National Cancer Institute®
Last Modified: February 1, 2002
UI - 11745675
AU - Lam KY; Law S; Luk JM; Wong J
TI - Oesophageal basaloid squamous cell carcinoma: a unique clinicopathological entity with telomerase activity as a prognostic indicator.
SO - J Pathol 2001 Nov;195(4):435-42
AD - Department of Pathology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong. email@example.com
Oesophageal basaloid squamous cell carcinoma (BSCC) is uncommon and has been reported to have a worse prognosis than squamous cell carcinomas (SCCs), but this tumour has not been fully characterized. The aim of the present study was to analyse the clinicopathological features of a large cohort of patients with oesophageal BSCC treated at a single institution. The pathology of 756 primary oesophageal cancers treated fulfilled the diagnostic criteria of BSCC were identified and were compared with SCC. Their expression of MIB-1, DNA ploidy, and telomerase activity were also studied. Thirty Chinese patients (25 men and five women) with BSCC were found, comprising 4% of patients with oesophageal cancer treated by surgical resection in the study period. Their median age was 67 years (range 40-78 years). Dysphagia was usually the main presenting symptom. Other concomitant malignant tumours were seen in three patients and paraneoplastic glomerulopathy in one. Five tumours were located in the upper third, 19 in the middle third, and six in the lower third. The median length was 5.8 cm (range 2-12 cm). The median MIB-1 score of BSCC was 750 (range 400-858) and was higher than that of SCC (p=0.003). The primary tumour and metastatic BSCC were aneuploid, as detected by flow cytometric analysis in nine patients. Telomerase activity was positive in 95% (19 out of 20) of the cases analysed. The 5-year survival of patients with BSCC was 12%. Distant metastases were seen in 53% (n=16); lung and liver were the most common sites. The median survival of patients with tumours which had a high level of telomerase activity was significantly shorter than those with low levels of telomerase activity (1 vs. 27 months) (p=0.001). The median survival of patients with BSCC and SCC was 26 and 16 months, respectively (p=0.3). In conclusion, BSCC has distinctive clinicopathological features and its long-term prognosis is no worse than SCC. The level of telomerase activity may have a prognostic role. Copyright 2001 John Wiley & Sons, Ltd.
UI - 11521805
AU - Gallus S; La Vecchia C; Levi F; Simonato L; Dal Maso L; Franceschi S
TI - Leanness and squamous cell oesophageal cancer.
SO - Ann Oncol 2001 Jul;12(7):975-9
AD - Istituto di Ricerche Farmacologiche Mario Negri, Universita degli Studi di Milano, Milan, Italy. firstname.lastname@example.org
BACKGROUND: Squamous cell oesophageal cancer is one of the few neoplasms inversely related to body mass index (BMI). However, it is not clear whether this is due to cancer-related weight loss or to other correlates of leanness. PATIENTS AND METHODS: 395 incident, histologically confirmed cases of squamous cell oesophageal cancer and 1,066 controls, admitted for acute, non-neoplastic diseases, in Italy and Switzerland. Odds ratios (ORs) were derived from multiple logistic regression, including terms for education, tobacco. alcohol, non-alcohol energy, fruit and vegetable intake. RESULTS: The ORs for the lowest vs. the highest quartile of BMI in the year before diagnosis were 2.0 in men, 1.6 in women, and 1.9 (95% confidence interval: 1.3-2.9) in both sexes combined. The association with leanness was stronger in heavy smokers, but was not accounted for by smoking and drinking, nor by differences in diet. Weight change in the decade prior to diagnosis showed no linear association with risk. However, cases were not leaner than controls at age 30 (OR = 0.6 for the lowest BMI quartile) and 50 (OR = 1.1). CONCLUSIONS: Leanness appears to be an indicator of squamous cell oesophageal carcinogenesis. However, low BMI in the distant past was unrelated to oesophageal cancer risk.
UI - 11778281
AU - Wang D; Zhang R; Sun K
TI - [The digestive functions of the stomach after esophagectomy with vagus nerve preserved or severed in esophageal cancer patients: a comparative study]
SO - Zhonghua Zhong Liu Za Zhi 2000 Sep;22(5):414-6
AD - Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To study the feasibility, indication, and clinical significance of preserving the vagus nerve during esophagectomy for patients with cancer of the esophagus. METHODS: The digestive functions of the stomach were studied and compared before and after esophagectomy in patients with vagus nerve intact (n = 11) or severed (n = 12). RESULTS: According to Angorn's grading system, patients with vagus nerve preserved (VNP) had less symptoms after operation than those with vagus nerve severed (VNS). The gastric emptying time of the intrathoracic stomach in patients with VNS was much prolonged compared with that in patients with VNP. There was no significant difference in the preoperative and postoperative mean basal gastric acid output and the 24-hour pH monitoring in patients with VNP, while in VNS patients they were significantly decreased after operation. Fasting serum gastrin level in VNS patients was significantly elevated but this was not observed in VNP patients. Fibroptic endoscopic examination revealed higher incidence of postoperative atrophic gastritis in VNS than in VNP patients. CONCLUSION: Preservation of the vagal trunks during surgical resection for cancer of the esophagus is beneficial to keep the postoperative digestive functions of the stomach in a better condition.
