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Query: UMLS:C0007097 (carcinoma)
 152,788 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To comprehend the frequency and clinical features of adenocarcinomatous components in carcinoma of the esophagus, 135 lesions in 128 patients with carcinoma of the esophagus were histochemically and clinicopathologically studied. Mucus-histochemistry, especially mucicarmine staining, revealed mucus-secreting components in 48 lesions (35.6%). This is a much higher rate of esophageal cancers with adenocarcinomatous components than previously reported. Furthermore, no significant clinicopathologic differences were noted between the mucus-stain-positive and -negative groups, except for a higher rate of venous infiltration in the mucus-stain-positive group. Carcinoma of the esophagus with adenocarcinomatous components, particularly mucoepidermoid carcinoma, has generally been considered to arise from the proper esophageal gland or its ductal epithelium. However, certain evidence in this study, such as the mucus-secreting components in mucosal carcinoma and a high incidence of intraepithelial spread, suggested a squamous epithelium origin. Immuno-histochemistry using the peroxidase-antiperoxidase (PAP) technique revealed 49 lesions (36.3%) to be positive for tumor carcinoembryonic antigen (CEA). Tissue CEA was found mostly around mucins and/or glandular structures, and CEA-stain-positive lesions were more prominent in the mucus-stain-positive group, suggesting that CEA in carcinoma of the esophagus originates in the adenocarcinomatous components. Furthermore, the mucus-stain-positive group showed significantly higher rate of patients with pathologic serum CEA levels. Therefore, the serum CEA level is useful for the follow-up patients with mucus-stain-positive carcinoma of the esophagus.
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PMID:[Histochemical study of adenocarcinomatous components in carcinoma of the esophagus]. 245 43

The number of options now open to surgeons in the treatment of carcinoma of the oesophagus is considerable. One, two or three different approaches can be used to remove tumours at any level between the hypopharynx and the cardia. The Sweet procedure involves a left thoracotomy followed by anastomosis. The Lewis Tanner operation begins with the stomach being mobilized through an abdominal approach followed by resection and anastomosis by a right thoracotomy. A triple approach--cervical, thoracic and abdominal--is selected when anastomoses are extrathoracic. In McKeown's operation, the whole stomach is used and the posterior mediastinal route selected. Akiyama tubulizes the stomach and has chosen the retrosternal route. Orringer has recently developed oesophagectomy without thoracotomy. When tumour removal is impossible or there is a local or general reason for refusing excision, the surgeon can turn to palliative surgery to give the patient the means of enjoying a normal life during the time that is left to him. The whole stomach can be used or it can be made into a tube by resecting the lesser curvature. Postlethwait made use of Lortat-Jacob's technique. Reversing the stomach has also been suggested. Colonic oesophagoplasty is possible if previous gastrectomy has been carried out. The surgical management of malignant oesophagotracheal fistulae can be limited to bipolar exclusion of the oesophagus. Ideally, a retrosternal gastric plasty should also be performed with drainage of the lower oesophagus into a Roux-en-Y loop. The choice of treatment is made on the basis of the preoperative assessment of the patient. The extent of disease spread is evaluated. The most important diagnostic tools are fibreoptic bronchoscopy and ultrasound. The type of surgery selected is contingent on the tumour site and the patient's physical condition. Oesophagectomy without thoracotomy has meant that surgery is available to patients for whom thoracotomy would have been inadvisable. Malignant oesophagotracheal fistulation must be treated by the Kirschner operation. Palliative bypass is carried out only in patients under 50 years of age. It is our opinion that surgery is too often overlooked in the treatment of oesophageal carcinoma. The survival rate at 5 years is 23% for potentially curable resection and the operative mortality 2.6%. In other cases, palliative resection (or bypass for patients under 50) allows the patient to feed himself and lead a normal life until the inevitable fatal outcome.
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PMID:Surgical possibilities of oesophageal cancer. 245 61

