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

Preoperative staging in esophageal cancer is usually done by noninvasive tests. Currently, in the staging of lung cancer, when lymph nodes are identified preoperatively by CT or MRI to be greater than 1 cm, surgical staging using mediastinoscopy, Chamberlain procedures, or thoracoscopy are employed. We describe herein the use of thoracoscopy in routine preoperative staging of esophageal cancer. With the advent of newer laparoscopic techniques currently available, thoracoscopy plays an increasing role in the management of intrathoracic disease. Staging thoracoscopy as a routine preoperative invasive staging test appears to be a good diagnostic test.
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PMID:Thoracoscopic lymph node dissection in the staging of esophageal carcinoma. 159 80

Endoscopic ultrasonography (EUS), performed by means of an endoscope equipped with an ultrasound transducer, has been used in the imaging, staging, and follow-up of esophageal cancer for a decade. Although at first considered as a more or less experimental procedure, it emerged in the last six years as a valuable and precise tool for the assessment of various upper GI disorders. It is now well established that EUS can provide more accurate staging information on upper GI pathology than other imaging techniques such as conventional radiology, conventional ultrasound, CT, MRI and endoscopy. However, it remains complementary to other imaging methods, and is not suited for routine screening purposes. The instrumentation, technique, limitations, pitfalls, accuracy, and possible future of EUS are discussed, particularly concerning esophageal cancer.
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PMID:Endoscopic ultrasonography and esophageal cancer. 179

In 104 patients with esophageal cancers, magnetic resonance (MR) imaging was performed to detect the invasion to aorta and tracheobronchial tree. Relatively short TR images (TR 300 or 40 msec) were best for depiction of esophageal cancers and neighboring structures. The detectability of esophageal cancer was 0% in cases of muscularis mucosa invasion, 50% in cases of submucosa invasion, and 75% in cases of muscularis propria invasion. In more invaded cases, all cases were detectable. Aortic invasion was evaluated according to the extent of contact and its consecutiveness between the esophagus and aorta; if contact more than 1/4 circumference was seen more than three contiguous slices, aortic invasion was diagnosed as positive. The accuracy rate of this criterion was 96.6%. Tracheobronchial invasion was evaluated according to the deformities of the trachea and bronchi by contiguous cancers those were classified into four types. It was determined that convex type (Type I) and flat type (Type II) were negative and concave type (Type III) and displaced type (Type IV) were positive. The accuracy rates of this criteria were 95% in the trachea and 87.7% in the bronchi. MRI is useful for the detecting of local invasion of esophageal cancer.
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PMID:[Magnetic resonance (MR) imaging for the detection of the invasion into neighboring structures in esophageal cancers]. 188 68

The usefulness of MRI (magnetic resonance imaging) was evaluated in the diagnosis of the mediastinal invasion of esophageal cancer. MR examination was performed in 30 subjects without esophageal diseases and 23 patients with esophageal cancer. Normal esophagi and cancers were well visualized using T1-weighted image. In the axial section, every normal esophagus was contact to the aorta in the angle of less than 30 degree of the aortic circle. When the contact angle was less than 30 degrees, the stage of the cancer was below a1. When the angle was 30 degrees or greater, the stages were ranged from a0 to a3. In the oblique section orthogonal to the contact plain between the cancer and the aorta, the depth of the aortic invasion could be estimated. The sagittal scan was also helpful in the diagnosis of the invasion to trachea, left main bronchus and left atrium.
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PMID:[Evaluation of MRI for the staging of esophageal cancer]. 232 73

