Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fever of unknown origin presents both a clinical and diagnostic challenge and is usually caused by inflammatory and neoplastic diseases. We present a unique case of a previously healthy 77-year-old woman whose sole complaint was fever. Complete hospital investigation failed to reveal the underlying process. 4 months after the onset of fever, dysphagia appeared and she was then diagnosed as suffering from squamous cell carcinoma of the esophagus. The question of early barium swallow X-ray in such cases is raised.
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PMID:[Esophageal carcinoma presenting as fever of unknown origin]. 915 75

Eighty patients underwent transhiatal esophagectomy for squamous cell carcinoma of the esophagus. Dysphagia for solids was the presenting symptom in 90% of the patients. The standard technique of transhiatal esophagectomy was used and cervical anastomosis were hand sewn. The average operative time and blood loss were 190 min and 350 cc respectively. The 30 day mortality rate was 7.5% (six patients). Major respiratory complications were observed in 15 (18.7%) patients. Anastomotic leak rate was 10% (eight patients). The incidence of recurrent laryngeal nerve injury was 6.2% (five patients). The average hospital stay was 14 days. Four patients had stage I, 30 had stage II and 46 had stage III disease. Forty-nine patients (60%) had lymph node involvement. The overall actual survival at 2 years was 55% and at 5 years was 37%. Of the operative survivors, 87% patients resumed normal swallowing and 10 patients (13.5%) required dilatation for anastomotic stricture. Transhiatal esophagectomy can be performed with low operative mortality, acceptable morbidity and offers good long-term functional results without compromising the survival of patients.
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PMID:Transhiatal esophagectomy for squamous cell carcinoma of the esophagus. 1007 3

Basaloid-squamous cell carcinoma of the esophagus (BSCC) is an extremely rare tumor. Histologically, this tumor should be differentiated from adenoid cystic carcinoma (ACC) and small cell undifferentiated carcinoma (SCUC). Biologically, this tumor is very aggressive, with a propensity for distant metastasis. We report a 64-year-old male with esophageal BSCC. The patient complained of dysphagia and was found to have a torous lesion in the esophagus on radiological examination. Upper gastrointestinal fiberscopy showed a localized ulcerative type tumor, which was diagnosed as squamous cell carcinoma (SCC) on biopsy. Surgery resulted in curative resection. A histological examination of the resected tumor showed features of BSCC. Immunohistochemical examination demonstrated AE3/1- and CAM 5.2-positive tumor cells, and laminin-positive cells in the periphery of the nests. These data were useful in differentiating this tumor from ACC and SCUC. Six months after surgery, the patient developed hepatic metastases, which were successfully treated by regional chemotherapy via the hepatic artery by using fluorouracil. The patient is currently being followed up at the outpatient clinic and shows no signs of any recurrence.
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PMID:Basaloid-squamous cell carcinoma of the esophagus: diagnosis based on immunohistochemical analysis. 1135 May 61

Advanced squamous cell carcinoma of the esophagus (SCCE) is usually a disease of dismal prognosis. Palliation of dysphagia is the main goal of its treatment. This trial compared surgical to endoscopic palliation of dysphagia. Forty patients(32:8a, age 39-79y) suffering from TNM stage III or IV SCCE were divided into two groups: 20 patients were submitted to esophagogastric bypass (surgical group), and 20 patients had an endoscopically placed auto-expandable metal stent (EsophaCoil "In stent", Minnesota, USA)(endoscopic group). Both groups were similar regarding demographic data and nutritional status. The palliation of dysphagia, the incidence of early and late complications, the life quality (Karnofsky Index), the survival, the length of inpatient stay and the costs were evaluated in both groups. There was no difference between surgical and endoscopic groups regarding palliation of dysphagia, frequency of complications, quality of life, and survival. Early and late most common postsurgical complications were anastomotic leak and stenosis, respectively. The most common post-endoscopic complications were both late: benign hyperplasia and tumour overgrowth. None of the surgical or endoscopic complications were related to mortality. Hospital length stay and the costs were significantly higher in the surgical group (15.5 days vs 3 days, P < 0.001; U$ 4.690,45 +/- 1.360,28 vs U$ 2.618,24 +/- 944,98 P < 0.001). In conclusion, the endoscopic placement of an esophageal metal stent for the palliation of malignant dysphagia in patients with irresectable disease is equally effective as surgical bypass at lower costs and reduced length of inpatient stay.
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PMID:[Palliative treatment of advanced esophageal cancer. Comparative study: auto-expandable metal stent and isoperistaltic esophagogastric bypass]. 1137 Jan 75

