Carcinoma Of Cardia Research Articles

Clinicopathologic studies of gastric carcinoma

We reviewed the clinical and pathologic experiences of gastric carcinoma cases seen in our department. Early diagnostics of the carcinomas were documented, especially in the cases of small gastric carcinoma, carcinoma of the gastric cardia, and in cases of young patients. The importance of lymphadenectomy in surgical treatment was emphasized as a cure for patients with gastric carcinoma. The surgical treatment and results for far advanced cases were also demonstrated. Several pathologic factors related to prognosis were shown; these included growth patterns, special gross or histologic types, stromal reactions, immunohistochemical studies, and others. We emphasize that a full understanding of the pathologic characteristics of gastric carcinoma is indispensable for providing adequate treatment.

Results of surgical treatment in 6,123 cases of carcinoma of the esophagus and gastric cardia.

Six thousand one hundred twenty-three cases of carcinoma of the esophagus and gastric cardia were treated surgically from 1965 to 1985. Overall resectability was 89.9%. Postoperative mortality was 3%, and incidence of postoperative complication, 10.3%. Follow-up rate was 91.3%, with 5 year survival of 36.8% (esophageal nearly twice that of gastric cardia), and 10 year survival of 17.2%. Factors affecting long-term survival were clinicopathologic staging and preoperative irradiation. Early discovery and timely treatment are the key to high resectability and improved long-term survival. More efficacious combined therapies are needed for the predominant late cases. We propose more radical resection because of the multifocal tendency of esophageal and extensive submucosal infiltration of cardia carcinoma. Continuing refinements of surgical technique helped to reduce postoperative leakage and structure.

Definition of carcinoma of the gastric cardia.

This study concerns the definition of carcinoma of the gastric cardia. The topography of the esophagogastric mucosal junction (mucosal EGJ) was investigated with an endoscope in 182 patients who were free of hiatal hernias, ulcers, and neoplasms in the esophagus and stomach. The relationship between the EGJ and the cardiac gland area was then examined histologically in 56 resected specimens containing intact EGJs and cardia gland areas. Furthermore the cancerous center was determined; the shortest distance between the cancerous center and the EGJ and the amount of esophageal invasion were measured in 102 resected carcinomas located close to the junction; the carcinomas contained the EGJ and were good enough for pathohistological examination. The EGJ was located 0.5 - 1.0 cm proximal to the His angle (the gastric cardia) in radiological and endoscopic examinations. Histologically the cardiac gland area was found to straddle the EGJ at a range of about 1 cm proximal and 2 cm distal to the junction. Among the upper stomach carcinomas, most of the tumors (87.5%) whose center was located within 2 cm from the EGJ invaded the esophagus. In conclusion, carcinoma of the gastric cardia is defined as a lesion with its center located within 1 cm proximal and 2 cm distal to the EGJ.

Difference in main lymphatic pathways from the lower esophagus and gastric cardia.

Lymphatic pathways draining the lower esophago-cardiac region were studied in 17 patients with carcinoma of the lower esophagus or gastric cardia, by measuring radioisotope uptakes in the regional lymph nodes. The uptakes were most remarkable in lower mediastinal and upper gastric lymph nodes, when the radioactive colloid was injected at the lower esophagus. A lesser degree of uptakes were observed both in other mediastinal and abdominal lymph nodes. On the contrary, a high degree of uptakes were detected only in abdominal lymph nodes, when the colloid was injected at the gastric cardia. The results indicated that main lymphatic pathways originating from the lower esophagus advance both upward and downward, and that those from the gastric cardia make their way downward to upper gastric, para-celiac and para-aortic lymph nodes. The actual incidences of lymph node metastases were also studied in 108 patients with carcinoma of the lower esophagus and 93 patients with carcinoma of the gastric cardia. In the former group, very high incidences were observed in lower esophageal and upper gastric lymph nodes. In the latter group, the incidence was most remarkable in upper gastric lymph nodes and far less significant in lower mediastinal lymph nodes. The results confirmed those of the radioisotope study. The importance of dissection of para-aortic lymph nodes near the left renal vein was also stressed.

Natural history of early esophageal squamous carcinoma and early adenocarcinoma of the gastric cardia in the People's Republic of China.

