and carditis are
discussed, together with the factors determining the risk of progression
to adenocarcinoma of the oesophagus or cardia. The risk factors include
familial/genetic, environmental and dietary characteristics. Finally,
these risk factors are discussed within the context of cancer
prevention.
8
UI - 11884045
AU - Kyriazanos ID; Tachibana M; Yoshimura H; Kinugasa S; Dhar DK; Nagasue N
TI -
Impact of splenectomy on the early outcome after oesophagectomy for
squamous cell carcinoma of the oesophagus.
SO - Eur J Surg Oncol 2002 Mar;28(2):113-9
AD - Second Department of Surgery, Shimane Medical University, Izumo, 693
8501, Japan. yannis@shimane-med.ac.ip
AIM: Operative procedures for oesophageal malignancies are becoming more
extensive and may result in fatal complications. Splenectomy compromises
the immune system and can lead to increased susceptibility to
infections. The aim of the present study was to report the early outcome
of patients who underwent oesophagectomy and simultaneous splenectomy
due to oesophageal squamous cell carcinoma (SCC). METHODS: Pre-operative
risks and post-operative morbidity and mortality in 135 patients who had
undergone extensive oesophagectomy without simultaneous splenectomy for
SCC of the thoracic oesophagus were compared with those of 14 patients
who had undergone oesophagectomy associated with splenectomy. RESULTS:
Post-operative pneumonia, intra-abdominal abscess, post-operative sepsis
and anastonotic leakage were significantly increased when splenectomy
was added to the original operation. The incidence of in-hospital death
was significantly higher among splenectomized than non-splenectomized
patients (35.7% vs 8.1%, P<0.01). Pulmonary complications and leakage
were the main causes of death. Multivariate analysis recognized
splenectomy as an independent prognostic factor for in-hospital death
following transthoracic oesophagectomy for SCC. CONCLUSION: The addition
of splenectomy to transthoracic oesophagectomy for oesophageal carcinoma
can be a fatal combination. Preservation of the spleen should be the
primary intention. In circumstances that necessitate splenectomy
precautions should be taken to prevent post-operative infectious
complications. Copyright Harcourt Publishers Limited.
9
UI - 11934919
AU - Britton D
TI -
Oesophageal cancer surgery.
SO - J R Soc Med 2002 Apr;95(4):218
10
UI - 11937011
AU - Ilson DH
TI -
New developments in the treatment of esophageal cancer.
SO - Curr Oncol Rep 2002 May;4(3):213-21
AD - Gastrointestinal Oncology Service, Department of Medicine, Memorial
Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10011,
USA. ilsond@mskcc.org
Esophageal cancer is a rare but highly virulent malignancy in the United
States and Western Europe, and adenocarcinoma of the esophagus has had
the most rapid rate of increase of any solid tumor malignancy. Combined
chemoradiotherapy is the standard of care in the nonsurgical management
of esophageal cancer. Trials of preoperative chemotherapy followed by
surgery have not shown a consistent benefit. Preoperative
chemoradiotherapy followed by surgery continues to be actively studied
in the surgical management of locally advanced esophageal cancer.
Pathologic complete responses are seen in 20% to 40% of patients, with
5-year survival achieved in 30% to 35%. Newer agents, such as the
taxanes and irinotecan, have been evaluated in combined
chemoradiotherapy trials. These trials have shown promising antitumor
activity and therapy tolerance, depending on the dose and schedule of
therapy administered. Increasing the dose of radiotherapy, or adding a
brachytherapy boost to chemoradiotherapy, has not improved the outcome
of treatment in clinical trials. The advent of newer targeted therapies,
including agents directed against growth factor receptor pathways, tumor
angiogenesis, and tumor invasion and metastasis, is leading to a new
generation of clinical trials combining these agents with conventional
cytotoxic chemotherapy and radiation.
11
UI - 11930636
AU - Wang T; Zhang W; Liu Y
TI -
[Clinical significance of the novel tumor marker CYFRA21-1 in patients
with esophageal cancer]
SO - Zhonghua Yi Xue Za Zhi 2001 Nov 25;81(22):1390-1
AD - Department of Thoracic Surgery, Peking Union Hospital, Peking Union
Medical Collage, Beijing 100730, China.
