Carcinoma Of Gastric Cardia Research Articles

Increased incidence of adenocarcinomas at the gastro-oesophageal junction in Dutch males since the 1990s.

Worldwide population-based studies suggest that the incidence of oesophageal and gastric cardia adenocarcinomas has increased since the 1970s. We studied time trends in mortality and incidence rates of oesophageal and gastric carcinomas according to subsite and histology in the south-east Netherlands since 1978. The age-adjusted mortality and incidence rates for oesophageal cancer doubled in males over the entire 19-year study period from 2.7 to 5.6 and from 2.4 to 4.8 per 100,000 person years, respectively. In females, a similar trend for the mortality and incidence rates was seen, but at a lower level. The age-adjusted mortality and incidence rates for gastric cancer decreased with time from 20.7 to 12.8 and from 21.6 to 15.9 per 100,000 person years in males, respectively. In females, age-adjusted mortality and incidence rates for gastric cancer also decreased. Analysis of incidence rates by subsite and subtype showed an increase in adenocarcinomas of the oesophagus and gastric cardia, largely restricted to males. In females, the rise in incidence of squamous cell carcinoma of the oesophagus appeared to be more marked than the rise in adenocarcinomas, whereas the incidence of gastric cardia carcinomas has remained stable over the last 10 years. Neither the decrease in the number of unspecified tumours with time, nor the increase in the use of diagnostic endoscopy and imaging techniques, is likely to explain completely the observed increases. The increase in incidence of adenocarcinomas at the gastro-oesophageal junction in the south-eastern Netherlands seems, at least in part, to represent a true underlying increase that is restricted largely to males.

Unchanging trend of adenocarcinoma of the esophagus and gastric cardia in Taiwan: a 15-year experience in a single center.

Chronic gastroesophageal reflux disease is closely associated with esophageal adenocarcinoma and gastric cardia carcinoma, and esophageal adenocarcinoma and gastric cardia carcinoma have both been increasing in Western countries recently. Gastroesophageal reflux disease is not rare in Taiwan, but the frequency of occurrence of esophageal adenocarcinoma or gastric cardia carcinoma has not been studied here to date. Patients diagnosed with esophageal and gastric cancers at this hospital between 1981 and 1995 were recruited using the hospital tumor registry database. There were 45, 1546, 970, and 4167 patients diagnosed with esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cardia carcinoma, and gastric noncardia adenocarcinoma, respectively. The ratios of esophageal adenocarcinoma versus esophageal squamous cell carcinoma among the three cohorts were 0.030, 0.016, and 0.041, respectively (trend, P = 0.086). The corresponding values for gastric cardia carcinoma versus gastric noncardia adenocarcinoma were 0.252, 0.232, and 0.218, respectively (trend, P = 0.256). The ratios of esophageal adenocarcinoma versus esophageal squamous cell carcinoma and of gastric cardia carcinoma versus gastric noncardia adenocarcinoma have not risen in the three cohorts. Unlike the situation in Western countries, the incidence of esophageal adenocarcinoma and gastric cardia carcinoma versus esophageal squamous cell carcinoma and gastric noncardia adenocarcinoma have not increased over the past 15 years among the Chinese in Taiwan. Although gastroesophageal reflux disease is common here, its definite pathogenesis leading to esophageal adenocarcinoma or gastric cardia carcinoma remains unresolved.

Tumor suppressor gene p16 and Rb expression in gastric cardia precancerous lesions from subjects at a high incidence area in northern China.

To further understand the molecular basis for gastric cardia carcinogenesis and to provide etiological clues. Endoscopic mucosa biopsy and histopathological examinations were made on 37 subjects from a high incidence area for both esophageal and gastric cardia carcinomas in northern China. All the biopsy samples were fixed in 850 ml. (-1)L alcohol and embedded in paraffin. Each block contained one piece of tissue and was serially section at 5 microm. Immunohistochemistry (ABC) was carried out on these gastric cardia samples to determine the alterations of p16 and Rb. Based on the histopathlogical examination there were 11 cases of chronic superficial gastritis, 12 cases of chronic atrophic gastritis and 14 cases of dysplasia. The immunostaining demonstrated different levels of unclear immunostaining of p16 and Rb in normal gastric cardia tissue and the tissues with different severity of lesions. With the lesions progressing, the positive immunostaining rates for p16 protein had a decreasing tendency. In contrast, the positive immunostaining rate for Rb protein had an increasing tendency. There was a significant negative relationship between the two parameters. Changes of p16 was CSG 11(100%), CAG 7(58%), DYS 4(29%) and changes of Rb was CSG 2(18%), CAG 8(67%) and DYS 12(86%), (P<0.05). The alterations of p16 and Rb protein may play a role in the early stages of gastric cardia carcinogenesis.

Rising incidence of esophageal adenocarcinoma in Western countries: is it possible to identify a population at risk?