Ninety cases of early esophageal squamous carcinoma (EESC) and 27 patients with early adenocarcinoma of the gastric cardia (EAGC), who for various reasons refused surgical treatment, radiotherapy or chemotherapy, were followed up endoscopically and roentgenologically for 19 to 78 months. Of the 90 cases with EESC, 52 (58%) were still found to have superficial mucosal lesions, 8 cases progressed to an advanced stage, 27 died of cancer with an average survival time of 53.2 months, and 3 died of other non-malignant diseases. The estimated median survival time of EESC is about 75 months. Among 21 patients with EAGC, 8 (30%) were still presenting with superficial malignant changes, 6 cases progressed to advanced cancer, 11 died of carcinoma with an average survival time of 53.3 months, and 2 died of non-malignant diseases. The estimated median survival time of EAGC is about 73 months. The period for a carcinoma in situ of the esophagus and the gastric cardia to progress to an advanced stage appears to be 4-5 years.

Carcinoma of the gastric cardia: surgical management and long-term survival.

AbstractFrom 1964 to 1985, a total of 114 patients (94 men and 20 women) were operated on. The resectability rate was 71%, and 53% of the patients were thought potentially curable. Either abdominal or combined abdominal and thoracic approaches were preferred. Proximal esophagogastrectomy (54 cases) was performed in cases with wide esophageal extension and total gastrectomy (27 cases) was performed for tumors localized in the gastric cardia. There was intraoperative examination of the esophageal margin. There was lymph node involvement in 57% of cases and esophageal extension in 59%. Three patients died in the postoperative course, none after curative resection. There was 1 (1.2%) clinical anastomotic leak. The overall 5‐year survival rate was 18.5%. The actuarial 5‐year survival rate was 29±8% after resection and 40±7% after curative resection, and the 10‐year survival rate was 20±7 and 28±7, respectively. Symptom duration, age, or sex had no significant influence on prognosis. Lymph node involvement, tumor depth penetration, and esophageal extension were the main prognostic factors.

12 Palliation of obstructive oesophageal and cardial carcinomas with laser and endoluminal iridium radiation

The combination of laser with endoluminal 192-iridium radiation for the palliation of malignancies of the oesophagus and the cardia has been introduced to overcome the short-lived effect of laser treatment alone. Concluding from early experience, this method seems to prolong the effect of laser treatment alone, with a low risk of complications. However the initial optimistic results, claiming a permanent relief of dysphagia in 80% of the patients, cannot be reproduced under prospective conditions. The combination of laser and 192-iridium radiation with other palliative methods, such as external radiation and/or chemotherapy is feasible and remains to be studied in a comparative way.

Early carcinoma of the gastric cardia. A clinicopathologic study of 21 cases.

A clinicopathologic study was done on 21 cases of early carcinoma of the gastric cardia. The disease was preponderant in men, with a male-female ratio of 17:4. Five patients had no symptoms, while the other 16 had epigastric pain, epigastric discomfort, or other symptoms. Melena or hematemesis occurred in five patients. The first detection was made by barium study in 16 and by endoscopy in five. Detailed examinations using double-contrast radiography in both the prone right anterior oblique and supine left lateral projections were useful to detect the early carcinoma of the gastric cardia. All depressed-type carcinomas were incidentally detected during endoscopic examinations of benign peptic ulcers, therefore, whenever endoscopic examinations are being done for other entities, all the stomach including the cardia should be examined, carefully and continuously. Compared with early carcinomas of the other areas of the stomach, grossly elevated and histologically well-differentiated early carcinomas were more common in the gastric cardia. In the mucosa adjacent to the carcinoma, chronic gastritis was apparent in almost all cases, although intestinal metaplasia was found less frequently than in other areas of the stomach.

Carcinoma of the Gastric Cardia: Factors Influencing the Choice of Therapy and the Outcome of Different Treatment Modalities

Carcinoma of the gastric cardia is a cancer found with increasing frequency. Nevertheless, there are no clear strategies for the operative treatment of this cancer. In accordance with the long-term complications and postoperative quality of life we recommend abdominal gastrectomy for carcinomas of the gastric fundus involving the cardia without infiltration of the esophagus. Barett's carcinoma should be treated like esophageal cancer. The typical carcinoma of the cardia is best treated by abdominothoracal gastrectomy in younger patients, whereas in high-risk patients we prefer the abdominothoracal proximal resection.

Incidence rate of adenocarcinoma of the gastric cardia, and endoscopic classification of early cardial carcinoma in Henan Province, the People's Republic of China.