OBJECTIVE: To study the clinical significance of the novel tumor
marker--CYFRA21-1 in patients with esophageal cancer. METHODS: The
CYFRA21-1 level in serum of 84 patients with a definite diagnosis of
esophageal cancer was examined 10 days before and after operation by
ELISA. A 3 years' follow-up was conducted to the survival of patients.
RESULTS: (1) The CYFRA21-1 level was > 3.3 ng/ml in 72.6% of the
patients (61/84). (2) The serum CYFRA21-1 level decreased significantly
after operation in patients at stage III or with high differentiation (P
< 0.05). (3) The difference between pre- and post-operative serum
CYFRA21-1 levels was statistically significant in patients who had
undegone radical operation, and was not in patients who had undergone
palliative operation. (4) In addition to stage (P < 0.05) and type of
operation (P < 0.05), the difference of CYFRA21-1 level before and after
operationwas closely related to the prognosis (P < 0.05). CONCLUSION:
CYFRA21-1 is a useful marker in diagnosis and prediction of prognosis of
esophageal cancer.
12
UI - 11859713
AU - Xing D; Song N; Tan W
TI -
[Detection of malondialdehyde-DNA adduct level by 32P-postlabeling assay
in normal human esophageal epithelium and esophageal squamous cell
carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):473-6
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing 100021, China.
OBJECTIVE: To study whether the main malondialdehyde-DNA adduct (M1-dG)
produced by lipid peroxidation is involved in the carcinogenesis of
esophagus. METHODS: DNA samples were isolated from normal esophageal
epithelium (n = 32) obtained by biopsy and esophageal squamous cell
carcinoma specimens (n = 30) obtained by surgery. All tissue samples
came from individuals living in Linxian, Henan, a high-risk area of
esophageal cancer. Contents of M1-dG adducts were detected by
32P-postlabeling method. RESULTS: M1-dG adducts were detectable both in
the normal and cancerous tissue samples. However, normal esophageal
epithelial tissues exhibited significantly lower levels of M1-dG adducts
(median 3.4, range 1.7/10(8)-55.4/10(8) nucleotides) than those found in
esophageal cancer tissues (median 14.1, range 1.4/10(8)-59.0/10(8)
nucleotides, P < 0.0001). The adduct levels were neither associated with
gender, age, tobacco smoking status or genetic polymorphism in the
CYP2E1, an enzyme participating in the oxidation of ethanol to form
reactive free radicals. CONCLUSIONS: Our findings provide evidence that
DNA damage, resulted from lipid peroxidation, can accumulate in the
normal human esophageal tissue and reach relatively high level in cancer
tissue which suggests that M1-dG adducts may be involved in the
initiation and progression of cancer with its mutagenic and carcinogenic
effects.
13
UI - 11954403
AU - Melville A
TI -
Better quality of care for UGI cancer patients.
SO - Nurs Times 2001 Mar 22-28;97(12):36-7
14
UI - 11914632
AU - Hoang MP; Hobbs CM; Sobin LH; Albores-Saavedra J
TI -
Carcinoid tumor of the esophagus: a clinicopathologic study of four
cases.
SO - Am J Surg Pathol 2002 Apr;26(4):517-22
AD - Division of Anatomic Pathology, University of Texas Southwestern Medical
Center, Dallas, Texas 75390-9073, USA.
Several case reports have emphasized that esophageal carcinoid tumors
are associated with a poor prognosis. To expand our knowledge about the
pathology and biologic behavior of these rare tumors, we reviewed the
clinicopathologic and immunohistochemical findings of four cases of
primary esophageal carcinoid. The age of the patients ranged from 48 to
82 years (mean 63 years; median 61 years). The lower segment of the
esophagus was involved in two cases and the mid segment was involved in
one case. The sizes of the tumors ranged from 0.3 cm to 3.5 cm. Two
tumors were confined to the lamina propria and two invaded into the
muscular wall. Two tumors appeared polypoid, whereas the remaining two
were incidental findings and associated with adenocarcinoma arising in a
background of Barrett esophagus. The adenocarcinoma was superficially
invasive in one case, whereas it penetrated the muscular wall in the
other. All four carcinoid tumors were immunoreactive with chromogranin
and synaptophysin. There was focal expression of serotonin in two cases,
glucagon in one case, and pancreatic polypeptide in one case. Endocrine
cell hyperplasia was noted in both the Barrett esophagus and the
invasive adenocarcinoma. One patient died secondary to postoperative
pneumonia. Three patients are alive and disease free at 1, 6, and 23
years status post therapy. None of the patients had metastatic disease.