Symptomatic gastroesophageal reflux disease (GERD) and Barrett's mucosa are risk factors for esophageal adenocarcinoma (ADC). The aim of this study was to analyze the anthropometric features and prevalence of GERD in patients with ADC compared with patients with squamous cell carcinoma (SCC) and control subjects. A total of 262 patients with ADC and 302 with SCC were enrolled consecutively. A control group of 262 individuals, sex and age matched to the ADC group, and an additional group of 138 patients with GERD confirmed by 24-h pH monitoring were used for comparison. The prevalence of symptomatic GERD was 32.4% in the subgroup of patients with Barrett's ADC (male-female=6.4:1; mean age=62 years) vs. 8% in those with gastric cardia carcinoma (P< 0.01), 3% in the SCC group (P< 0.01), and 10% in the control group (P< 0.01). ADC patients, controls and refluxers had similar body mass index (BMI) that was significantly higher than in the SCC group (P< 0.05). Whether surveillance endoscopy is indicated in men over 50 years with a long-lasting history of GERD and a BMI >25 remains to be determined.

Relationship between anal occult blood and hepatobiliary pancreatic carcinoma screening.

Cotton swab anal smear instead of stool occult blood test can not only be used as a mass screening method for colorectal cancer, but is an auxiliary way to screen hepatobiliary pancreatic carcinoma. Two hundred and twenty-three cases of hepatobiliary pancreatic carcinoma patients received anal occult blood test, of which 121 were positive (54.3%). The screening test was performed in 14,645 healthy people aged 40-60 years; 511 persons (3.4%) were positive for anal blood. Among these, six cases of digestive tract cancer were found (one oesophageal carcinoma, one gastric cardia carcinoma, two gastric carcinomas, two liver carcinomas). This suggests that when anal occult blood is positive, the patient should be scanned by ultrasonic means to rule out hepatobiliary pancreatic tumour.

Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTX trial

The aim of this trial was to investigate whether pre-operative chemotherapy leads to a 15% higher curative resectability rate in patients with operable gastric cancer. In this randomised trial, patients were allocated to receive either four courses of chemotherapy using 5-fluorouracil, doxorubicin and methotrexate (FAMTX) prior to surgery or to undergo surgery only. Patients younger than 75 years of age with a good physical and mental condition and a histologically proven adenocarcinoma of the stomach without clinical or radiographic (computed tomography scan) evidence of distant metastases were eligible for this trial. Early gastric cancer or cardia carcinoma were excluded. The response to chemotherapy was evaluated after two and four courses. In case of progressive disease (PD) after two courses, patients were operated upon as soon as possible. Otherwise complete response (CR) partial response (PR) or stable disease (SD), two more courses were scheduled. The standard surgical procedure was a limited lymphadenectomy (D1) with staging biopsy of the para-aortic lymph nodes. Between September 1993 and February 1996, 56 eligible and evaluable patients were entered: 27 were randomised to receive FAMTX before surgery and 29 to undergo surgery only. In the FAMTX+surgery treatment group, 15/27 (56%) had curative resections versus 18/29 (62%) in the surgery only arm. There was no difference in the frequency of TNM stages I+II in both treatment arms: 15/27 versus 15/29. Due to PD and/or toxicity, 12 patients (44%) could not complete the planned four courses of FAMTX. Response evaluation after chemotherapy was possible in 25 patients: 2 CR, 6 PR, 8 SD and 9 PD. The difference in curative resectability rate was 6.5% (95% confidence interval −32 to +19%) in favour of surgery only. Downstaging for stages I+II did not occur. PD was more often the reason for not completing the planned four courses than toxicity. More active regimens than FAMTX are required for future randomised trials.

Esophageal Invasion of Carcinoma of Gastric Cardia

Esophageal Invasion of Carcinoma of Gastric Cardia

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.

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.

Studies on intestinal absorption in postoperative patients with carcinoma of esophagus and gastric cardia

Studies on intestinal absorption in postoperative patients with carcinoma of esophagus and gastric cardia

Segmental resection for carcinoma of the esophagus. Report of a case with five-year survival.

CARCINOMA of the esophagus is one of the least successfully treated malignant tumors. Usual features of the disease which undoubtedly contribute to its lethal nature are its elusion of early detection and the presence of mediastinal extension at the time of operation. Representative results of treatment are those reported by Kay¹in which only 2% of the entire group and 5% of the resected patients with esophageal carcinoma survived five years. In a series of patients with carcinoma of both esophagus and gastric cardia, Adams²achieved five-year success in 9% of a group of patients treated by surgery followed by high voltage radiation therapy. Although Ellis³and coauthors achieved 17% five-year survival for patients who survived resections for lesions of the esophagus and cardia, their success during the same period for all patients in their study was only 4%. Although in recent years extensive and adequate operations