Hyperthermia using a radiofrequency system with an endotract antenna, combined with irradiation and chemotherapy, was prescribed for patients with resectable (n = 62) and unresectable (n = 31) squamous cell carcinoma of the esophagus, admitted to the 2nd Department of Surgery, Kyushu University Hospital from 1978. The histopathological effectiveness, according to the Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus, and the long-term results were compared between two groups of patients treated with hyperthermo-chemo-radiotherapy (HCR therapy) and those treated with chemo-radiotherapy but not hyperthermia (CR therapy). In the resected cases, preoperative HCR therapy resulted in a significantly higher histopathological effectiveness rate (66%) compared with that in cases treated by CR therapy (49%) (p less than 0.05). The five-year survival rates of patients with resectable carcinoma given preoperative HCR therapy or CR therapy were 43.2% and 14.7%, respectively, and the two-year survival rates of those with unresectable carcinoma were 15.5% and 1.2%, respectively. Thus, HCR therapy produced not only a significantly higher histopathological effectiveness rate but also a significantly longer survival without severe side effects. This treatment would contribute to improvement of the prognosis of patients with carcinoma of the esophagus.
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PMID:[Clinical results and prospects of hyperthermia in the treatment of patients with esophageal carcinoma]. 245 10

The management of carcinoma of the oesophagus poses formidable logistic problems in countries such as Transkei where the condition is common and resources are limited. Most patients present late, often with complications, and are reluctant to undergo major surgery. Two hundred and fifty consecutive patients who presented over nine months in Transkei were studied. The incidence increased with age until 70 years and the disease occurred equally in men and women. The neoplasm was predominantly squamous cell (243 patients, 97%) and was found most often in the middle third of the oesophagus (118, 47%). On admission only eight of the 250 patients could take a semi-solid diet and only 21 a fluid diet. The policy where feasible was to introduce a Proctor Livingstone tube endoscopically through the dilated oesophageal stricture by a pulsion technique under light general anaesthesia. When abdominal perforation of the oesophagus seemed likely, retrograde intubation via a gastrotomy was performed. Sixty patients were not intubated, because the stricture was too proximal (47) or could not be dilated adequately (6), the lesion was suitable for resection (6), or the patient refused (1). Fifty one (27%) patients died in hospital, 29 deaths being due to oesophageal perforation (including six of the 10 who were intubated retrogradely). The mean hospital stay was 4.7 days. On discharge 64% of the intubated patients were able to take semi-solid food and a further 6% a fluid diet. Palliation by intubation was performed rapidly and the tube was well tolerated by patients. The overall mortality was high, but this can be reduced by experience. Intubation is an acceptable, cost effective solution where large numbers of patients present with advanced oesophageal carcinoma in circumstances where resources are severely limited.
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PMID:Carcinoma of the oesophagus in Transkei: treatment by intubation. 246 98

The authors give an account of 17 late re-operations performed after 14 resections and three palliative operations of carcinoma of the oesophagus and cardia, on account of stenosis of the anastomosis. After primary resection on account of carcinoma of the cardia 9 patients were re-operated and on account of carcinoma of the oesophagus five patients: three times because of a cicatricial stenosis and 11 times on account of narrowing of the anastomosis due to a relapse of the oesophageal tumour or in the surrounding nodes. The interval after resection was on average 13.7 months. Re-resection was possible only in two patients, seven times an endoprosthesis was introduced, three times a bypass was made, once jejunostomy and once the operation ended by probatory laparotomy. The mortality of all re-operations was 35.7%, the survival was 6-11 months.
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PMID:[Late reoperation in patients with carcinoma of the esophagus and cardia]. 247 Jan 56

A case of progressive dysphagia due to metastatic carcinoma of the esophagus from breast cancer is described herein. The patient was a 55-year-old Japanese woman who had undergone a right radical mastectomy for carcinoma of the right breast 9 years previously. We performed a subtotal esophagectomy and reconstruction, using the stomach. She is now well and working without any further symptoms, five years after surgery. Thus, palliative surgery for the complications caused by metastatic carcinoma of the esophagus may be worthwhile.
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PMID:Successful esophagectomy for metastatic carcinoma of the esophagus from breast cancer--a case report. 247 61