These findings show that esophageal carcinoids are associated with a
favorable prognosis. They arise in two settings: (1) a single large
polypoid tumor or (2) an incidental finding and in association with
adenocarcinoma arising in the background of Barrett esophagus. The
presence of endocrine cell hyperplasia in the Barrett mucosa and the
adenocarcinoma supports the hypothesis that these lesions arise from a
common stem cell.
15
UI - 11965462
AU - Decker P; Lippler J; Decker D; Hirner A
TI -
Use of the Polyflex stent in the palliative therapy of esophageal
carcinoma: results in 14 cases and review of the literature.
SO - Surg Endosc 2001 Dec;15(12):1444-7
AD - Department of Surgery, Rheinische Friedrich Wilhelm University Bonn,
Sigmund Freud Strasse 25, 53105 Bonn,Germany.
BACKGROUND: Several prospective randomized trials have shown that
self-expanding stents have advantages over conventional plastic tubes.
Nevertheless, the optimal stent has not yet been developed. The Polyflex
stent is a completely new model that represents an improvement over the
old metal stents. We have used this stent in a prospective study and
herein our present preliminary results. METHODS: In 14 patients with
nonresectable esophageal carcinoma, the Polyflex stent was implanted to
reduce dysphagia. The grade of dysphagia, the complications following
intervention, and the patients' total survival time were documented
prospectively every 4 weeks. RESULTS: The implantation of the stent was
successful in all cases. The grade of the dysphagia was reduced from 3.0
to 0.5 after stent implantation. One patient died during the hospital
stay from a non-stent-induced complication. Stent dislocation occurred
once, and tumor overgrowth at the stent margins was observed twice. The
mean survival time was 6.2 months, and the reintervention rate was
21.3%. CONCLUSION: The new Polyflex stent, which is based on a
completely new design, can be implanted without any difficulty and has
had very good short- and long-term results. Therefore, it is a worthy
alternative to the metal stents in current use.
16
UI - 11943125
AU - Urschel JD; Vasan H; Blewett CJ
TI -
A meta-analysis of randomized controlled trials that compared
neoadjuvant chemotherapy and surgery to surgery alone for resectable
esophageal cancer.
SO - Am J Surg 2002 Mar;183(3):274-9
AD - Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
urschelj@mcmaster.ca
BACKGROUND: Esophagectomy is often considered the standard treatment for
resectable esophageal cancer but the rate of cure is low. Combining
neoadjuvant chemotherapy with surgery has theoretical appeal and some
clinical evidence suggests a benefit. We performed a meta-analysis of
randomized controlled trials (RCTs) that compared neoadjuvant
chemotherapy and surgery with surgery alone for esophageal cancer.
METHODS: Medline and manual searches were done to identify all published
RCTs that compared neoadjuvant chemotherapy and surgery to surgery alone
for esophageal cancer. The selection process was inclusive; no trials
were excluded. Trial validity assessment was done and a trial quality
score was assigned. Outcomes assessed by meta-analysis included 1-, 2-,
and 3-year survival, rate of resection, rate of complete resection,
operative mortality, anastomotic leaks, postoperative pulmonary
complications, all treatment mortality, local-regional cancer
recurrence, distant cancer recurrence, and all cancer recurrence. A
random-effects model was used and odds ratio was the principal measure
of effect. Systematic quantitative review was done for outcomes unique
to the neoadjuvant chemotherapy treatment group (clinical response,
pathological complete response, and chemotherapy mortality). RESULTS:
Eleven RCTs, which included 1,976 patients, were selected with quality
scores ranging from 1 to 3 (5-point Jadad scale). Odds ratio (95%
confidence interval [CI]; P value), expressed as chemotherapy and
surgery versus surgery alone (treatment versus control; values <1 favor
chemotherapy-surgery arm), was 1.00 (0.76, 1.30; P = 0.98) for 1-year
survival, 0.88 (0.62, 1.24; P = 0.45) for 2-year survival, 0.77 (0.37,
1.59; P = 0.48) for 3-year survival, 1.71 (1.22, 2.40; P = 0.002) for
rate of resection, 0.71 (0.58, 0.87; P = 0.001) for rate of complete
resection, 0.94 (0.66, 1.35; P = 0.76) for operative mortality, 1.08
(0.45, 2.60; P = 0.87) for anastomotic leaks, 1.31 (0.77, 2.23; P =
0.32) for postoperative pulmonary complications, 1.36 (0.83, 2.25; P =
0.22) for all treatment mortality, 0.71 (0.36, 1.42; P = 0.33) for
local-regional cancer recurrence, 0.79 (0.57, 1.10; P = 0.16) for
distant cancer recurrence, and 0.63 (0.28, 1.41; P = 0.26) for all
cancer recurrence. A clinical response to chemotherapy was observed in
31% of patients and 5% had a complete pathological response.