Mass surveys of 29,235 people in high-risk areas for esophageal carcinoma have been carried out, and 21,721 cases examined by gastroscopy were collected from 13 hospitals in high- and low-risk areas for esophageal carcinoma in Henan Province. During the mass surveys, it was found that the incidence rate of adenocarcinoma of the gastric cardia (AGC) was 0.19%, and the ratio of esophageal carcinoma (EC) to ACG was 3.28:1. The prevalence rate of AGC was 5.12% in the 8 hospitals in the high-risk areas for EC, in contrast to 3.57% (P less than 0.01) in the group in low-risk regions, showing that the incidence rate of AGC was also high in the populations living in the high-risk areas for EC. Most gastric cancers detected in both the high- and low-risk areas for EC have a predominantly proximal location, most being located in the gastric cardia. The endoscopic findings of 79 cases with early adenocarcinoma of the gastric cardia (EAGC) are described. It is suggested that EAGC could be divided into four types - congestive type, erosive type, plaque-like type and polypoid type.

APPLICATION OF THE PULLING-UP RETRACTOR AND AUTOSUTURE IN TRANSABDOMINAL SURGERY FOR CARCINOMA OF THE GASTRIC CARDIA

Recently, application of a pulling-up retractor (divised by Morioka) to a transabdominal approach has facilitated dissection of the lymph nodes in the lower mediastinum and diffuse removal of the esophagus. In addition, application of an EEA type autosuture has made intramediastinal anastomosis at the middle or inferior esophagus possible. At present, this procedure is commonly undertaken as the curative operation for carcinoma of the gastric cardia with esophageal invasion of less than 3cm. Out of 41 operations for carcinoma of the gastric cardia over the last three years, 36 were transabdominal procedures and the others were transthoracic ones. EEA was used in 22 of these 36 cases. Anastomotic insufficiency occurred in 7.1% of the sutured group, while none in the EEA or transabdominal group suffered from this complication. Pulmonary complications were noted in 7.1% of the sutured group, 13.6% of the EEA group and 20.0% of the transabdominal group. We concluded that application of the pulling-up retractor and autosuture in transabdominal surgery is very useful for carcinoma of gastric cardia with esophageal invasion because this makes it possible to dissect the lymph nodes of the lower mediastinum and remove the esophagus sufficiently.

Endoscopic findings in patients with ulcer-like dyspepsia.

One hundred and sixty-seven patients in a single general practice who presented with ulcer-like dyspepsia were offered an upper gastrointestinal fibre endoscopy. Twenty-two patients had a peptic ulcer while only three had a gastric ulcer. One patient had a carcinoma of the cardia, one an adenocarcinoma in the body of the stomach and one a carcinoma at the ampulla of Vater. In another 55 patients the main findings at endoscopy were edema/reddening or erosions in the antral or duodenal mucosa. Endoscopic findings were normal in 46 patients. Malignancies were found only in patients over 50 years of age and only 4 ulcers were seen in patients under 40. The clinical findings of presence of night pain, pain relief after food intake and history of peptic ulcer were more common in patients with an existing peptic ulcer than in those with a normal endoscopy.

Surgical treatment for carcinoma of the gastric cardia: a modified proximal esophagogastrectomy.

Proximal esophagogastrectomy saving only the distal half of the greater curvature of the stomach was retrospectively evaluated in 91 consecutive patients with resectable carcinoma of the gastric cardia. Division of the right gastric artery at its beginning provided a free nodal margin if N1 diffusion was observed. Operative mortality was 6.5% and fatal leak rate 3.8%. Survival without dysphagia occurred in all but stage I tumors; for larger tumors recurrence and reflux esophagitis were not able to produce dysphagia because distant metastases were faster to kill the patients. Five-year survival was 0% for stage IV (i.e. incomplete macroscopic resection), 8% for stage III, 12% for stage II and 53% for stage I. Local recurrence occurred only at esophageal anastomosis and for every stage, whereas regional recurrence occurred only for tumors with nodal diffusion. The results of this study are not suitable for a comparison with total esophagogastrectomy by inductive logic, nevertheless deductive arguments are possible if patterns of recurrence are considered. The possibility of regional recurrence for N1 and not for N0 tumors means that the volume of nodal resection has diagnostic specificity for N0 but not for N1 tumors. If N2 nodal diffusion is really a sistemic disease, as indicated by current reports, than greater nodal resection by total esophagogastrectomy can only improve the diagnostic specificity of N1 assessment but not survival.

