Detection Of Esophageal Cancer Research Articles

Experience in Simultaneous Endoscopic Submucosal Dissection Treating Synchronous Multiple Primary Early Esophageal Cancers.

Objective: Synchronous multiple primary early esophageal cancers (SMPEEC) are rare and aggressive. Early detection of esophageal cancer can improve survival rate. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment of early esophageal cancers. However, ESD for SMPEEC is little known. We aimed to clarify the clinical outcomes of simultaneous ESD treating SMPEEC. Methods: We retrospectively reviewed the medical data of 34 patients, who underwent ESD for SMPEEC at Endoscopy Center of Zhongshan Hospital, Fudan University, between May 2013 and December 2014. The data of lesion size, histopathology, en bloc resection, curative resection, complication, and tumor local recurrence were analyzed. Results: Among 34 patients, 67 lesions were removed simultaneously in 33 cases; 2 lesions were removed in 2 operations for 1 case. For the simultaneous resection, the en bloc rate was 97.01% (65/67) and the curative resection rate was 92.54% (62/67). Postoperative stricture occurred in two cases and delayed bleeding occurred in one case. There was one local recurrence, no metastasis or procedure-related death. Conclusions: Simultaneous ESD as a treatment for SMPEEC is technically feasible, benefited from reducing hospitalization time and medical expenses. For the cases with risk factors of complications, simultaneous ESD needs to be avoided.

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

Minichromosomal Maintenance Component Complex 5 (MCM5) as a Marker of Barrett's Esophagus-Related Neoplasia: A Feasibility Study.

The endoscopic detection of esophageal cancer is suboptimal in both patients referred with dyspeptic symptoms and those enrolled in Barrett's surveillance programs. MCM5 expression in cells collected from gastric fluid may be correlated with the presence of dysplasia or adenocarcinoma. Analysis of this biomarker may improve the detection of cancer. Sixty-one patients were enrolled at a single UK referral center. From each patient, 5-10ml of gastric fluid was aspirated endoscopically. Patients were categorized according to their histology, normal, non-dysplastic Barrett's (NDBE), high-grade dysplastic Barrett's (HGD), and esophageal adenocarcinoma (EAC). All histology was confirmed by Seattle protocol biopsies or endoscopic mucosal resection. Samples were centrifuged, and the cell pellet was lysed. MCM5 expression levels were quantified using a proprietary immunoassay. The mean MCM5 expression was compared between groups by Kruskal-Wallis test. ROC curves were also used to assess diagnostic utility. The mean expression of MCM5 increases as patients progress from a normal esophagus to NDBE, HGD, and EAC (14.4; 49.8; 112.3; and 154.1, respectively). There was a significant difference in the MCM5 expression of patients with a normal esophagus compared to those with EAC (p = 0.04). There was a trend toward higher MCM5 expression in patients with EAC compared to those with NDBE (p = 0.34). MCM5 expression was a fair discriminator (AUC 0.70 [95% CI 0.57-0.83]) between patients without neoplasia (normal and NDBE) and those with early neoplasia (HGD and EAC). MCM5 expression in gastric fluid samples can differentiate patients with a histologically normal esophagus compared to those with early adenocarcinoma. Larger, powered studies are needed to assess whether it can be used to differentiate those with HGD from NDBE.

Red Fluorescence Probe Targeted to Dipeptidylpeptidase-IV for Highly Sensitive Detection of Esophageal Cancer.

We have developed an activatable red fluorescence probe for dipeptidylpeptidase-IV (DPP-IV) by precisely controlling the photoinduced electron transfer (PeT) process of a red fluorescent scaffold, SiR600. The developed probe exhibited an extremely low background signal and showed significant fluorescence activation upon reaction with DPP-IV, enabling sensitive detection of esophageal cancer in clinical specimens from cancer patients.

Detection of Early Esophageal Cancer by NIR-FME.

Detection of Early Esophageal Cancer by NIR-FME.

Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening.

White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright images in the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellent visibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green color of metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history of Helicobacter pylori eradication.LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes in mucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection of early esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinal cancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtain images useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange) surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.

Salvage Radiation Therapy with Elective Nodal Irradiation for Superficial Esophageal Cancer after Incomplete Endoscopic Resection