Chemotherapy mortality (before surgery) was 1.6%. CONCLUSIONS: Compared
with surgery alone, neoadjuvant chemotherapy and surgery is associated
with a lower rate of esophageal resection but a higher rate of complete
(R0) resection. It does not increase treatment related mortality. This
meta-analysis did not demonstrate a survival benefit for the combination
of neoadjuvant chemotherapy and surgery.
17
UI - 11943134
AU - Nakabayashi T; Mochiki E; Garcia M; Haga N; Kato H; Suzuki T; Asao T;
TI -
Kuwano H
Gastropyloric motor activity and the effects of erythromycin given
orally after esophagectomy.
SO - Am J Surg 2002 Mar;183(3):317-23
AD - First Department of Surgery, Faculty of Medicine, Gunma University,
3-39-15, Showa-machi, 371-8511, Maebashi, Japan.
BACKGROUND: The motor activity of the gastric tube as an esophageal
replacement after esophagectomy is poorly understood. The aims of the
present study were to examine the gastropyloric motility of the gastric
tube and the effects of erythromycin given orally. METHODS:
Interdigestive gastropyloric motility was recorded by manometry with a
sleeve sensor in 23 esophagectomized patients. The 23 patients were
classified into 3-, 12-, and 24-month groups according to postoperative
follow-up time. Radiopaque markers were used in 8 patients to assess
gastric emptying. The effects of erythromycin were studied after the
patients received 600 mg during fasting and 1 g postprandially. RESULTS:
Compared with the 3-month group, the 12-month group and the 24-month
group showed significantly increased pyloric and antral motility,
respectively. During a fast, erythromycin induced phase III in 44.4% of
the patients with more than 12 months of follow-up. In contrast to the
normal subjects, esophagectomized patients showed delayed gastric
emptying at 3 and 4 hours. However, erythromycin significantly
accelerated gastric emptying at 1, 2, 3, and 4 hours. CONCLUSIONS: The
motor activity of the gastric tube returns towards normal in a
progression over time from the pylorus cephalad. Erythromycin given
orally might be used as a prokinetic agent in patients after
esophagectomy.
18
UI - 11953125
AU - Li C; Wu M; Liang Y; Xu L; Cai W
TI -
[Analysis of telomerase activity in esophageal carcinoma using
microdissection telomeric repeat amplification protocol assay]
SO - Zhonghua Yi Xue Za Zhi 2002 Jan 10;82(1):39-42
AD - Department of Pathology, Shantou University Medical College, Shantou,
Guangdong 515031, China.
OBJECTIVE: To investigate the changes of telomerase activities in
atypical hyperplasia of esophageal mucosal epithelium and esophageal
squamous cell carcinoma (SCC) and to study the association of telomerase
activity with differentiation, invasiveness, and lymphatic metastasis of
cancer. METHODS: The telomerase activities of esophageal SCC tissues,
adjacent tissue with dysplasia, and normal mucosal epithelium from
surgical edge of 45 cases were detected by microdissection-TRAP
(Telomeric Repeat Amplification Protocol)-silver assay. RESULTS: The
telomerase activity rates were 79.3% (23/29) in atypical displastic
epithelium, 82.2% (37/45) in SCC tissue, and only 5% (2/40) in normal
epithelium. The difference of telpmerase activity between dysplastic and
normal esophageal epithelia was highly significant (P < 0.01). In the
same cancer tissue the differences of telomerase activity among cancer
nests to different degrees of defferentiation and to different depths
were not significant (P > 0.05). The positive rate of telomerase
activity was significantly higher in cases with lymphatic metastasis
than in cases without lymphatic metastasis (P < 0.05). CONCLUSION: The
telomerase activities is increased in esophageal SCC tissue and adjacent
atypical dysplastic tissue. The telomerase activity in SCC tissue is
related to lymphatic metastasis but not related to cancer
differentiation.