Computed tomography in carcinoma of esophagus and cardia.

CT scanning was performed on 36 patients with carcinoma of the esophagus or cardia. In a retrospective study, staging of esophageal malignancy, obtained by CT, was correlated with clinical data as well as endoscopic, bronchoscopic, operative, and/or autopsy findings. The results indicated that CT is a useful method for pretherapeutic staging in carcinoma of the esophagus and cardia and should be routinely performed in conjunction with conventional x-ray examination and esophagoscopy. The use of mediastinoscopy and diagnostic surgical procedures such as exploratory thoracotomy and laparotomy can be reduced.

Infusional chemotherapy and cyclic radiation therapy in inoperable esophageal and gastric cardia carcinoma.

Infusional chemotherapy and cyclic radiation therapy in inoperable esophageal and gastric cardia carcinoma.

Surgical Treatment of Carcinoma of trie Esophagus and Cardia Among the Chinese

Clinical data on 1,450 patients with epidermoid carcinoma of the esophagus and 727 with adenocarcinoma of the cardia (seen from 1952 to 1980) are presented, with the results of surgical treatment in 387 epidermoid carcinomas and 164 adenocarcinomas. The rates of resectability, postoperative complications, and surgical mortality were 44.3%, 28.5%, and 5.1% in epidermoid carcinoma and 39.6%, 17.4%, and 5.9% in adenocarcinoma, respectively. Five-year survival after resection was 11.9% in epidermoid carcinoma and 6.7% in adenocarcinoma. The operative procedure is described. According to our experience, extensive resection of the esophagus followed by reconstruction of the alimentary tract with esophagoileocoloplasty or esophago-gastrostomy retrosternally for the epidermoid carcinoma appears to be the treatment of choice. For adenocarcinoma of the cardia, resection of the tumor and esophagogastrostomy or esophagojejunostomy, can be done transthoracically if the esophageal involvement is not high. In any case, early diagnosis and early treatment are the only ways to improve the present results.

Carcinoma of the gastric cardia in young people.

Carcinoma of the gastric cardia is usually considered a disease of middle-aged or elderly patients and is rarely suspected in young individuals. However, six cases are reported in patients under 45 years of age. The youngest was 26. A review of patient records revealed no obvious predisposing factor to account for the development of cancer at an early age. In four cases, double-contrast upper gastrointestinal examinations revealed a polypoid mass at the cardia. In two cases, however, the true origin of a tumor arising at the cardia was only recognized by obliteration of the normal anatomic landmarks at the cardia associated with irregular areas of ulceration. In all six cases, the tumor extended into the distal esophagus. Five patients presented with dysphagia. Careful radiographic evaluation of the cardia and fundus is therefore essential to rule out an underlying carcinoma of the cardia in all patients with dysphagia, regardless of age.

Extented esophago-gastretomy as surgical treatment for carcinoma of the cardia.

With the object of designing a feasible and more radical surgical intervention for the treatment of carcinoma of the gastric cardia and improving the long term survival of these patients, a procedure was described which entails total esophagogastrectomy and resection of the distal pancreas, spleen and regional lymphnodes. The esophagus was mobilized via the diaphragmatic hiatus without thoracotomy. Intestinal continuity, installed isoperistaltically was restituted in the same operation using a segment of transverse and descending colon transferred to the left lateral cervical aspect by way of the posterior mediastinum. The procedure was used in four patients and mortality and serious complications were nil.

Collision carcinoma of the gastric cardia

A case of squamous cell carcinoma of the lower end of the esophagus colliding with adenocarcinoma of the cardiac end of the stomach is reported. The rarity of the lesion, its diagnostic criteria, and therapeutic implications are briefly discussed.

Prognosis of cardia carcinoma

Based on a material of 223 patients treated for cardia carcinoma the surgical problems and the results after palliative, radical and enlarged resection are discussed. In the early stage without nodular involvement (I) in 72% of the radically operated patients a 5-years and 10-years cure could be obtained, in relation to all patients observed the success, however, is only 10% for 5-years and 8% for 10-years cure. This is caused by the fact that stage I was found in only 10% of the patients admitted to our hospital. The need for a close observation programm for clearly defined high risk groups must be pointed out and the possibilities of a special postoperative adjunct therapy should be fully used.