Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For thoracic esophageal cancer, we perform extended three field lymph node dissection, and have achieved nearly 50% of overall 5-year survival. However, patients sometimes develop lymph node recurrences in spite of having no lymph node metastases found by conventional histopathologic examination. In a patient with esophageal squamous cell carcinoma, we sequenced all the p53 cDNA translated regions (exon 2-10) of primary carcinoma, and confirmed one p53 nonsense mutation in exon 10. Then we extracted genomic DNA from 150 surgically dissected lymph nodes from that patient, and performed polymerase chain reaction analysis (PCR-RFLP) to detect the same p53 mutation in the lymph nodes. PCR-RFLP analysis showed the same p53 mutation in six lymph nodes. One node was located along the right recurrent laryngeal nerve, where no positive nodes was identified by conventional histopathologic examination. The p53 mutational diagnosis of metastatic cancer may be useful in detecting minimal residual disease.
Dis Esophagus 1998 Oct
PMID:p53 gene mutation in 150 dissected lymph nodes in a patient with esophageal cancer. 1007 15

Squamous cell carcinoma of the esophagus shows a wide variation in incidence worldwide. It is the fifth leading cause of cancer-related death in men and usually diagnosed at an advanced stage with unsatisfactory therapeutic results. The techniques available for early detection of esophageal carcinoma are reviewed in this paper, as well as its overall effect on survival. For the time being, only surgical resection at a very early stage may improve survival of the disease. Esophageal cancer can be treated at an earlier stage when it is diagnosed by mass screening detection. However, despite a high survival rate at 5 years, local recurrences and distal metastases may still occur even 10 years after treatment. Prevention and therapeutic intervention at an earlier stage before the oncologic process has resulted in cancer changes is necessary to alter the natural evolution of the disease.
Dis Esophagus 1999
PMID:Early detection of esophageal squamous cell carcinoma and its effects on therapy: an overview. 1063 5

We retrospectively investigated whether the number of involved lymph nodes and the radiation therapy for recurrence affect survival in patients with thoracic esophageal carcinoma. Eighty-nine patients underwent surgical resection and reconstruction for thoracic esophageal squamous cell carcinoma beyond the mucosal layer. Patients were classified into three groups: group 1 comprised 40 patients without lymph node involvement; group 2 comprised 34 patients with 1-3 positive nodes; and group 3 comprised 15 patients with > or = 4 involved lymph nodes. The 3-year and 5-year survival rates were 77.5% and 73.2% respectively in group 1, 64.8% and 55.8% respectively in group 2, and 28.1% and 0% respectively in group 3. The mean survival time (MST) mean +/- SD of the patients in group 3 (772.1 +/- 146.2 days) was significantly shorter than that of patients in group 1 (3728.5 +/- 320.7 days, p < 0.0001) and group 2 (2330.4 +/- 344.3 days, p = 0.0130). The MST of the patients in group 2 was also significantly shorter than that of patients in group 1 (p = 0.0366). Patients with recurrent lymph nodes that were localized were treated effectively with radiation therapy. We conclude that the number of lymph node metastases influences survival in thoracic esophageal cancer. Early detection as well as radiation therapy for recurrent lymph node metastases is effective in improving long-term survival.
Dis Esophagus 1999
PMID:Number of lymph node metastases influences survival in patients with thoracic esophageal carcinoma: therapeutic value of radiation treatment for recurrence. 1063 14

In the past, adenocarcinomas were thought to occur rarely in the esophagus and to comprise a small percentage of the tumors. In recent years the incidence has risen so that they represent 25% to 35% of all esophageal tumors. Epidemiological studies have shown that the tumor is more common in men than women ( approximately 8:1) and in whites than non-whites ( approximately 7:1). The most common associated condition is Barrett's esophagus, but the evaluation is clouded by the inconsistent definition of Barrett's esophagus in the gastroenterology literature. The diagnosis of Barrett's esophagus requires the identification of metaplastic glandular epithelium with goblet cells in the esophagus. The management of adenocarcinomas of the esophagus is difficult to evaluate because the tumors are frequently included with squamous carcinomas of the esophagus or adenocarcinomas of the gastric cardia. Esophageal adenocarcinomas are associated with a high rate of local recurrence when treated with surgery or radiation alone. Their pattern of spread is different from that of gastric carcinomas in that peritoneal seeding is uncommon and liver and pulmonary parenchymal metastases are less common, whereas pleural and bony metastases are more common. This would suggest that they should be analyzed as a separate clinical entity. In the absence of prospective trials, the reported experience suggests that these patients should be considered for combined surgery and preoperative or postoperative chemotherapy and radiation. Patients who are not candidates for surgery can receive effective and durable palliation from chemosensitized radiation. There are theoretical advantages to both preoperative and postoperative therapy and the selection of treatment programs should be individualized.
 ...
PMID:Controversies in the Management of Adenocarcinoma of the Esophagus and Esophagogastric Junction. 1071 5