19
UI - 11993218
AU - Tsurumaru M
TI -
[Current and future problems of treatments for esophageal carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):323-4
AD - First Department of Surgery, Juntendo University School of Medicine,
Tokyo, Japan.
20
UI - 11993219
AU - Tamura K; Yoshikawa K; Tsujii H; Murata H
TI -
[Diagnosis of esophageal cancer using positron emission tomography]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):325-30
AD - National Institute of Radiological Sciences, Research Center Hospital
for Charged Particle Therapy, Clinical Diagnosis Section, Chiba, Japan.
Fluorodeoxyglucose positron emission tomography (FDG-PET) is more
accurate than computed tomography (CT) for evaluating lymph node
metastases and for N staging, but less accurate than combined CT and
endoscopic ultrasonography (EUS). Lymph nodes located adjacent to the
primary lesion tend to be false negatives. We consider that combined
FDG-PET and EUS is the most accurate for the detection of lymph node
metastasis in esophageal cancer. FDG-PET is also more accurate than CT
for detecting distant metastases and improves the detection of stage IV
disease compared with the conventional staging modalities. For the
diagnosis of recurrence except for perianastomotic recurrence, FDG-PET
provides additional information and is more sensitive than conventional
work-ups. FDGPET is a valuable tool for the noninvasive assessment of
tumor response after neoadjuvant therapy. 11C-methionine (MET) is
another tracer for PET that can be used to assess the metabolism of
amino acids, since MET accumulates in esophageal malignant tumors.
Choline-PET is more accurate than FDG-PET for the detection of
mediastinal lymph node metastases.
21
UI - 11993220
AU - Okuda I; Kokubo T; Hoshihara Y; Udagawa H
TI -
[Imaging diagnosis of esophageal carcinoma by computed tomography and
magnetic resonance imaging]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):331-6
AD - Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan.
The staging diagnosis of esophageal carcinoma is important to determine
therapeutic modalities and to predict prognosis. The current status of
imaging diagnosis of tumor invasion to the adjacent organs and lymph
node metastasis is described. The diagnostic criteria used to determine
tumor invasion to the adjacent or gans by computed tomography (CT) and
magnetic resonance imaging(MRI) are displacement and compression
deformity of the tracheobronchial tree and obliteration of the
periaortic fat plane over more than 90 degrees of the aortic
circumference. Detection of the fat plane between the esophagus and the
aorta supported by density profile analyzing software on CT may enable
the diagnosis of invasion. Cine-MRI imaging is also useful to obtain
dynamic information on the tumor and aorta. Tumor invasion to the aortic
wall can be excluded when a low-intensity stripe is recognized between
the tumor and the aortic wall. Although the criterion for lymph node
metastasis on CT is 10 mm or more in long transverse diameter, the
diagnostic accuracy is poor. The accuracy improves when imaging patterns
such as heterogeneous internal structures in the enhanced lymph nodes
and/or hyperenhancement in the lymph nodes in the early phase by dynamic
study are added to the diagnostic criteria. However, small metastatic
lymph node remain undetected and it is difficult to diagnose negative
lymph node metastasis properly on CT and MRI. It is important to have
full knowledge of the advantages and limitations of each imaging
modality and to obtain objective information form them.
22
UI - 11993221
AU - Yoshida M; Momma K
TI -
[Endoscopic evaluation of the depth of invasion in cases of superficial
esophageal cancer in determining indications for endoscopic mucosal
resection]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):337-42
AD - Department of Surgery, Tokyo Metropolitan Komagome General Hospital,
Tokyo, Japan.