We reported two cases of squamous cell carcinoma of the esophagus following endoscopic injection sclerotherapy (EIS) for esophageal varices. Both patients were cigarette smokers and had a long history of alcohol abuse. HBsAg and Anti-HCV were negative, and Anti-HBs was positive in one of the patients. They were diagnosed as alcoholic cirrhosis with esophageal varices and received EIS treatment. Sotradecol was utilized as the sclerosant with a mean total volume of around 30 ml. Patients developed dysphagia at 5 and 48 months following EIS, respectively. Endoscopic examination showed stenosis and ulcerative mass at the lower portion of the esophagus. Biopsy revealed well- to moderately differentiated squamous cell carcinoma of the esophagus. We conclude that endoscopic follow-up is essential and carcinoma of the esophagus should be included in the differential diagnosis for esophageal ulceration and dysphagia following EIS, particularly in those patients with risk factors for developing esophageal carcinoma.
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PMID:Esophageal cancer after endoscopic injection sclerotherapy for esophageal varices. 1149 40

Patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus should undergo computed tomography of the chest and abdomen and positron emission tomography to look for evidence of distant metastatic disease. In the absence of systemic metastases, locoregional staging should be performed with endoscopic ultrasonography and fine needle aspiration of accessible periesophageal lymph nodes and any detectable celiac lymph nodes. Patients found to have T3 tumors (transmural extension), T4 tumors (invasion of adjacent structures), or N1-M1a (lymph node-positive) disease do poorly when treated with surgery alone; 5-year survival is less than 20%. These patients should be considered for combined modality therapy. Patients with T4 disease are generally not deemed candidates for surgical resection; they may be considered for definitive chemoradiotherapy. Patients with T3 disease or lymph node-positive disease may be treated with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy alone. Patients considered for trimodality therapy should be fully restaged before surgery to assess their response to neoadjuvant treatment. This should include repeat endoscopic ultrasound and fine needle aspiration of lymph nodes. Patients whose lymph node metastases do not completely respond to neoadjuvant therapy are unlikely to benefit from the addition of surgery. Patients with persistently positive celiac lymph nodes have a very poor prognosis and should not undergo surgery. Patients with persistent nodal disease who have good performance status may be considered for additional chemotherapy. Patients with locally advanced esophageal cancer who have poor performance status are not good candidates for combined modality therapy. These individuals are best managed with palliative intent. Particular attention should be given to alleviating the common problem of dysphagia, which causes significant morbidity.
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PMID:Locally advanced esophageal cancer. 1239 37

Vinorelbine and docetaxel are two effective drugs in esophageal cancer; our purpose was to evaluate efficacy and toxicity of a combination of these drugs in recurrent squamous cell esophageal cancer. Twenty patients previously treated with concomitant chemoradiotherapy (n = 14), surgery alone (n = 2), surgery plus radiotherapy (n = 2), or concomitant chemoradiotherapy + surgey (n = 2) were enrolled. Thirteen patients had a local-regional recurrence, two patients had metastases, and five patients had both. The doses were 80 mg/m(2) for docetaxel and 20 mg/m(2) for vinorelbine on d 1 every 21 d for a maximum of six cycles. Twenty patients received a total of 106 cycles (median per patient, 5). Neutropenia was the most frequent and severe side effect (grade 4 in 80%; grade 3 in 20%). The overall response rate was 60%, which included 3 of 20 complete responses (15%) and 9 of 20 partial responses (45%). Median response duration was 7 mo (2-50+). Overall median survival was 10.5 mo (range, 2-55+). A dysphagia improvement was observed in 81% of patients. In conclusion, the data from this phase II study indicate that this combination is effective in recurrent heavily pretreated patients with a short-lasting manageable toxicity.
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PMID:Docetaxel and vinorelbine: an effective regimen in recurrent squamous cell esophageal carcinoma. 1266 80