Endoscopic resection (ER) is widely used as an effective treatment for superficial esophageal cancer. However, the risk of lymph node metastasis increases in case of muscularis mucosae or deeper invasion, and additional treatment such as radiotherapy (RT) or surgery is required in those cases. The aim of this study is to investigate the efficacy and toxicity of salvage RT after incomplete ER as an organ preservation strategy. We retrospectively reviewed 37 esophageal cancer patients received salvage RT after incomplete ER at one institution between 2000 and 2014. There were 34 males and 3 females, and the median age was 67 (range: 53-85). All patients had squamous cell carcinoma. Pathological invasion depth was muscularis mucosae/submucosal layer/muscularis propria in 14/22/1 patients, respectively. The circumference of tumor was less than three quarters in 25 patients, more than three quarters in 4 patients, entire in 4 patients and unknown in 4 patients. All patients received external beam radiotherapy (EBRT). Among them, 8 patients received intraluminal brachytherapy (IBT) following EBRT. Elective nodal irradiation (ENI) was administered in all patients. Median EBRT dose was 60 Gy/30 fractions (range: 50.4-66Gy). IBT was administered to a total dose of 10 Gy/4 fractions. Twenty-five patients received concurrent platinum and 5FU-based chemotherapy. The Kaplan–Meier method was used to generate actual survival curves. Fisher’s exact test was used for statistical comparisons. Median follow-up time was 56 months (range: 3-212 months) for all patients. The 5-year progression free survival and overall survival rates were 61% and 75%, respectively. Local recurrence and regional lymph node recurrence was not observed. Distant metastasis was observed in 2 patients (5%). Metachronous esophageal cancer was observed in 6 patients (16%) and 4 patients were salvaged by ER. The 5-year incidence rates of metachronous tumor were 15%. Double cancer after RT was observed in 15 patients (41%). The causes of death were attributed to esophageal cancer in 1 patient, metachronous esophageal cancer in 1 patient, other malignancies in 8 patients, and other causes in 6 patients. Although grade 2 esophageal stenosis was observed in 7 patients (19%), and significantly high in patients with tumor circumference more than 3/4 (p<0.001). Grade 3 or worth stenosis was not observed. Late cardiac toxicities ≥ grade 3 was observed in 6 patients (pericardial effusion in 2, ischemic heart disease in 1 and arrhythmia in 3 patients) and one patient died of arrhythmia. Salvage radiotherapy after incomplete esophageal ER is effective treatment as an organ preservation strategy. Although muscularis mucosae and submucosal cancer have a high risk of lymph node metastasis, our results suggest that ENI contribute to reduce regional node metastases. Early detection of metachronous esophageal cancer and other malignancies is important for survivors.

Automated Detection of Precancerous Lesion and Early Esophageal Squamous Cancer Using a Deep Learning Model

Introduction: Early detection of esophageal squamous cancer is essential for favorable prognosis of patients. However the ability to detect precancerous lesion and early esophageal squamous cancer is substantially subject to operator experience. We develop an artificial intelligence model(AIM) for automated detection of these lesions, trying to reduce interobserver variability and improve the diagnosis of early esophageal cancer. Methods: We used 1014 narrow band images(NBI) of precancerous lesions and esophageal squamous cancers in 95 cases and 1071 NBI images of non-cancerous lesions in 198 cases from 2017, to train the model. 1478 malignant NBI images in 59 consecutive cases diagnosed as precancerous lesion or esophageal squamous cancer from January 2018 to February 2018 were included to test the mode. 3899 non-cancerous NBI images in 1205 cases dignosed as normal squamous epithelium(821 cases), esophagitis( 109 cases), heterotopic gastric mucosa(154 cases), esophageal varices(69 cases) and submucosal tumor (52 cases) from 2018 were also tested. AI hot zone image was generated for any input endoscopic image. The red color indicates high possibility of cancerous lesion, while the blue color indicates noncancerous lesion. When AIM detected any precancerous lesion or esophageal squamous cancer, a blue spot was displayed to indicate the lesion of interest. Results: Among 59 cases, 32 cases (total 35 lesions) were diagnosed as precancerous lesion or early esophageal squamous cancer by endoscopic submucosal dissection or surgery. The rest 27 cases(total 29 lesions) were diagnosed as cancerous lesions by biopsy including early and advanced esophageal cancer. The sensitivity of AIM for precancerous lesion and early esophageal squamous cancer images in 32 cases was 97.1%. The sensitivity of AIM for all malignant images in 59 cases was 97.8%. The specificity of AIM for all non-cancerous images was 76.2%. Conclusion: AIM demonstrated high diagnostic accuracy for precancerous lesion and early esophageal cancer. False positive rate was high under current mode. Future effort is warranted to build a more accurate mode.317_A Figure 1. patient characteristic and AI test result317_B Figure 2. AI result of cancerous image317_C Figure 3. AI result of non-cancerous image

The Experiences of Early Detection, Early Diagnosis and Early Treatment of Cancer in Rural Areas of China

Background: The cancers of the lung, liver, stomach, esophagus, colorectum and nasopharynx account for more than 70% of the causes of cancer death, making them the major cancer burdens in China. The early detection and treatment of cancers including lung, liver, stomach, esophagus, colorectum and nasopharynx was supported by the central government special financial transfer payment in the rural areas in 2006-2017. Aim: To improve the efficiency of early diagnosis and early treatment to reduce cancer mortality and incidence in the population in China. Methods: Cancer screening methods developed by Group of Expert Committee of Cancer Foundation of China were used, including digestive tract endoscopy for stomach and esophageal and colorectal cancer, LDCT for lung cancer, AFP and abdominal ultrasound for liver cancer, EB virus antibody detection and nasal endoscopy for nasopharyngeal carcinoma. Results: Among the cancers of lung, liver, stomach, esophagus, colorectum and nasopharynx, the screening high risk population were 55,363; 126,443; 103,3036; 1,425,642; 252,911; and 79,726 respectively; and the screening detection rates of precancerous lesions and cancer were 0.62%, 0.66%, 0.87%, 1.62%, 5.29% and 0.49% respectively; and the early diagnosis rates were 47.80%, 60.86%, 71.24%, 73.38%, 91.85% and 64.43% respectively; and the treatment rates were 83.28%, 90.33%, 87.94%, 82.91%, 94.04% and 95.88% respectively. Conclusion: The programs for early detection and early treatment of colorectal cancer and esophageal cancer demonstrated a promising benefit, which should be generalized to broad population implementation.