Endoscopic mucosal resection (EMR) should be performed for the treatment
of squamous cell carcinoma of the esophagus limited to the lamina
propria mucosae (m1 and m2 cancers), because lymph node metastasis is
rare in these cases. The lymph node metastasis rate is 6% when cancers
reach the muscularis mucosa(m3) or slightly invade the submucosa (sm1).
Lymph node metastasis is noted in 47% of esophageal cancers moderately
or severely invading the submucosa(sm2 and sm3). Radical esophagectomy
is recommended for sm2 and sm3 disease. Type 0-II cancers are candidates
for EMR, because 86% remain within the mucosa, while 90% of type 0-I
lesions and 96% of type 0-III lesions are submucosal cancers. Among type
0-II cancers, most type 0-IIb lesions are m1 cancer. Among type 0-IIa
cancers, 96% are mucosal. Type 0-IIc lesions are frequent among
superficial esophageal cancers and 19% reach the submucosa. Endoscopic
diffrentiation of m1 and m2 cancers is reliable, since 96% of all m1 and
m2 cancers were correctly diagnosed before treatment. In cases with type
O-IIc lesions which is most frequent among superficial esophageal
cancers, m1 cancer showed very slight depressions with a smooth surface
and reddening. Sometimes fine granular changes are seen. They are also
delineated as an unstained area by endoscopic toluidine blue-iodine
double staining. They showed very slight depressions with a smooth
surface and reddening. Sometimes fine granular changes are seen. They
are also delineated as an unstained area by endoscopic toluidine
blue-iodine double staining. Dark blue dots, spots, or reticular
staining are frequently identified in m2 cancers. In cases with m3 or
sm1 cancer, coarse granular changes, small nodular elevations, or
slightly deeper depressed areas in the m1 and m2 lesions suggest sites
of deeper invasion.
23
UI - 11993222
AU - Kajiyama Y; Tsurumaru M
TI -
[Esophagectomy with lymph node dissection through right thoracotomy]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):343-7
AD - First Department of Surgery, Juntendo University School of Medicine,
Tokyo, Japan.
In esophageal cancer, the incidence of lymph node metastasis is much
higher than that in gastric or colonic cancer. Lymph node metastasis is
frequently found along the recurrent laryngeal nerve and around the
gastric cardia. The accuracy rate of preoperative diagnosis of lymph
node metastasis is up to 80%, in spite of vigorous diagnostic efforts.
In Japan, "esophagectomy with 3-field lymph node dissection through a
right thoracotomy" is the standard surgery for advanced esophageal
cancer. However, based on the "Comprehensive Registry of Esophageal
Cancer in Japan," this standard operation does not prevail nationwide.
Although, it is difficult to obtain evidence showing the effects of
lymph node dissection for ethical reasons, we must continue accurate
lymph node dissection with the best surgical techniques to improve
patient survival.
24
UI - 11993223
AU - Ide H; Narumiya K; Eguchi R; Nakamura T; Kobayashi A; Ota M
TI -
[Radical surgery with mini-thoracolaparotomy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):348-53
AD - Department of Surgery, Institute of Gastroentelorogy, Tokyo Women's
Medical University, Tokyo, Japan.
In our institute, radical esophagectomy through mini-thoracolaparotomy
has been performed as a less-invasive surgery for esophageal cancer
since 1996. We describe the indications for and operative procedures of
mini-thoracolaparotomy. Next we report the preliminary results of a
prospective randomized trial that compared mini-thoracolaparotomy with
conventional thoracolaparotomy in 30 patients without neoadjuvant
therapy. There were no differences between the two groups in operative
time, bleeding volume, and number of dissected lymph nodes.
Thoracolaparotomy was effective in decreasing the quantity of
morphinerequired in the ICU and shortening hospitalization after
surgery. Thoracolaparotomy was effective in preventing a decrease in and
early recovery of postoperative vital capacity. In clinical data on
radical esophagectomy performed through a right thoracotomy and
reconstruction with a stomach tube from 1996 to 2000, the 5-year
survival rate of 63 patients in the thoracolaparotomy group (67.6%) did
not differ from that of 124 patients in the conventional surgery group
(49.9%).