UI - 11816477
AU - Nara S; Konishi T
TI - [Critical path for esophagectomy of esophageal cancer]
SO - Gan To Kagaku Ryoho 2002 Jan;29(1):45-53
AD - Department of Surgery, NTT Kanto Medical Center, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
We have introduced a critical path for esophagectomy of esophageal cancer from January, 2001 and got good results. It is important of the adaptation and the evaluation of variances for the critical path. Patients and co-medicals understood deeply the disease and the treatment of esophageal cancer. We could improvement the process of treatments by changing the critical path easily. We concluded that a critical path was adapted for esophagectomy of esophageal cancer, and it will be getting important.
UI - 11601573
AU - Kawai KI; Kakibuchi M; Sakagami M; Fujimoto J; Toyosaka A; Nakai K
TI - Supercharged gastric tube pull-up procedure for total esophageal reconstruction.
SO - Ann Plast Surg 2001 Oct;47(4):390-3
AD - Department of Otolaryngology, Hyogo College of Medicine, Japan.
Total esophageal reconstruction using a gastric tube is complicated because it sometimes causes postoperative complications such as anastomotic leakage, stenosis, or fistula formation resulting from insufficient blood flow at the distal end. To overcome this problem, during the past 5 years the authors performed seven additional microvascular anastomoses using the short gastric vessels of the gastric tube. No postoperative complications occurred except partial tracheal necrosis in 1 patient. Postoperative radiographic examination showed no reflux or stasis in all patients, and no evidence of necrosis at the anastomotic site of the pulled-up gastric tube was observed by postoperative endoscopy. This technique reduces risk and may contribute to the successful reconstruction of the digestive tract after total esophagectomy.
UI - 11776621
AU - Zhou B; Ding Z; Guo L
TI - [Prediction of the outcome of dysplasia of esophageal epithelium by high resolution image analysis]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):439-43
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021.
OBJECTIVE: To predict the outcome of dysplasia of esophageal epithelium by means of high resolution image analysis(HRIA). METHODS: Asymptomatic adults were examined for balloon cytology of the esophagus in 1983 from Heshun Commune of Linxian County. Ninety three cases of severe dysplasia and 122 cases of mild dysplasia of the esophagus were selected for this study. By means of an Axiomat-microscope equipped with TV-camera, 100 normal nuclei of well-preserved cells in the intermediate layer of Pap-stained squamous epithelium were randomly examined. RESULTS: Of the 93 cytologically diagnosed severe dysplasia cases, 24, 14 and 7 progressed to carcinoma in 3, 5 and 9 years, respectively. In the other 48 cases, dysplasia remained stable or regressed to normal. The other cases were used as the control. According to chromatin features, correct diagnosis of cases was achieved by HRIA in 75.0%(18/24), 85.7%(12/14) and 85.7%(6/7) of the cases examined, respectively (P < 0.001). Of the 122 cytologically diagnosed mild dysplasia, 16, 13 and 12 cases progressed to carcinoma in 3, 5 and 9 years, respectively. The other 81 cases remained stable or regressed to normal. Correct diagnosis was made by HRIA in 93.8%(15/16), 76.9%(10/13) and 83.3%(10/12) of the cases examined, respectively (P < 0.001). CONCLUSION: Chromatin nuclear features examined by HRIA can predict the outcome of precancerous lesions and discriminate progressor from non-progressor ones. It can be used as surrogate endpoint biomarkers for the evaluation of efficacy of chemoprevention trial.
UI - 11776631
AU - Gao Y; Wang L; Zhang D
TI - [Surgical treatment of esophageal leiomyosarcoma: a review of the literature and report of 11 cases]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):470-2
AD - Cancer Hospital (Institate), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021.
OBJECTIVE: To discuss the clinical biocharacteristics, diagnosis, operation and prognosis of esophageal leiomyosarcoma (ELS). METHODS: Clinical materials and follow-up results of 11 surgically treated ELS patients were analyzed. RESULTS: All 11 cases received radical resection of tumor. The 5-year survival rate was 54.5% (6/11). Grossly, two types of ELS were observed: the polyp form (4 cases) and invasive form (7 cases). The 5-year survival rate was 75.0% and 42.9%, respectively. Two patients died of local recurrence, another 2 cases died of distant metastasis. CONCLUSION: In patients with ELS surgically treated, prognosis of polyp form ELS is better than that of invasive form ELS. Local recurrence and distant metastasis are the major cause of death.
