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Query: UMLS:C0546837 (esophageal cancer)
 8,907 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

CT is readily available to all patients. It is relatively inexpensive and fees are usually reimbursed. It provides exquisite anatomic detail of the chest and abdomen in patients with esophageal cancer. The only reliable use of CT in the determination of T is the exclusion of T4 tumors, which is suggested by the preservation of fat planes. Enlarged lymph nodes are suspicious for metastatic disease but require further study or tissue sampling if nodal metastases will determine treatment. Its major use is in the detection of distant metastatic disease; however, 30% to 60% of distant metastases may be radiographically occult. There is a significant learning curve for EUS staging of esophageal cancer. It is suggested that this study be performed at institutions where there is a dedicated, experienced endoscopic ultrasonographer with adequate instrumentation that allows specialty imaging and EUS-FNA. EUS is the best means of clinically determining T. The addition of EUS-FNA to routine EUS evaluation of lymph nodes allows an accuracy similar to the EUS determination of T. EUS has no purpose in assessment of non-nodal distant metastatic disease; however, the serendipitous finding of distant metastases in adjacent structures visualized during the evaluation of the primary tumor and lymph nodes has, on occasion, detected M1b disease. FDG-PET represents an advance over CT scanning in the screening for distant metastases. The major problems with FDG-PET staging of esophageal cancer is failure to detect metastatic deposits less than 1 cm in diameter and lack of anatomic definition. It is unable to determine T and has been inaccurate in the detection of lymph node metastases. Because this test is not readily available, is expensive, and is not routinely reimbursed, its use in staging esophageal cancer continues to be limited. Today, CT and EUS are the mainstays in the clinical staging of esophageal carcinoma. When possible, FDG-PET should be added to CT to improve the evaluation of non-nodal M1b disease. Results of these studies should determine the necessity for invasive staging techniques and direct their use.
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PMID:Clinical staging of esophageal carcinoma. CT, EUS, and PET. 1096 51

Despite numerous phase-II and phase-III studies investigating neoadjuvant treatment in esophageal and gastric cancer, the value of multimodal therapy in these tumors is not clearly defined yet. One reason are the different study entry criteria and different staging modalities in the investigations published so far. Concerning esophageal cancer, neoadjuvant chemotherapy does not yet have a definite role after several phase-III studies. It may be that this treatment should only be inaugurated in innovative protocols. Furthermore, in esophageal cancer it is proven that chemoradiation is superior to radiation alone in the neoadjuvant setting. Following neoadjuvant chemoradiation, there is a distinct trend in favor of multimodal therapy. In the case of locally advanced squamous cell carcinoma of the esophagus, neoadjuvant chemoradiation offers 30%-60% of the patients the possibility for a complete resection (UICC-R0); however, this is accompanied by increased postoperative morbidity and mortality. In gastric cancer, neoadjuvant chemotherapy is still an experimental approach. Intraperitoneal chemotherapy has failed to show any benefit in Western trials. Clinically related research is concentrating on the problem of distinguishing responder from non-responder at the beginning of the therapy. First results indicate that with molecular markers, response might be predicted before therapy. Using 18-FDG PET, it could be possible that the response can be recognized after only 1 week of treatment, opening the door to early response evaluation. New therapeutics like monoclonal antibodies for adjuvant therapy, which is again under discussion in gastric cancer, are only in phase-I studies.
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PMID:[New therapy approaches in tumors of the upper gastrointestinal tract (esophagus, stomach)]. 1119 63

The role of preoperative chemotherapy for esophageal cancer still remains controversial. Only one study of the recently published, randomized controlled trials in potentially resectable esophageal cancer has shown improvement in survival by preoperative chemotherapy compared to surgery alone. Nevertheless, there has been a consistent observation that in patients who respond to preoperative therapy survival was significantly prolonged. Therefore, a diagnostic test that allows prediction of response is considered to be crucial for the future use of preoperative chemotherapy in patients with esophageal cancer. Molecular markers for response prediction and reliable non-invasive techniques such as FDG-PET are not yet established. At the moment therefore responder should undergo esophagectomy for definitive curative treatment, whereas non-responder may undergo individualized salvage therapy.
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PMID:[Multimodality therapy concepts in esophageal carcinoma]. 1182 82