Since carcinoma of the oesophagus is considered to be frequently multicentric, total oesophagectomy appears the only radical therapeutical approach. A follow-up of 366 patients who underwent partial oesophagectomy shows that this procedure can be curative as well as palliative and is sometimes the only procedure possible with a reasonable mortality. These patients had an oesophageal carcinoma located between the cardia and the level of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these, 22% were over 70 years of age. The surgical route was a left thoracotomy in 280 cases (with anastomosis below or above the aortic arch) or a laparotomy and right thoracotomy in 86 cases. The oesophagus was transected as high as possible and replaced by an isoperistaltic tube fashioned from the greater curvature of the stomach. Mediastinal tissues and the lesser curvature with their lymph nodes were removed. The overall operative mortality was 7% (4% in patients less than 70 and 15% over 70). Very few anastomotic fistulae were observed (6 cases) but they were always severe (6 deaths). The middle and long term results show acceptable functional sequelae and a good survival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at 5 years (27% when the excision appeared curative). There was no significant difference in survival for patients whose cancer was in the mid-oesophagus compared to the lower oesophagus. There was no difference in survival in the cell type squamous or adenocarcinoma. Death was mainly due to metastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer. From a follow-up of 366 cases. 248 41

Twenty-nine patients with carcinoma of the esophagus were treated with 5-fluorouracil (5-FU) (1000 mg/m2/d as a continuous intravenous [IV]infusion on days 1 through 4), cisplatin (100 mg/m2 IV on day 1), mitomycin C (10 mg/m2 IV on day 1), and concurrent radiation therapy (4500 cGy/4.5 wk). If no disease progression was observed, operable patients underwent surgery 4 to 6 weeks after completion of radiation therapy. A thoracotomy with a gastric pull-through operation was performed in the first six patients. Subsequently, a transhiatal ("blunt") esophagectomy was used. Twenty-five patients had squamous cell histology and four had adenocarcinoma. Of 25 patients with squamous cell carcinoma, 13 underwent esophagectomy. The clinical complete response rate was 61% (eight of 13 patients), with a pathologic complete remission documented in five of 13 patients (38%). The overall local tumor sterilization rate was 53% (seven of 13 patients). In the 12 patients who did not undergo surgery after chemoradiotherapy, four had a complete clinical response (33%) and five had a partial response (41%). Symptoms or signs of local disease recurrence or stricture were noticed in ten of 12 patients who did not undergo surgery (83%), compared with 28% of patients who underwent surgery. The median survival time of the group receiving surgery was 10 months, compared with 5 months for those who did not undergo operation (P = 0.027). Patients undergoing transhiatal esophagectomy had shorter postoperative hospital stays and fewer serious complications, compared with patients undergoing transthoracic esophagectomy. The use of chemoradiotherapy and transhiatal esophagectomy for esophageal carcinoma should be evaluated using alternative sequences of treatment (e.g., postoperative therapy) to reduce toxicity while maintaining local control of disease.
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PMID:Cisplatin, 5-fluorouracil, mitomycin C, and concurrent radiation therapy with and without esophogectomy for esophageal carcinoma. 250 Oct 18

Carcinoma of the esophagus continues to carry a very poor prognosis. Previous studies have rarely reported the exact cause of death in these patients. Twenty-five autopsies were retrospectively reviewed in patients with the diagnosis of carcinoma of the esophagus, noting the cause of death. Two-thirds of all patients with unresected middle-third lesions ultimately died as a result of direct extension of the tumor into the aorta or tracheobronchial tree. Other findings included a high incidence of second neoplasms (12%) and the lack of an antemortem diagnosis of esophageal cancer in three of four females in the series.
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PMID:Cause of death in carcinoma of the esophagus. 277 9

A primary small cell carcinoma of the esophagus in a 61-year-old woman was treated by transhiatal esophagectomy. The clinical data were correlated with data obtained from a review of the 129 cases reported in the world literature, thereby providing a clinical profile and suggested management strategy for this rare type of esophageal malignancy. Presenting symptoms of esophageal small cell carcinoma include dysphagia (75.3%), weight loss (38.4%), and chest pain (23.3%). Treatment regimens have included surgical intervention in 58%, radiotherapy in 10%, chemotherapy in 6%, or some combination of these in 26%. Overall survival is only 20.7 weeks after diagnosis. The fact that three fourths of affected patients had metastatic disease at the time of diagnosis leads us to recommend surgical intervention plus systemic chemotherapy in these patients.
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PMID:Primary small cell carcinoma of the esophagus. 253 65


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