UI - 11808965
AU - Farhadi A; Fields J; Banan A; Keshavarzian A
TI - Reactive oxygen species: are they involved in the pathogenesis of GERD, Barrett's esophagus, and the latter's progression toward esophageal cancer?
SO - Am J Gastroenterol 2002 Jan;97(1):22-6
AD - Department of Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA.
UI - 11801940
AU - Watanabe A; Kawabori S; Osanai H; Taniguchi M; Hosokawa M
TI - Preoperative computed tomography diagnosis of non-recurrent inferior laryngeal nerve.
SO - Laryngoscope 2001 Oct;111(10):1756-9
AD - Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan. email@example.com
OBJECTIVE: The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. Preoperative recognition of the NRILN should be advantageous in the prevention of intraoperative nerve damage. The purpose of this study was to assess the possibility of diagnosis of an aberrant subclavian artery by computed tomography (CT) of the neck, which is often performed before thyroid surgery. METHODS: We retrospectively studied the preoperative CT films from 594 thyroid or patients, and a right recurrent inferior laryngeal nerve (RILN) was observed in 588 of these patients. We evaluated whether the brachiocephalic artery could be identified on the CT scan and classified the positional relationship between the right subclavian artery and the tracheoesophagus into three types. RESULTS: The brachiocephalic artery was identified on the CT films in 158 cases, all of which were cases of RILN. The right subclavian artery was detected on the ventral side of the membranous wall of the trachea in all 588 RILN cases, whereas it was detected on the dorsal side in all 6 NRILN cases. CONCLUSIONS: It was possible to predict an aberrant subclavian artery by identifying the brachiocephalic artery and position of the right subclavian artery on the CT film of the neck. When an anomaly of the subclavian artery is thus preoperatively detected, NRILN can be preoperatively predicted, which likely will enable prevention of vocal cord paralysis.
UI - 11677937
AU - Monig SP; Schroder W; Beckurts KT; Holscher AH
TI - Classification, diagnosis and surgical treatment of carcinomas of the gastroesophageal junction.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1231-7
AD - Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Str. 9, 50924 Cologne, Germany.
The incidence of adenocarcinoma of the gastroesophageal junction has risen faster than that of any other malignancy in various western countries. Adenocarcinoma of the gastroesophageal junction can be topographically classified into three types: carcinomas of the distal esophagus (type I), true carcinomas of the cardia (type II) and carcinomas of the subcardial region (type III). This surgical classification has proven to be of value for planning the extent of resection and for comparing epidemiologic data and therapeutic results of different series. The preoperative assignment is achieved by contrast X-ray and endoscopy and enables the surgeon to plan preoperatively the adequate extent of the resection. The type I-adenocarcinoma represents a distal esophageal cancer and consequently is treated by esophageal resection as transhiatal subtotal radical esophagectomy or in case of more proximal carcinoma by transthoracic en bloc esophagectomy. The type II- and type III-adenocarcinomas are treated by a gastrectomy and distal esophageal resection with D2-lymphadenectomy via an abdominal and transhiatal approach. In case of an advanced carcinoma with high risk of incomplete resection, neoadjuvant radiochemotherapy should be taken into consideration.
UI - 11677965
AU - Kubota K; Kato H; Tachimori Y; Watanabe H; Yamaguchi H; Nakanishi Y;
TI - Iinuma G Surgical therapy for recurrent esophageal cancers at anastomoses after esophagectomy.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1364-7
AD - Department of Surgery, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo 104-0045, Japan.
BACKGROUND/AIMS: The long-term prognosis of a recurrent esophageal cancer at the anastomosis after esophagectomy is generally unfavorable. We have experienced six cases in our institute where surgical treatment resulted in a good prognosis. METHODOLOGY: Between 1962 and 1997, 1720 patients underwent esophagectomy for esophageal cancers in our institute. Anastomotic recurrence was identified in 13 and surgical therapy was performed for six of these. Their clinical and histopathological features were examined with reference to control of anastomotic recurrent esophageal cancers. RESULTS: The six patients were all males with an average age of 61.5 years. Their median disease-free interval was 5.5 months. Three patients lived more than five years after the first esophagectomy. Histopathologically, regional lymph node metastases were found in four of the cases and cervical lymph node metastases were detected in two at the initial esophagectomy. Vessel invasion was evident in three cases, intraepithelial spread in one, and multiple cancers in two. There were no cases with intramural metastasis. Radiotherapy and/or chemotherapy were added for three cases. CONCLUSIONS: After esophagectomy for esophageal cancers, frequent examination of the anastomotic site using endoscopy and long-term follow-up studies are desirable. The option of surgery should not be ignored when a recurrent cancer appears only at the anastomosis.