Fluorodeoxyglucose positron emission tomography (FDG-PET) is more accurate than computed tomography (CT) for evaluating lymph node metastases and for N staging, but less accurate than combined CT and endoscopic ultrasonography (EUS). Lymph nodes located adjacent to the primary lesion tend to be false negatives. We consider that combined FDG-PET and EUS is the most accurate for the detection of lymph node metastasis in esophageal cancer. FDG-PET is also more accurate than CT for detecting distant metastases and improves the detection of stage IV disease compared with the conventional staging modalities. For the diagnosis of recurrence except for perianastomotic recurrence, FDG-PET provides additional information and is more sensitive than conventional work-ups. FDGPET is a valuable tool for the noninvasive assessment of tumor response after neoadjuvant therapy. 11C-methionine (MET) is another tracer for PET that can be used to assess the metabolism of amino acids, since MET accumulates in esophageal malignant tumors. Choline-PET is more accurate than FDG-PET for the detection of mediastinal lymph node metastases.
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PMID:[Diagnosis of esophageal cancer using positron emission tomography]. 1199 19

During the past decade the clinical value of PET imaging has been investigated for many different tumors. As knowledge of the advantages and limitations of this modality increased, PET has gained acceptance in tumor imaging. (18)F-FDG PET is now successfully used and approved for procedure reimbursement in many types of cancer-for example, lung cancer, melanoma, lymphoma, head and neck tumors, brain tumors, esophageal cancer, and colorectal cancer. In osteosarcoma, the introduction of neoadjuvant chemotherapy has dramatically improved survival rates, thus changing the demands for state-of-the-art imaging to provide detailed information on tumor staging and grading, evaluating treatment, and detecting recurrences. In this review, the available literature on PET imaging in osteosarcoma patients is critically summarized with respect to diagnosis, staging, therapy monitoring, and follow-up focusing on the clinically used tracers (18)F-FDG and (18)F-fluoride ion. Potential and probable indications are outlined. Because of the relatively small number of patients enrolled in clinical trials published to date, further research needs to be done in larger, prospective patient series to determine the full utility of PET in osteosarcoma.
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PMID:PET imaging of osteosarcoma. 1529 71

Accurate preoperative staging is essential for the indication and selection of the appropriate surgical procedure in patients with esophageal cancer. The present prospective study was designed to determine if the preoperative use of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) increases the accuracy of staging esophageal cancer compared with computed tomography (CT) and if it thereby leads to a different therapeutic approach. A total of 58 patients, 46 men and 12 women (mean age 61 years), with histologic proof of esophageal carcinoma underwent FDG-PET of the neck, chest, and abdomen, as well as CT of the chest and abdomen, to determine tumor stage. FDG-PET and CT data were compared with each other and with pathohistologic findings. Sensitivity, specificity, and overall accuracy for detecting histologically verified lymph node and distant metastases were calculated for FDG-PET and CT. FDG-PET showed a higher specificity, whereas CT had higher accuracy for detecting both abdominal (73% vs. 59%) and thoracic (73% vs. 63%) lymph node metastases. The accuracy of detecting blood-borne and lymphatic distant metastases was identical for CT and FDG-PET imaging (50%). FDG-PET had a higher specificity than CT (87% vs. 13%) but lower sensitivity (35% vs. 67%). FDG-PET did not provide new information on the indication for surgery, nor was it helpful for choosing the appropriate surgical procedure in patients with esophageal carcinoma. In view of the relatively high cost of FDG-PET examinations, the use of this modality is indicated primarily in patients with inconclusive CT findings or for scientific research projects. Higher sensitivity as a result of tumor-affinity radiopharmaceuticals and optimized apparatus resolution, in addition to the advantages offered by whole-body PET scanning, may lead to new indications for this staging procedure in the future.
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PMID:Positron emission tomography for staging esophageal cancer: does it lead to a different therapeutic approach? 1291 69