Although there are no differences worth mentioning between esophageal cancer in Japan and in Europe regarding epidemiology, tumor stages at the beginning of therapy and surgical selection. In Japan, early esophageal squamous cell carcinoma is more often diagnosed than in Europe where esophageal adenocarcinoma, especially that of the endobrachyesophagus, is becoming more and more relevant. For a long time, the limiting factor for the prognosis of esophageal cancer was the postoperative lethality. However, by carefully analysing the factors influencing this operative lethality over the last few years, the lethality following esophagectomy has been decreased to approximately 15 per cent. In fact, in some specialized centers, the lethality is now less than 10 per cent and in selected patient groups even 3 per cent has been reached. It is only through this achievement that the prognosis for esophageal cancer has been able to be markedly improved. The results of this analysis can be detailed as follows: 1) The preoperative definition of tumor stage by CT or MRI is not reliable, the validity being between 45 per cent and 73 per cent. Therefore, no therapeutical decision can be made on the basis of these diagnostic procedures. Hopefully the intraluminal ultrasound will improve this situation in the future. 2) The analysis of preoperative nutritional status did not allow a definition of risk groups. 3) Decisive improvements were able to be achieved by the standardising of surgical procedures and indications. Enbloc resection is indicated for all intrathoracic squamous cell carcinomas and accounts for a high percentage of RO-resections. The blunt dissection is especially appropriate for distal adenocarcinomas. 4) Endobronchial one-sided ventilation during the operation and prophylatic assisted ventilation have both decreased the pulmonary risk considerably. A further improvement in the prognosis of esophageal carcinoma can possibly be achieved by the preoperative identification of advanced tumors (T3/T4) and preoperatively treating these tumor types accordingly. From our own experience, we believe combined radio-chemotherapy could be successful.
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PMID:Esophageal cancer from the German point of view. 265 62

Esophageal carcinoma is a highly lethal disease with a dismal prognosis. Essential elements in the diagnosis of esophageal cancer are: a high index of suspicion; adequate knowledge of the precancerous conditions; optimal radiological examination; expert endoscopy with multiple biopsies and/or cytology; final staging including endoscopic ultrasonography, CT scan, MRI and, whenever appropriate, laryngo-bronchoscopy and ultrasonography with cytological puncture of cervical lymph nodes. This overview mainly concentrates on X-ray, endoscopy, endosonography and CT scanning. At present the routine use of MRI for preoperative staging cannot be recommended.
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PMID:Modern diagnostic evaluation and preoperative staging of esophageal cancer. 851 41

Esophageal cancer is frequently found when it is already in the advanced stage and curative surgery for such cases is consequently difficult to perform. The new multi-disciplinary treatment for esophageal cancer presented here was, therefore, conceived to improve both the survival rate and quality of life of these patients. This combined treatment modality consists of limited surgery, external irradiation, intracavitary irradiation with remote-controlled after-loading system (RALS) and peri-operative chemotherapy. In the present series, 45 patients with esophageal cancer received esophagectomy and on another 11 patients bypass operation was performed. All patients were treated with this multi-disciplinary treatment after operation. A 3 cm-wide thin gastric tube was made from the greater curvature of the stomach of the patient using an autosuture apparatus (PLC55 or GIA). In the bypass operation, the jejunum was anastomosed to the original esophagus in the Roux-en Y fashion and jejunostomy was performed on the oral side of the Roux loop. A silastic tube of 9 mm inner diameter was inserted from the jejunostomy and placed into the original esophagus for the purpose of postoperative intracavitary irradiation with RALS. For the patients receiving esophagectomy, a similar silastic tube was also placed in the posterior mediastinum for intracavitary irradiation with RALS. The indication of the bypass operation was i) a tumor length longer than 9 cm on the X-ray film and/or ii) direct invasion to the aortic wall evident by CT or MRI examination. Two weeks after the operation, external irradiation to the mediastinum with Linac 10 MV X-ray, and to the bilateral cervical regions with Linac 15 MeV electron beam, was started. The irradiation doses were 30 Gy (2 Gy/day, 5 times/ week) and 48 Gy (4 Gy/day, 3 times/week), respectively. The intracavitary irradiation with RALS was started shortly before the end of the external irradiation period and was delivered from a 60Co source. The total dose was 24 Gy (6 Gy/day, once a week) for the esophagectomized cases, and 18 Gy for the bypassed cases. Two or three weeks after the termination of the radiotherapy, chemotherapy with cisplatinum and 5-fluorouracil was performed and repeated every 6 months for 2 years. All patients could eat normally and were discharged after finishing the first chemotherapy session. The overall 5-year survival rate was 49% for the esophagectomized cases and 11% for the bypassed cases. The longest survival time in the bypassed cases was 5 years and 4 months. Neither operative death nor severe complications were experienced during the treatment period. The results indicate that this newly developed multi-disciplinary treatment with RALS can improve the prognosis and the quality of life not only in the esophagectomized patients but also in the bypassed patients with advanced esophageal cancer.
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PMID:New multi-disciplinary treatment modality with RALS for patients with esophageal cancer. 968 27