UI - 11781277
AU - Dulai GS; Guha S; Kahn KL; Gornbein J; Weinstein WM
TI - Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review.
SO - Gastroenterology 2002 Jan;122(1):26-33
AD - Division of Gastroenterology and Hepatology, Department of Medicine, UCLA School of Medicine, CURE Digestive Diseases Research Center, Los Angeles, California 90073, USA.
BACKGROUND & AIMS: The public health impact of past screening and surveillance practices on the outcomes of Barrett's related cancers has not previously been quantified. Our purpose was to determine the prior prevalence of Barrett's esophagus in reported cases of incident adenocarcinoma undergoing resection, as an indirect measure of impact. METHODS: We performed a systematic review of the literature from 1966 to 2000. Studies were included if they reported: (1) the number of consecutive adenocarcinomas resected, and (2) the number of those resected who had a previously known diagnosis of Barrett's. We generated summary estimates using a random effects model. RESULTS: We identified and reviewed 752 studies. Twelve studies representing a total of 1503 unique cases of resected adenocarcinomas met inclusion criteria. Using a random effects model, the overall percentage of patients undergoing resection who had a prior diagnosis of Barrett's was 4.7% +/- 2.9%. CONCLUSIONS: The low prior prevalence (approximately 5%) of Barrett's esophagus in this study population provides indirect evidence to suggest that recent efforts to identify patients with Barrett's-whether through endoscopic screening or evaluation of symptomatic patients-have had minimal public health impact on esophageal adenocarcinoma outcomes. The potential benefits of endoscopic surveillance seem to have been limited to only a fraction of those individuals at risk. These data thus provide a clear and compelling rationale for the development of effective screening strategies to identify patients with Barrett's esophagus.
UI - 11082084
AU - Macdonald CE; Wicks AC; Playford RJ
TI - Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study.
SO - BMJ 2000 Nov 18;321(7271):1252-5
AD - Leicester General Hospital NHS Trust, Leicester LE5 4PW, UK.
OBJECTIVES: To review the benefit of an endoscopic surveillance programme for patients with Barrett's oesophagus. DESIGN: Observational study. SETTING: University teaching hospital. PARTICIPANTS: 409 patients in whom Barrett's oesophagus was identified during 1984-94; 143 were entered into the annual surveillance programme. MAIN OUTCOME MEASURES: Development of dysplasia and cancer and mortality. RESULTS: The average period of surveillance was 4.4 years; 55 patients were reassessed in 1994 but only eight remained in the programme in 1999, withdrawal being due to death (not from carcinoma of the oesophagus), illness, or frailty. Five of the patients who entered surveillance developed carcinoma of the oesophagus. Only one cancer was identified as a result of a surveillance endoscopy, the others being detected during endoscopy to investigate altered symptoms. Of the 266 patients who were not suitable for surveillance, one died from oesophageal cancer and 103 from other causes. Surveillance has resulted in 745 endoscopies and about 3000 biopsy specimens. CONCLUSION: The current surveillance strategy has limited value, and it may be appropriate to restrict surveillance to patients with additional risk factors such as stricture, ulcer, or long segment (>80 mm) Barrett's oesophagus.
UI - 11360913
AU - Eksteen JA; Jankowski JA
TI - Surveillance for Barrett's oesophagus. The conundrum of Barrett's oesophagus is changing.
SO - BMJ 2001 May 5;322(7294):1124-5; discussion 1126
UI - 11360915
AU - Wild CP; Forman D
TI - Surveillance for Barrett's oesophagus. It is too early to dismiss surveillance programmes.
SO - BMJ 2001 May 5;322(7294):1125; discussion 1126
UI - 11360916
AU - Carr RA
TI - Surveillance for Barrett's oesophagus. Patients need to be appropriately selected for follow up.
SO - BMJ 2001 May 5;322(7294):1125; discussion 1126
UI - 11693897
AU - Gaspar LE; Winter K; Kocha WI; Pinover WH; Herskovic; Graham M;
TI - Gunderson L Swallowing function and weight change observed in a phase I/II study of external-beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 9207).
SO - Cancer J 2001 Sep-Oct;7(5):388-94
AD - University of Colorado, Denver, USA.