25
UI - 11993224
AU - Osugi H; Takada N; Masashi; Takemura; Lee S; Ueno M; Tanaka Y; Fukuhara
TI -
K; Kinoshita H
[Thoracoscopic esophagectomy]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):354-8
AD - Department of Gastroenterological Surgery, Osaka City University
Graduate School of Medicine, Osaka, Japan.
The current roles of thoracoscopic esophagectomy in the treatment of
cancer in Japan are described. Lymphadenectomy of the same quality as
open surgery should be performed thoracoscopically to obtain good
oncological outcomes. The indications for thoracoscopic esophagectomy
are 1) no extensive pleural adhesions; 2) pulmonary function sufficient
for single-lung ventilation; and 3) tumor not invading other organs.
Hand-assisted or mini-thoracotomy facilitates the dissection of lymph
nodes, especially on the left side of the trachea. However, for any type
of procedure, a good en-face view is essential for safe and accurate
lymphadenectomy. The magnifying effect of video, with the camera in
close proximity, is important to maintain a proper dissecting plane.
Although sufficient experience is necessary to master the learning
curve, lymphadenectomy of the same quality as open surgery can be
performed with mini-thoracotomy in a feasible time period. Thoracoscopic
esophagectomy contributes to reducing postoperative pain and
constrictive pulmonary dysfunction. It may be too soon to assert that
the thoracoscopic approach can provide oncological outcomes comparable
to those after open surgery because long-term follow up is not yet
sufficient. Thoracoscopic esophagectomy, however, has the potential to
improve the postoperative quality of life of patients with esophageal
cancer.
26
UI - 11993225
AU - Ando N; Shih CH
TI -
[Chemotherapy for the patients with esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):359-63
AD - Department of Surgery, Tokyo Dental College, Ichikawa General Hospital,
Ichikawa, Japan.
The combination of cisplatin and continuous-infusion 5-fluorouracil is
the standard regimen for the treatment of both squamous cell carcinoma
and adenocarcinoma. Paclitaxel has shown favorable results as a single
agent or in combination with cisplatin. The efficacy of neoadjuvant
chemotherapy in terms of survival benefit remains controversial despite
large-scale, randomized, controlled trials comparing it with surgery
alone. The disease-free survival benefit of postoperative adjuvant
chemotherapy was recognized in a Japan Clinical Oncology Group
randomized controlled trial in comparison with surgery alone.
27
UI - 11993226
AU - Masamichi N
TI -
[Radiotherapy and chemotherapy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):364-70
AD - Department of Radiology, National Sapporo Hospital (Hokkaido Cancer
Center), Sapporo, Japan.
The nonsurgical gold standard treatment for esophageal cancer is
radiotherapy, but chemoradiation therapy using anticancer agents
concurrently is becoming standard management. With chemoradiation
adverse responses in the acute stage may be enhanced in comparison with
conventional radiation therapy alone, but improved treatment outcomes
are reported. A consensus has nearly been reached on the standard
radiation technique and dose, and a guideline changes, but drug type,
timing, and optimum dosage in chemoradiation are unclear. Further future
study is thus necessary. In this report, recent trends in radiotherapy
and chemoradiation are outlined and future problems described.
28
UI - 11993227
AU - Shimada H; Matsubara H; Ochiai T
TI -
[Gene therapy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):371-5
AD - Department of Academic Surgery, Chiba University Graduate School of
Medicine, Chiba, Japan.
Esophageal cancer is a highly malignant disease in which progression is
observed in most patients even at the first medical examination.
Neoadjuvant cytoreduction treatments are frequently used for the purpose
of tumor down-staging, increasing the resection rate, and possibly
improving survival. Although combination therapy with radiation and
anticancer agents is available, no satisfactory treatment regimen has
yet been established due to the development of resistance. Based on the
concepts of genetic alteration in carcinogenesis, cancer gene therapy
has been developing rapidly. We previously reported the growth
inhibitory effect of adenovirus-mediated wild-type p53 gene transfer
into esophageal squamous carcinoma cell lines. After extensive
preclinical study of p53 gene therapy in vitro and in vivo, we are
conducting a phase I/II clinical trial. The target of this trial is
patients with unresectable esophageal cancer resistant to
chemoradiotherapy. As of December 1, 2001, 8 candidates had been
admitted to our hospital. After extensive examination, 4 patients were
enrolled in this trial. After giving informed consent, the first patient
received injections of Ad5 CMV-p53 on December 19, 2000. No serious
adverse events have occurred so far in these patients, and the trial has
been conducted safely.