Esophageal squamous papillomatosis is a rare condition associated with human papilloma virus infection and has been complicated by the development of squamous cell carcinoma. Photodynamic therapy using porfimer sodium has been used for the treatment of esophageal cancer but has not been utilized in the treatment of esophageal squamous papillomatosis. We report here the first case of papillomatosis and obstructing squamous cell carcinoma of the esophagus palliated with porfimer sodium photodynamic therapy indicating successful photosensitizer uptake in papilloma-laden tissue. Extensive debulking of papilloma and tumor allowed esophageal recanalization and placement of a self-expanding metal stent for long-term dysphagia palliation. This unique case highlights the combined use of endoscopic techniques for optimal treatment results.
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PMID:Photodynamic therapy and endoscopic metal stent placement for esophageal papillomatosis associated with squamous cell carcinoma. 1523 Jul 38

The aim of this retrospective study was to evaluate the effectiveness of low-dose cisplatin and 5-fluorouracil (low-dose FP) as an adjuvant chemoradiotherapy for resected advanced squamous cell carcinoma of the esophagus. From 1994 to 1999, 57 patients who showed an invasion of the tumor over the muscularis propria (T2-T4), regional lymph node metastasis (N1), and no distant metastasis (M0) were enrolled in this analysis. Postoperative chemoradiotherapy (CRT group) was performed on 14 of the patients, and they were compared to the patients who underwent surgery alone (S group) using the matched pair algorithm. In the CRT group, chemotherapy of low-dose FP was combined with concurrent radiotherapy after the esophagectomy. A side-effect of severe dysphagia (NCI-CTC Grade 3) was observed in 4 patients (28.6%) and leukocytopenia in 1 patient (7.1%) among the CRT group. The overall survival rate of the CRT group and matched S group were 35.7% and 28.5% at 5 years, respectively, with no significant difference. In the CRT group, 7 of 14 patients (50%) had a recurrence. The recurrence rate was slightly lower than in the S group (57%), with no significant difference. This combined chemoradiotherapy using low-dose FP did not improve the prognosis of patients with resected advanced esophageal carcinoma.
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PMID:Clinical evaluation of low-dose cisplatin and 5-fluorouracil as adjuvant chemoradiotherapy for advanced squamous cell carcinoma of the esophagus. 1618 Jun 98

Combined chemoradiation therapy has proven to be an effective treatment for unresectable esophageal cancer. Nonsurgical endoscopic palliation of local disease has become feasible with neodymium:yttrium-aluminum-garnet laser, BICAP tumor probe, and metallic stents. Alternatively, endoscopic injections of ethanol are safe, inexpensive, and useful for palliation of malignant dysphagia. Two patients with unresectable squamous cell carcinoma of the esophagus were treated with 1 mL of absolute (95 g/L) alcohol injections once a week for 4 weeks, followed by chemoradiation therapy consisting of concomitant 5-fluorouracil 300 mg/m/d and radiation therapy (total of 60 Gy over 6 weeks). One patient had a complete response but died of alcoholism 25 months after diagnosis without evidence of tumor recurrence. The other patient had a partial response but died 16 months after diagnosis from disease progression. We conclude that tumor ablation by ethanol injection for palliation combined with chemoradiation may be a low-cost alternative for advanced unresectable esophageal cancer.
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PMID:Palliative ethanol injections of unresectable advanced esophageal carcinoma combined with chemoradiation. 1647 88


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