BACKGROUND: A multi-institutional, prospective study was designed to determine the feasibility and tolerance of combined-modality chemotherapy, external-beam irradiation, and esophageal brachytherapy in a potentially curable group of patients with adenocarcinoma or squamous cell carcinoma of the esophagus. Swallowing function and weight were assessed before and after treatment. MATERIALS AND METHODS: Planned treatment was with 50 Gy of external-beam irradiation (25 fractions/5 weeks) followed 2 weeks later by esophageal brachytherapy (either a high dose rate of 5 Gy at weeks 8, 9, and 10 for a total of 15 Gy or a low dose rate of 20 Gy at week 8). Chemotherapy was given weeks 1, 5, 8, and 11 with cisplatinum, 75 mg/m2, and 5-fluorouracil, 1,000 mg/m2/24 hours in a 96-hour infusion. Swallowing was graded from 0 (no dysphagia) to 4 (complete obstruction for solids and liquids). Weight "loss" or weight gain was defined as a change in 3-month post- to pretherapy weight of < or = 5% or > 5%, respectively. RESULTS: The estimated survival rate at 1 and 2 years was 49% and 31%, respectively, and the estimated median survival was 11 months. Swallowing before treatment was graded as grade 1 in 14 patients, grade 2 in 22 patients, grade 3 in nine patients, and grade 4 in four patients. Swallowing grade after treatment was reported as improved in 29 patients (59%), unchanged in 12 patients (24.5%), and worse in eight patients (16.5%). The bestimproved dysphagia score after treatment in the 29 patients reporting improvement was grade 0 in 19 patients, grade 1 in five patients, grade 2 in four patients, and grade 3 in one patient. A posttreatment weight in 42 evaluable patients was categorized as a loss in 29 patients (69%), a gain in four patients (9.5%), and stable in nine patients (21.5%). Weight loss was significantly correlated with high swallowing grade, low performance status, and absence of a feeding tube. CONCLUSIONS: Swallowing function after brachytherapy and concurrent chemoradiation therapy is satisfactory in most surviving patients. Ninety-two percent of patients were able to swallow at least liquids at some point after therapy. Future plans are to compare this with other cooperative group studies that utilized chemoradiation or surgery, without brachytherapy.
UI - 11782570
AU - Giroux MA; Audrezet MP; Metges JP; Lozac'h P; Volant A; Nousbaum JB;
TI - Labat JP; Gouerou H; Ferec C; Robaszkiewicz M Infrequent p16/CDKN2 alterations in squamous cell carcinoma of the oesophagus.
SO - Eur J Gastroenterol Hepatol 2002 Jan;14(1):15-8
AD - Service d'Hepatogastroenterologie, Hopital de La Cavale Blanche, Brest, France.
Loss of heterozygosity (LOH) on chromosome 9 and p16 (MTS1/CDKN2) gene mutations have been reported in various human cancers. The present study aimed to determine the prevalence of LOH in 100 oesophageal squamous cell carcinomas (OSCCs) by typing microsatellite loci and mutations of the p16 gene. The methods used included denaturing gradient gel electrophoresis (DGGE) and DNA sequencing of exon 2. LOH was found in 14.7% of the OSCC cases. Six gene alterations were identified in exon 2. They consisted of three deletions and the same polymorphism in three samples. The relatively low rate of p16 mutation compared with the frequency of LOH suggests the possible involvement of another tumour suppressor gene located on chromosome 9 in oesophageal carcinogenesis.
UI - 11714113
AU - Abnet CC; Qiao YL; Mark SD; Dong ZW; Taylor PR; Dawsey SM
TI - Prospective study of tooth loss and incident esophageal and gastric cancers in China.
SO - Cancer Causes Control 2001 Nov;12(9):847-54
AD - Cancer Prevention Studies Branch, Division of Clinical Sciences, National Cancer Institute, Bethesda, MD 20892-7058, USA. firstname.lastname@example.org
OBJECTIVE: To determine the association between tooth loss and the risk of developing esophageal squamous cell carcinoma, gastric cardia adenocarcinoma, or gastric non-cardia adenocarcinoma in a prospective study. METHODS: Cox proportional hazards regression was used to examine these associations in a 28,868-person cohort followed prospectively for 5.25 years. The baseline questionnaire included questions regarding tooth loss, and individuals reporting lost teeth had their teeth counted by study personnel. The analytic cohort included 620 esophagus, 431 gastric cardia, and 102 gastric non-cardia cancer cases. RESULTS: Tooth loss was associated with a significantly elevated risk of developing all three cancers. When examined as median splits, tooth loss was associated with a relative risk (RR) (95% confidence interval, CI) of 1.3 (1.1-1.6) in the esophagus, 1.3 (1.0-1.6) in the gastric cardia, and 1.8 (1.1-3.0) in the gastric non-cardia. Further analysis demonstrated that this increased risk was most strongly associated with the loss of the first few teeth and was primarily confined to the younger members of our cohort. CONCLUSIONS: In this cohort tooth loss increased the risk of developing upper gastrointestinal cancer. We hypothesize that this may be related to alterations in oral bacterial flora and subsequent increases in the in-vivo production of carcinogens such as nitrosamines.
