Article

Multiple management modalities in esophageal cancer: epidemiology, presentation and progression, work-up, and surgical approaches

Emory University School of Medicine, Department of Radiation Oncology, Atlanta, Georgia, USA.
The Oncologist (Impact Factor: 4.54). 02/2004; 9(2):137-46.
Source: PubMed

ABSTRACT Annually, approximately 13,200 people in the U.S. are diagnosed with esophageal cancer and 12,500 die of this malignancy. Of new cases, 9,900 occur in men and 3,300 occur in women. In part I of this two-part series, we explore the epidemiology, presentation and progression, work-up, and surgical approaches for esophageal cancer. In the 1960s, squamous cell cancers made up greater than 90% of all esophageal tumors. The incidence of esophageal adenocarcinomas has risen considerably over the past two decades, such that they are now more prevalent than squamous cell cancer in the western hemisphere. Despite advances in therapeutic modalities for this disease, half the patients are incurable at presentation, and overall survival after diagnosis is grim. Evolving knowledge regarding the etiology of esophageal carcinoma may lead to better preventive methods and treatment options for early stage superficial cancers of the esophagus. The use of endoscopic ultrasound and the developing role of positron emission tomography have led to better diagnostic accuracy in this disease. For years, the standard of care for esophageal cancer has been surgery; there are several variants of the surgical approach. We will discuss combined modality approaches in part II of this series.

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    • "Although it is relevant to mention that very wide variations can occur even within a country, as it happens in China where the incidence ranges from 1.4 to 400 per 100,000 inhabitants per year, a fact probably related to variations of diet habits. On the other hand, it is in Western Europe and the USA where it is recorded the lowest incidence of 5 per 100,000 inhabitants per year [13] [14] [15] [16]. Within Europe, the highest incidence is reported in the United Kingdom, France and Ireland [4] [7]. "
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    ABSTRACT: Generalities. The esophageal cancer is the 8th most frequent malignant tumor worldwide, with about 400.000 new cases diagnosed each year, with a constantly increasing incidence. It is characterized by its rapid development and fatal prognosis in most cases, secondary to its early spreading and late diagnosis. There is an increased incidence in Caucasian males and a smaller incidence for black males and women. The overall 5 year survival rate it is estimated at 15% with very few series reporting 5 year survival rates higher than 20%. Incidence. Esophageal cancer incidence and mortality is strongly related to race and gender.
    Esophageal Cancer, 2014 edited by F.Lopez - R. Marti Obiol, 12/2014: chapter Epidemiology and Screening of Esophageal Cancer: pages 1-16; Nova Science Publishers ,Inc., ISBN: 978-1-63321-082-0
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    • "It is also used to relieve painful symptoms and prior to surgery in hopes of reducing the size of a tumor. [29] Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Pancreatic cancer is the fifth leading cause of cancer-related mortality in the United States, with an estimated 33,370 deaths attributable to this disease in 2007. "
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    ABSTRACT: Smoking is a major cause for several types of cancer. Smoking increases the risk of cancers of the lungs, bladder, cervix, kidney, larynx (voice box), pharynx (upper throat), nose, mouth, oesophagus (foodpipe), pancreas, stomach, liver and some types of leukaemia. And smokers are 7 times more likely to die of these cancer than non-smokers. Scientists have identified about 4,000 different chemicals in tobacco smoke. Chemicals such as nitrosamines, benzo(a)pyrene, benzene, acrolein, cadmium, and polonium-210 can damage DNA.Within this review article we will focus on the correlation between smoking and oxidative stress and the role of smoking in increasing the risk of gastric cancer .
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    ABSTRACT: Regarding the mortality causes, esophageal squamous cell carcinoma (ESCC) is on the 7th place in the US and the 6th place in the world, with 5 year overall survival rate of 14%, which is still modest in comparison to other digestive neoplasia. Multiples strategies were involved to improve this percentage, associating surgical procedures and chemo- and radio- oncologic therapies. The distant results showed sensitive improvement, after INTRODUCTION of multimodality neoadjuvant therapies. Material and method: Fifty-seven patients diagnosed with ESCC were evaluated between 2006 and 2010, male preponderance (77%), average age of 55. A multimodality therapeutic protocol was used: first - radio-chemotherapy (RCT), second - surgery and/or third - chemo- or radiotherapy. Four weeks post RCT all patients were evaluated to determine the response to neoadjuvant treatment followed by surgery - esophageal resection. Histopathological (HP) and immunohistochemical (IHC) analysis of the pathological specimens were performed in order to identify the molecular predictors with responsive or non responsive character; the studied markers were p53 (Dako 1:50), Ki-67 (Biogenex, 1:20), c-erbB-2 (Dako, 1:250). Based on these results, the working model used to determine the response to neoadjuvant therapy was tumor regression grade (TRG). RESULTS: After HP and IHC examination, the patients were included in two groups: responders and non responders (tumor cells > 10%). Complete neoplasia sterilization was achieved in 5 of the patients. Conclusions: We are able to state that the identification of potential predictive markers along with HP and IHC results represents a great perspective alternative in the ESCC therapy outcome. The detection of molecular type aggressiveness of the neoplastic process allows therapeutic orientation or guidance to certain therapy sequences or even to specific molecular targeted treatments.
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