Imaging by MR (MRI) and esophageal barium meal of 17 cases of hypopharyngeal and cervical esophageal cancer were analyzed. The results indicate that esophageal barium meal can not demonstrate the invading of neoplasms to the adjacent structure. Therefore, it is difficult to use the only data of esophageal barium meal for TNM staging. The results also indicate that MRI is more useful and reliable in assessing the three dimensional structure and the neoplasms invading to the adjacent structure. This results suggest that MRI is that useful in determining the diagnosis, TNM staging and the determining the appropriate operative therapy for hypopharyngeal and cervical esophageal cancer.
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PMID:[Magnetic resonance imaging of hypopharyngeal and cervical esophageal cancer]. 1118 43

We report an 80-year-old man with vascular parkinsonism whose frozen gait was transiently worsened by a cerebellar infarction. Four months before his first admission, he was diagnosed with gastric and esophageal cancer at another hospital, where he had a partial remission by radiotherapy. Two weeks before admission, left hemiparesis due to a lacunar infarction appeared, and he was transferred to our hospital for rehabilitation. Upon admission, he had minimum left hemiparesis and mild frozen gait caused by multiple cerebral infarctions. His condition was improved by physical therapy, and he became ambulatory. Two months later, however, he suddenly became unable to walk and was readmitted. Neurological examination revealed severe frozen gait without other changes. An MRI scan revealed a small new infarction in the left cerebellum between the lateral and the medial superior cerebellar artery area. By supportive therapy, his gait disturbance was gradually resolved except for a slightly short step. Frozen gait is considered a sign of dysfunction of the frontal lobe or nigro-striate system. It is regarded as a component of vascular parkinsonism. Some vascular parkinsonism patients are known to show wide-based gait and some cerebellar signs. It was presumed that our patient's frozen gait might have been exacerbated by impaired equilibrium resulting from the border zone cerebellar infarction.
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PMID:[Transient exacerbation of frozen gait by a border zone cerebellar infarction in a patient with vascular parkinsonism: a case report]. 1216

Although the possible existence of micrometastasis in superficial esophageal cancer cases is the most important factor in deciding the therapeutic strategy, it is difficult. There are also limits to the diagnosis of the depth of tumor invasion by endoscopy and EUS. Therefore, the extension of the indication of EMR is planned. Then, the complement of diagnostic ability by EMR is being tried. Sentinel lymph node (s) identification and its biopsy also seem to be useful. In advanced esophageal cancer cases, diagnostic accuracy has been improving by speedup of CT and MRI scans and various image processing technology. More accurate diagnosis of metastasis using PET is much awaited. However, there is still insufficient ability to detect micrometastasis to date. Molecular bio-markers with comprehensiveness are not a valuable selection at this stage. Although advanced equipment has brought more diagnostic accuracy, ways to integrate or use these tools at the clinical level are sought. Some equipment developing and how to integrate them and how to select the appropriate examination in each patient are problems which are required in clinical practitioners.
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PMID:[Progress of diagnosis for esophageal cancer]. 1289 2


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