UI - 11788564
AU - Spencer GM; Thorpe SM; Blackman GM; Solano J; Tobias JS; Lovat LB; Bown
TI - SG Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: a randomised study.
SO - Gut 2002 Feb;50(2):224-7
AD - National Medical Laser Centre, Institute of Surgical Studies, Royal Free and University College Medical School, London, UK.
BACKGROUND: Many patients with advanced malignant dysphagia are not suitable for definitive treatment. The best option for palliation of dysphagia varies between patients. This paper looks at a simple technique for enhancing laser recanalisation. AIM: To assess the value of adjunctive brachytherapy in prolonging palliation of malignant dysphagia by endoscopic laser therapy. PATIENTS: Twenty two patients with advanced malignant dysphagia due to adenocarcinoma of the oesophagus or gastric cardia, unsuitable for surgery or radical chemoradiotherapy. METHODS: Patients able to eat a soft diet after laser recanalisation were randomised to no further therapy or a single treatment with brachytherapy (10 Gy). Results were judged on the quality and duration of dysphagia palliation, need for subsequent intervention, complications, and survival. RESULTS: The median dysphagia score for all patients two weeks after initial treatment was 1 (some solids). The median dysphagia palliated interval from the end of initial treatment to recurrent dysphagia or death increased from five weeks (control group) to 19 weeks (brachytherapy group). Three patients had some odynophagia for up to six weeks after brachytherapy. There was no other treatment related morbidity or mortality. Further intervention was required in 10 of 11 control patients (median five further procedures) compared with 7/11 brachytherapy patients (median two further procedures). There was no difference in survival (median 20 weeks (control), 26 weeks (brachytherapy)). CONCLUSIONS: Laser therapy followed by brachytherapy is a safe, straightforward, and effective option for palliating advanced malignant dysphagia, which is complementary to stent insertion.
UI - 11569925
AU - Shiraishi J; Utsuyama M; Akashi T; Nemoto T; Ohashi K; Akamatsu H;
TI - Sunamori M; Kitagawa M; Hirokawa K Immunohistological analysis of thymoma by molecules differentially expressed in the thymic cortex and medulla, and its application in the differential diagnosis of thymoma from esophageal and lung cancer.
SO - Pathol Res Pract 2001;197(9):611-9
AD - Department of Pathology and Immunology, Tokyo Medical and Dental University Graduate School, Japan.
The purpose of this study was to verify the WHO classification of thymic tumors using immunohistological methods, and to discover whether these methods can be applied to differentiate thymoma from squamous cell carcinoma (SCC) of the esophagus and the lung. Twenty-nine thymoma cases were classified according to WHO and were then immunohistologically examined for the positivity of these molecules. All thymoma cases investigated in this study were positive for IL-1R, and most of them were also positive for bek. In contrast, UH-1 was highly positive in B1 and B2 type thymomas, but negative or weakly positive in A, AB and B3 type thymomas. Twelve esophageal cancers and 21 lung cancers were also examined for the positivity of the same molecules. All esophageal cancers were negative for UH-1. Three of 12 cases were weakly positive for IL-1R, and four of these 12 cases were also weakly positive for bek. Twelve of 21 lung cancer cases were adenocarcinomas, all of them negative for IL-1R, bek and UH-1. Nine of 21 lung cancer cases were SCCs, all of them negative for UH-1. Eight of nine SCC cases were strongly positive for IL-1R, while seven of these were weakly positive for bek. We conclude that the WHO classification of thymic tumors is still valid as demonstrated by immunohistological analysis and that the positivity of UH-1, IL- 1R and bek might be helpful in differentiating thymoma from SCC of the esophagus and the lung.
UI - 11778747
AU - Makuuchi H
TI - Endoscopic mucosal resection for mucosal cancer in the esophagus.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):445-58
AD - Department of Surgery, Tokai University School of Medicine, Boseidai, Isehara, Kanagawa, Japan. email@example.com
Endoscopic mucosal resection of the esophagus was found to be safe and easy to perform. Efforts must be made to detect early m1 to m2 cancers, which are indicated for EEMR. It is necessary to perform periodic endoscopic examination. During endoscopic examination, it is important to wash the inside of the esophagus with water and perform careful observation. Also, in high-risk patients and patients with abnormalities, such as erythema, turbidity, or hypervascularity, iodine staining should be performed frequently. Patients at high risk for esophageal cancer include (1) men more than 55 years old who are heavy smokers and drinkers; (2) patients with cancer of the head and neck region; and (3) individuals with a family history of cancer and those with achalasia, corrosive esophagitis, or Barrett's esophagus.