29
UI - 11993228
AU - Yamana H
TI -
[Immunotherapy for esophageal carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):376-80
AD - Multidisciplinary Treatment Center, Kurume University School of
Medicine, Kurume, Japan.
Recent progress in gene technology has clarified the existence of some
cancer-rejection genes and peptides such as MAGE, MART, etc. Many
clinical trials with cancer vaccines have been performed. Since the
clinical efficacy of HLA class I-restricted peptide vaccines is still
poor, many researchers are mainly administering dendritic cell
therapies. However, there have been few clinicals trials of
cancer-specific immunotherapy for esophageal carcinomas. We have
performed cancer vaccine therapy with SART-1 peptide and locoregional
adoptive immunotherapy with activated autologous lymphocytes for
patients with advanced esophageal carcinoma in a phase I and a phase
I/II trial, respectively. The clinical responses were poor in the
vaccine trial because of the rapid growth of esophageal cancers and the
requirement for more than 2 months to activate and increase killer T
cells after in vivo vaccination, while locoregional adoptive
immunotherapy was effective for the treatment of esophageal cancers even
in advanced stages with organ metastases. Based on these results, we
think that a combination immunotherapy with adoptive immunotherapy and
vaccine therapy is needed for the treatment of advanced esophageal
carcinomas.
30
UI - 11785709
AU - Naso P; Bonanno G; Aprile G; Trama G; Favara C; Greco S; Russo A
TI -
EsophaCoil for palliation of dysphagia in unresectable oesophageal
carcinoma: short- and long-term results.
SO - Dig Liver Dis 2001 Nov;33(8):653-8
AD - Department of Surgery, Policlinico Universitario di Catania, Italy.
BACKGROUND AND AIM: Few reports have shown that EsophaCoil is an
effective and safe prosthesis for palliation of malignant oesophageal
dysphagia. A single centre experience using this type of prosthesis is
42 consecutive patients, 41 with unresectable oesophageal cancer and one
with oesophageal stenosis secondary to lung cancer, were treated with 44
EsophaCoils (2 patients received 2 stents). Tumours were located in
lower third of oesophagus and/or gastric cardia in 22 cases, in middle
third in 18 and in upper third in 2. Mean stricture length was 5.3 cm.
Implantation was performed on hospitalized patients. RESULTS: EsophaCoil
placement was successful all 44 times and was followed by complete
expansion of the prostheses. There were no major procedure-related
complications or deaths. Dysphagia score improved from mean of 2.9 to
1.3 within 24 hours of stent implantation. Median hospital stay was 2.7
days. Late complications occurred in 14 patients (34.2%): 3 migrations
into stomach, 7 tissue overgrowth, 2 late perforations and 2 food
impactions. Mean survival time was 4.2 months (range 1-10). CONCLUSIONS:
In our experience, full expansion of EsophaCoil was achieved in all
cases. This result, was associated with high incidence of retrosternal
pain. Relief of dysphagia score was identical to that obtained with
other types of Self-Expanding Metal Stent. Coil design prevented tumour
ingrowth and allowed retrieval of three migrated stents. Mean survival
time was similar to that reported in larger series using different types
of Self-Expanding Metal Stent.
31
UI - 11809537
AU - Nakakubo Y; Hida Y; Miyamoto M; Hashida H; Oshikiri T; Kato K; Suzuoki
TI -
M; Hiraoka K; Ito T; Morikawa T; Okushiba S; Kondo S; Katoh H
The prognostic significance of RCAS1 expression in squamous cell
carcinoma of the oesophagus.
SO - Cancer Lett 2002 Mar 8;177(1):101-5
AD - Hokkaido University Graduate School of Medicine, Division of Cancer
Medicine, Cancer Medicine, Surgical Oncology, N-14, W-5, Sapporo
060-8648, Japan. nakakubo@med.hokudai.ac.jp
Overexpression of RCAS1 (receptor-binding cancer antigen expressed on
SiSo cells) protects cancer cells from immune attack and might be
related to poor prognosis in several cancers. We investiga
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