Esophageal Cancer
Dongyou Liu in Tumors and Cancers, 2017
Early esophageal cancer. Due to increased screening and routine endoscopic surveillance for Barrett’s esophagus, the incidence of superficial esophageal cancer is rising. Superficial esophageal cancers are defined as tumors that invade no deeper than the submucosa. Accurate assessment of the depth of invasion (T stage) is critical in determining the extent of disease and treatment selection. T1a tumors are defined as intramucosal tumors and T1b tumors invade into the submucosa. Depending on the extent of submucosal involvement, treatment ranges from endoscopic resection +/− ablation to surgical esophagectomy. This drastic difference in treatment correlates with the risk of lymph node metastases. In one series of close to 4,000 patients derived from the National Cancer Database, the risk of lymph node metastases was 5% for T1a tumors versus 17% for T1b tumors.8
Esophageal stents
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
An increasing incidence of esophageal cancer in the Western hemisphere is occurring without a concomitant increase in the rate of early detection. Consequently, the number of patients presenting with advanced stage disease (not appropriate for surgery or irradiation) is increasing at an alarming rate, and the need to provide these patients with obstruction (a). A self-expandable metallic stent (SEMS) has been inserted to open up the lumen of the esophagus before initiation of chemoradiotherapy (b). palliative treatment options to maintain their quality of life is increasingly relevant. Among the most debilitating symptoms in patients with advanced stage esophageal cancer is dysphagia. Advancements in stent technology during the past two decades have dramatically improved the management of this condition, by far the most common indication for the placement of an esophageal stent. Unlike for other indications, the goal of treatment of malignant strictures and obstruction from tumor encroachment is to durably improve dysphagia while minimizing the risks of the intervention and the need for reinterventions. Overall, when SEMS are used to palliate malignant esophageal obstruction, they are cost-effective, efficient, and successful at palliating patients (see Figure 28.1).
Cell Turnover in the Gastrointestinal Tract and the Effect of Ethanol
Victor R. Preedy, Ronald R. Watson in Alcohol and the Gastrointestinal Tract, 2017
Long-term drinking of alcohol is also a major risk for esophageal cancer in humans.87,88,106 Pathogenic factors seem to be similar as those already discussed for the oropharynx. Under normal conditions, the passage of liquids through the esophagus is rapid, and the duration of contact with the surface is very brief. However, it has been shown in humans that ethanol given orally or intravenously decreases the frequency of peristalsis.107 This would delay clearance of the esophagus, and prolong the time of contact of the contents with the lumen surface. It also has been found that moderate alcohol intake in humans increases the frequency of gastric reflux into the esophagus.108 The acidic gastric content damages the esophageal mucosa. When isolated rabbit esophagus was perfused for 3.5 h, a solution containing 20% ethanol was relatively harmless, whereas 40% ethanol caused edema and erythema.109 In these experiments no effect was seen on cell replication. Using 20-min perfusion period, rat esophagus was perfused with either 2 ml apple brandy or 2 ml ethanol of the equivalent concentration through a catheter sewn into position in situ.110 Animals were then killed at intervals, 1 h after receiving an injection of radiolabeled thymidine. In both groups of animals the labeling index began to increase after 6 to 12 h and the mitotic index after 12 to 18 h. As there was no histological evidence for superficial desquamation, the proliferative response did not appear to be a reaction secondary to cellular shedding.
Advances in chlorin-based photodynamic therapy with nanoparticle delivery system for cancer treatment
Published in Expert Opinion on Drug Delivery, 2021
Lin Huang, Sajid Asghar, Ting Zhu, Panting Ye, Ziyi Hu, Zhipeng Chen, Yanyu Xiao
Esophageal cancer is a common gastrointestinal tumor. About 300,000 people die from esophageal cancer every year. The morbidity and mortality rates vary greatly from country to country. The disease incidence in women is higher than men. PDT only destroys cancer cells in the inner layer, or mucosa of the esophagus that can be reached by the light. It can’t be used for esophageal cancer that has spread into deeper layers of the esophagus or to other parts of the body. In clinical settings, laser irradiation is given via an endoscope and cylindrical diffusers near the tumor. The first studies with PDT in the esophagus were done as palliative treatment for obstructive tumors [231]. PDT can be used to treat any Barrett’s esophagus or early esophageal cancer left behind after EMR. PDT may also be offered to people with advanced esophageal cancer. It can relieve pain or make swallowing easier (called palliative PDT) [232]. Porfimer sodium has been approved by FDA to alleviate patients with completely obstructing esophageal cancer, or of patients with partially obstructing esophageal cancer. The recommended PS dose is 2 mg/kg with laser light dose 300 J/cm.
Proteogenomic examination of esophageal squamous cell carcinoma (ESCC): new lines of inquiry
Published in Expert Review of Proteomics, 2020
Shobha Dagamajalu, Manavalan Vijayakumar, Rohan Shetty, D. A. B. Rex, Chinmaya Narayana Kotimoole, T. S. Keshava Prasad
Esophageal cancer (EC) ranks seventh among the most common cancers and is estimated to be sixth among the most common cause of cancer deaths worldwide [1]. In 2018, approximately 572,000 new cases were estimated to be diagnosed, resulting in almost 509,000 deaths across the world [2]. As there are no obvious specific symptoms in the early stage of esophageal cancer, the cancer is usually detected in the advanced stage, when the patient experiences difficulty in swallowing food. The treatment strategy of esophageal cancer is developed considerably and depends on the state of the disease at the time of presentation. Esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) are two main types of esophageal cancer. ESCC arises from the squamous epithelium and adenocarcinoma arise from intestinal metaplastic epithelial cells or Barrett’s esophagus [3]. ESCC is the most prevalent esophageal cancer worldwide, occurs most often in the upper and middle portions of the esophagus.
Prognostic Value of the Geriatric Nutritional Risk Index in Patients Exceeding 70 Years Old with Esophageal Squamous Cell Carcinoma
Published in Nutrition and Cancer, 2020
Ying Wang, Lei Wang, Min Fang, Jianbo Li, Tao Song, Wenming Zhan, Hong’en Xu
On the other hand, dysphagia is reported as the major symptom in more than 90% of esophageal cancer patients (7). This combined with the incidence of severe gastrointestinal toxicities during dCRT makes nearly 80% of the patients require invasive nutritional support (8). The Geriatric Nutritional Risk Index (GNRI), first established by Bouillanne et al. (9), is an objective and simple nutritional assessment option determined by only serum albumin and body weight. It has been widely proposed for the evaluation of at-risk elderly patients (10–12), hemodialysis patients (13,14) and patients with heart failure (15). It was revealed to be an ideal predictor of morbidity and mortality and for possible use in grading the patient’s nutritional status (16). However, the prognostic influence of GNRI at diagnosis has never been investigated in elderly patients treated with curative intent by dCRT or RT alone in ESCC patients.
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