UI - 11778748
AU - Inoue H
TI - Endoscopic mucosal resection for the entire gastrointestinal mucosal lesions.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):459-78
AD - Department of Gastroenterology, Showa Northern Yokohama Hospital School of Medicine, Showa University, Japan. firstname.lastname@example.org
In general, mucosal cancer of the gastrointestinal tract has the lowest risk of lymph node metastasis, and is curatively managed by the EMR procedure.
UI - 11778749
AU - Nwakakwa V; Fleischer D
TI - Endoscopic mucosal resection of the esophagus: band ligation technique.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):479-88, vi
AD - Division of Gastroenterology, Georgetown University Medical Center, Washington, DC 20007, USA.
Endoscopic mucosal resection (EMR) is a minimally invasive endoscopic technique used in treating superficial cancers of premalignant lesions in the gastrointestinal tract. An attraction of this technique is that it can be curative with low morbidity, often providing the entire lesion for pathologic evaluation. The band ligation technique of EMR uses the existing technology of variceal band ligation to endoscopically place a band on flat mucosal lesions of the gastrointestinal tract to create a "pseudopolyp" before resection with an electrocautery snare. The band ligating technique and two variant band ligating devices are described.
UI - 11761814
AU - Kozuszko B; Skrzydlewski Z; Sulkowska M; Snarska J; Kozlowski M;
TI - Skrzydlewska E; Zalewski B [Cancer procoagulant activity in cases of esophageal, stomach and colorectal cancer considering progression degree and histological type of cancer]
SO - Pol Merkuriusz Lek 2001 Sep;11(63):218-20
AD - Bialostocki Osrodek Onkologiczny, Akademia Medyczna w Bialymstoku.
The cancer procoagulant activity has been evaluated in homogenates of esophagal, stomach and colorectal cancer tissues and in the blood serum of patients with these neoplasms's. Activity of CP was significantly higher in examined material than in control. The correlation between CP activity and progression degree as well as histological type was affirmed. The higher activity of CP in homogenates as well as in serum was observed in cases with higher degree of clinical progression and smaller activity of this enzyme corresponded with lower degree of the cancer progression. The highest activity of CP was observed in the cases of adenocarcinoma whereas the lowest in cases of squamous cell carcinoma. Higher activity of CP in homogenates of examined tissues correlated with higher activity of this enzyme in the serum. Activity of CP depended on the tissue localisation of the cancer and the highest was in the cases of stomach cancers whereas the lowest was in the cases of esophagal cancer.
UI - 11756219
AU - Nakakuki K; Imoto I; Pimkhaokham A; Fukuda Y; Shimada Y; Imamura M;
TI - Amagasa T; Inazawa J Novel targets for the 18p11.3 amplification frequently observed in esophageal squamous cell carcinomas.
SO - Carcinogenesis 2002 Jan;23(1):19-24
AD - Department of Molecular Cytogenetics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
Amplification of DNA in certain chromosomal regions, with consequent over-expression of specific genes within these amplicons, plays a crucial role in the development and progression of human cancer. Since our previous comparative genomic hybridization (CGH) study revealed frequent amplifications at 18p in esophageal squamous cell carcinomas (ESC) cell lines, we focused on the identification of genetic target(s) within the 18p amplicon. In four cell lines having remarkable copy-number amplification with homogeneously staining region (HSR) pattern by fluorescence in situ hybridization (FISH), the smallest common region of overlapping covered approximately 3.5 Mb at 18p11.3. We screened 29 ESC cell lines to discern amplifications and expression levels of 14 known genes and 21 uncharacterized transcripts within the amplicon. Only four known genes, YES1, TYMS, HEC and TGIF showed amplification and consequent over-expression. These genes were amplified in several of primary ESCs. Moreover, resistance to transforming growth factor beta (TGFbeta)-induced growth inhibition was enhanced in four cell lines with amplification and expression of TGIF, which encodes the repressor for TGFbeta-activated transcription, appears to be involved in the progression of ESC. Taken together, these results suggest that YES1, TYMS, HEC and TGIF are likely to be candidate targets for 18p11.3 amplification and be associated with esophageal tumorigenesis.
UI - 11821953
AU - Li M; Song S; Lippman SM; Zhang XK; Liu X; Lotan R; Xu XC
TI - Induction of retinoic acid receptor-beta suppresses cyclooxygenase-2 expression in esophageal cancer cells.
SO - Oncogene 2002 Jan 17;21(3):411-8
AD - Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, TX 77030, USA.