The incidence of esophageal adenocarcinoma has increased dramatically in Western societies over the last 20 years. Most patients present with advanced disease. Stage-dependent treatment protocols require the most complete and accurate staging possible. With all esophageal cancers (ie, adenocarcinomas and squamous carcinomas), it is perhaps most important to identify patients who are unlikely to benefit from aggressive treatment. The performance characteristics and clinical utility of CT scanning, endoscopic ultrasound, FDG-PET, and minimally invasive surgery in staging esophageal cancer are reviewed, including issues relating specifically to staging of adenocarcinomas. These investigations are not mutually exclusive and each has its own strengths and shortcomings. Accurate staging often requires the use of multiple modalities. The optimal staging algorithm for a given practice setting (if it exists) will be determined largely by local variables that include patient population, available technology, and local expertise in applying such technology. A lack of consensus on the effectiveness of therapeutic alternatives (particularly surgical v nonsurgical methods) may also affect the perceived value of the various staging modalities and how they are used.
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PMID:Staging esophageal adenocarcinoma. 1465 14

Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.
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PMID:Positron emission tomography imaging in evaluation of cancer patients. 1471 12

The purpose of this study was to clarify the normal gastric FDG uptake pattern to provide basic information to make an accurate diagnosis of gastric lesions by FDG PET. We examined 22 cases, including 9 of malignant lymphoma, 8 of lung cancer, 2 of esophageal cancer, and 3 of other malignancies. No gastric lesions were observed in any of the 22 cases on upper gastrointestinal examinations using either barium meal or endoscopic techniques. The intervals between FDG PET and the gastrointestinal examination were within one week in all cases. The stomach regions were classified into the following three areas: U (upper)-area, M (middle)-area, and L (lower)-area. The degree of FDG uptake in these three gastric regions was qualitatively evaluated by visual grading into 4 degrees, and then a semiquantitative evaluation was carried out using the standardized uptake value (SUV). Based on a visual grading evaluation, the mean FDG uptake score in the U-, M-, and L-areas was 1.14 +/- 0.96, 0.82 +/- 0.96, and 0.36 +/- 0.49 (mean +/- S.D.), respectively. The FDG uptake scores obtained in the three areas were significantly different (Friedman test, p < 0.05). Furthermore, the rank order of the FDG uptake score in each case (U > or = M > or = L) was found to be statistically significant (Cochran-Armitage trend test, p < 0.05). The mean SUVs of 11 cases in the three areas were 2.38 +/- 1.03, 1.91 +/- 0.71, and 1.34 +/- 0.44 (mean +/- S.D.), respectively. The SUV in the U-area was significantly higher than that in the L-area (Friedman test, p < 0.05). A significant difference in FDG uptake was observed among the three gastric areas, and the FDG uptake extent in all cases was U > M > L. In conclusion, the physiological gastric FDG uptake was significantly higher at the oral end. A stronger gastric FDG uptake at the anal end may therefore be suggestive of a pathological uptake.
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PMID:An analysis of the physiological FDG uptake pattern in the stomach. 1497 21

The three major aims of imaging in esophageal and gastric cancer are to distinguish between locoregional and systemic disease (M stage), to determine local tumor extension (T and N stages), and to assess response to chemotherapy or chemoradiotherapy. Depending on the applied standard of reference, the sensitivity of computed tomography (CT) for detection of distant metastases ranges between less than 50% to greater than 90%. In esophageal cancer, positron emission tomography with the glucose analog fluorodeoxyglucose (FDG-PET) has been shown to detect metastatic disease in approximately 20% of the patients who were considered to have only locoregional disease with CT. In clinical studies, endoscopic ultrasound (EUS) has been shown to differentiate between tumor stages T1/T2 and stages T3/T4 with an accuracy of more than 90%. Accuracy of EUS for differentiating individual tumor stages in routine clinical use has been reported to be markedly lower. Assessment of tumor response by FDG-PET has been shown to correlate with histopathologic tumor regression and patient survival. Furthermore, quantitative measurements of tumor FDG uptake may predict histopathologic tumor response and patient outcome as early as 2 weeks after initiation of preoperative chemotherapy.
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PMID:Imaging of esophageal and gastric cancer. 1529 44


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