In a retrospective study, the results after resection of carcinoma of the gastric cardia in the era without neoadjuvant therapy or extended lymph node dissection were evaluated. All 184 patients who underwent resection between January 1983 and December 1993 were included. Recurrence of disease, survival and prognostic factors were determined. The overall cumulative 5-year recurrence rate was 71% and the survival rate 23%. Multivariate analysis identified locoregional lymph node and distant metastases as the crucial prognosticators of recurrence of disease and survival. These results were similar to those from a previous study concerning our patients operated during the years 1983-88. The prognosis of a resected cardiacarcinoma has remained unchanged in our hands over the past 10 years. These results stress the importance of exploring new ways, such as the use of new diagnostic tools, to optimize preoperative patient selection and more aggressive treatment regimens to improve final outcome.
Dis Esophagus 2000
PMID:Recurrence and survival after resection of adenocarcinoma of the gastric cardia. Rotterdam Esophageal Tumor Study Group. 1100 29

is a rare disease, with only 200 cases being reported since this condition became an established clinical entity in 1963. This tumor, which accounts for only 0.1-0.2% of all esophageal neoplasms, is typically aggressive and disseminates early via the bloodstream and lymphatics, with only some 30% of patients surviving > 1 year after diagnosis. Management of patients with esophageal melanomata is unsatisfactory, as most tumors are advanced at diagnosis, and therapeutic options are limited by inaccessibility and early dissemination of the neoplasms. Poor survival rates reflect the inoperability of many tumors and the ineffectiveness of radiation and chemotherapy in eradicating advanced tumors and metastases. We present two patients with primary melanoma of the esophagus and discuss the treatment options currently available.
Dis Esophagus 2000
PMID:Primary malignant melanoma of the esophagus. 1128 83

The surgical treatment of cancer of the esophagus includes esophagectomy, adequate radical lymphadenectomy, and esophageal reconstruction. Lymph node metastasis of esophageal cancer is the major factor that influences the prognosis after surgery. Even with an invasion depth limited to the mucosa or submucosa, the prognosis is remarkably poor compared with the same invasion depth in gastric or colorectal cancer. Superficial cancer of the esophagus may metastasize into lymph nodes far distant from the primary tumor, not only into the mediastinum but also into the neck and abdomen. Therefore, these cases require treatment of potentially widely distributed metastases and a safe construction of a viable intestinoesophageal conduit. Under the prevailing conditions, however, surgical interventions without fundamental knowledge of the structures of this area are unacceptable.
Dis Esophagus 2001
PMID:Anatomical basis for the approach and extent of surgical treatment of esophageal cancer. 1155 13

In order to define the optimal extent of resection for cancer of the cardia, we considered 116 patients operated upon with five different surgical techniques. The procedures were: transabdominal total gastrectomy associated with distal esophagectomy in 38 patients; transabdominal total gastrectomy and left thoracotomic esophageal resection at the inferior pulmonary vein level in 26 patients; transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level in 27 patients; transabdominal total gastrectomy and transhiatal lower third esophagectomy in 18 patients; transhiatal total esophagectomy and upper third gastrectomy with cervical esophago-gastroplasty in seven patients. Grading, staging, neoplastic lymphangitis, satellite intramural metastases, infiltration of the resection margin, site of recurrence, and survival were analyzed. N+ was the single independent prognostic factor for survival. A poorly differentiated grading was related to T (P = 0.0009), N (P = 0.001), satellite growth (P = 0.05), and infiltration of the resection margin (P = 0.0001). Recurrence was local in 26% and distant in 74% of patients. The modalities of recurrence were not related to the aggressiveness parameters and the surgical technique. Infiltration of the esophageal resection margin was related to the type of operation (P = 0.005) and survival (P = 0.02), but it was not related to the site of recurrence. Transabdominal total gastrectomy and the right thoracotomic esophageal resection procedure achieved free margins and control of the lymph nodal metastatic spread. Transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level provides a radical oncologic resection, particularly in poorly differentiated tumors. However, surgery alone cannot cure the majority of adenocarcinomas of the cardia.
Dis Esophagus 2001
PMID:Surgical therapy for adenocarcinoma of the cardia: modalities of recurrence and extension of resection. 1155 18

Esophageal cancer can metastasize to the lymph nodes at a very early stage of the disease, and spread occurs both upwards and downwards. We have developed the 'three-field lymphadenectomy' (3-FD) technique, in which more than 100 lymph nodes are completely dissected from the lower neck, mediastinum, and upper abdomen. More than 700 patients have undergone 3-FD since 1984. Three-field lymphadenectomy is associated with considerable morbidity, although efforts have been made to reduce this by preserving tracheobronchial circulation and innervation. The mortality associated with 3-FD is acceptable (5-year survival rate of 53.8% for patients treated with curative surgery). We believe that 3-FD is a suitable standard operation for the treatment of thoracic esophageal cancer. Further trials are now under way with the aim of improving the results of the technique and also extending the applications of limited surgery and non-surgical therapy.
Dis Esophagus 2001
PMID:Surgical treatment of esophageal cancer: Tokyo experience of the three-field technique. 1155 19

The distribution of lymph node metastases of adenocarcinomas of the gastroesophageal junction is classified into three types. The R0 resection with complete lymphadenectomy therefore requires different resection methods for type 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the extended gastrectomy, no advantage in survival can be seen for one method or one tumor type (type 1 or type 2/3). The same is true for the lethality. Indeed, the transhiatal resection is accompanied by a higher complication rate. However, the different operation methods for cardiacarcinomas, with subtotal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, should be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esophagectomy with gastric tube interposition. Therefore, we suggest a subtotal esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended gastrectomy with resection of the distal esophagus, lymphadenectomy of the lower mediastinum, and D2 lymphadenectomy should be performed.
Dis Esophagus 2001
PMID:Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction. 1155 20


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