Since retinoic acid receptor (RAR)-beta mRNA is frequently lost during esophageal carcinogenesis and esophageal cancer cells that do not express RAR-beta are resistant to retinoic acid (RA), we stably transfected RAR-beta expression vector into an esophageal cancer cell line TE-8 and an antisense RAR-beta into TE-3 cells. Transfection of RAR-beta decreased cell growth and colony formation and induced apoptosis in TE-8 cells. Antisense RAR-beta-transfected TE-3 cells had a shorter doubling time and became resistant to RA. Induction of RAR-beta decreased COX-2 expression in RAR-beta transfected TE-8 cells, whereas antisense RAR-beta transfected TE-3 cells increased COX-2 expression. The inhibitory effect of RAR-beta on COX-2 expression was further enhanced in the presence of RA, which was blocked by an RAR antagonist. The synthetic retinoid N-(4-hydroxyphenyl)retinamide, which does not bind effectively to RAR-beta, had no effect on COX-2 suppression. Furthermore, RA blocked bile acid-induced COX-2 expression and prostaglandin E(2) production only in the RAR-beta positive cells. Our data demonstrated that anticancer effect of RAR-beta may be related to its ability to suppress COX-2 expression and support that the loss of RAR-beta expression may contribute to esophageal carcinogenesis.
UI - 11821959
AU - Selaru FM; Zou T; Xu Y; Shustova V; Yin J; Mori Y; Sato F; Wang S; Olaru
TI - A; Shibata D; Greenwald BD; Krasna MJ; Abraham JM; Meltzer SJ Global gene expression profiling in Barrett's esophagus and esophageal cancer: a comparative analysis using cDNA microarrays.
SO - Oncogene 2002 Jan 17;21(3):475-8
AD - Department of Medicine, Division of Gastroenterology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore VA Hospital, MD 21201, USA.
In order to identify and contrast global gene expression profiles defining the premalignant syndrome, Barrett's esophagus, as well as frank esophageal cancer, we utilized cDNA microarray technology in conjunction with bioinformatics tools. We hybridized microarrays, each containing 8000 cDNA clones, to RNAs extracted from 13 esophageal surgical or endoscopic biopsy specimens (seven Barrett's metaplasias and six esophageal carcinomas). Hierarchical cluster analysis was performed on these results and displayed using a color-coded graphic representation (Treeview). The esophageal samples clustered naturally into two principal groups, each possessing unique global gene expression profiles. After retrieving histologic reports for these tissues, we found that one main cluster contained all seven Barrett's samples, while the remaining principal cluster comprised the six esophageal cancers. The cancers also clustered according to histopathological subtype. Thus, squamous cell carcinomas (SCCAs) constituted one group, adenocarcinomas (ADCAs) clustered separately, and one signet-ring carcinoma was in its own cluster, distinct from the ADCA cluster. We conclude that cDNA microarrays and bioinformatics show promise in the classification of esophageal malignant and premalignant diseases, and that these methods can be applied to small biopsy samples.
UI - 11720435
AU - Ryan BM; McManus R; Daly JS; Carton E; Keeling PW; Reynolds JV; Kelleher
TI - D A common p73 polymorphism is associated with a reduced incidence of oesophageal carcinoma.
SO - Br J Cancer 2001 Nov 16;85(10):1499-503
AD - Department of Clinical Medicine and Gastroenterology, St. James's Hospital and Trinity College, Dublin 8, Ireland.
The incidence of oesophageal adenocarcinoma is rising; to date, no susceptibility genes have been identified. p73, a novel p53 homologue, maps to chromosome 1p36, a region commonly deleted in oesophageal cancers. p73 shares some p53-like activity, but in addition, may also play a role in gastrointestinal epithelial inflammatory responses. A non-coding p73 polymorphism (denoted AT or GC) may be functionally significant. We investigated whether this polymorphism might play a role in the aetiopathogenesis of oesophageal cancer. This was a case-control, retrospective study. 84 cases of oesophageal cancer (25 squamous and 59 adenocarcinoma) and 152 normal population controls were genotyped for this polymorphism. Informative cases were examined for p73 LOH within the tumour. AT/AT homozygotes were significantly less prevalent in the oesophageal cancer population (1/84 = 1.2%) compared to controls (15/152 = 9.9%) (P < 0.02), corresponding to an odds ratio of 0.11 (95% C.I. 0.02-0.6, P < 0.02), or 9-fold reduced risk. Moreover, AT/AT homozygotes were significantly less frequent in the cancer population than would be expected under the Hardy-Weinberg hypothesis (P = 0.0099). LOH at the p73 locus was observed in 37.8% (14/37) of the AT/GC heterozygotes studied; in all cases there was loss of the AT allele. Our findings indicate that p73 AT/AT homozygotes appear to be protected against the development of oesophageal cance