1852P - Intraoperative fluorescent image-guided detection of esophageal cancer in rabbit and patient specimens

1852P - Intraoperative fluorescent image-guided detection of esophageal cancer in rabbit and patient specimens

Barrett\u2019s oESophagus trial 3 (BEST3): study protocol for a randomised controlled trial comparing the Cytosponge-TFF3 test with usual care to facilitate the diagnosis of oesophageal pre-cancer in primary care patients with chronic acid reflux

BackgroundEarly detection of oesophageal cancer improves outcomes; however, the optimal strategy for identifying patients at increased risk from the pre-cancerous lesion Barrett’s oesophagus (BE) is not clear. The Cytosponge, a novel non-endoscopic sponge device, combined with the biomarker Trefoil Factor 3 (TFF3) has been tested in four clinical studies. It was found to be safe, accurate and acceptable to patients.The aim of the BEST3 trial is to evaluate if the offer of a Cytosponge-TFF3 test in primary care for patients on long term acid suppressants leads to an increase in the number of patients diagnosed with BE.MethodsThe BEST3 trial is a pragmatic multi-site cluster-randomised controlled trial set in primary care in England. Approximately 120 practices will be randomised 1:1 to either the intervention arm, invitation to a Cytosponge-TFF3 test, or the control arm usual care. Inclusion criteria are men and women aged 50 or over with records of at least 6 months of prescriptions for acid-suppressants in the last year. Patients in the intervention arm will receive an invitation to have a Cytosponge-TFF3 test in their general practice. Patients with a positive TFF3 test will receive an invitation for an upper gastro-intestinal endoscopy at their local hospital-based endoscopy clinic to test for BE.The primary objective is to compare histologically confirmed BE diagnosis between the intervention and control arms to determine whether the offer of the Cytosponge-TFF3 test in primary care results in an increase in BE diagnosis within 12 months of study entry.DiscussionThe BEST3 trial is a well-powered pragmatic trial testing the use of the Cytosponge-TFF3 test in the same population that we envisage it being used in clinical practice. The data generated from this trial will enable NICE and other clinical bodies to decide whether this test is suitable for routine clinical use.Trial registrationThis trial was prospectively registered with the ISRCTN Registry on 19/01/2017, trial number ISRCTN68382401.

372 - Detection of Esophageal Cancer by Assay of Novel Methylated DNA Markers in Plasma

372 - Detection of Esophageal Cancer by Assay of Novel Methylated DNA Markers in Plasma

Su1665 - Microrna Expression Profile in Esophagus of Children with Caustic Stenosis: A Novel Biomarker for Early Esophageal Cancer Detection?

Su1665 - Microrna Expression Profile in Esophagus of Children with Caustic Stenosis: A Novel Biomarker for Early Esophageal Cancer Detection?

Rapid detection of superficial head and neck squamous cell carcinoma by topically spraying fluorescent probe targeting dipeptidyl peptidase-IV.

A fluorescent probe glutamylprolyl hydroxymethyl rhodamine green (EP-HMRG), which becomes fluorescent after cleavage by dipeptidyl peptidase-IV (DPP-IV), has been reported to be useful for the detection of esophageal cancer. Thus, we investigated whether head and neck squamous cell carcinoma (HNSCC) can be detected by spraying EP-HMRG. Fluorescence imaging of 17 cases of HNSCCs resected using endoscopic or surgical resection was performed ex vivo after spraying EP-HMRG, and then the fluorescence intensity of the tumors and normal mucosa were measured. Iodine-voiding lesions became fluorescent within a few minutes after the application of EP-HMRG in 12 resected tumors without a history of radiotherapy but this was not observed in the normal mucosa. Fluorescence intensity in tumor lesions was significantly higher than normal lesions. However, 5 other tumors that developed after radiotherapy did not have sufficient contrast against normal mucosa. Fluorescence imaging with EP-HMRG would be useful for rapid detection of superficial HNSCC without a history of radiotherapy.

Blood biomarkers for early diagnosis of oesophageal cancer: a systematic review.

Oesophageal cancer prognosis remains poor owing to the inability to detect the disease at an early stage. Nontissue (serum, urinary or salivary) biomarkers potentially offer less invasive methods to aid early detection of oesophageal cancer. We aimed to systematically review studies assessing the relationship between nontissue biomarkers and subsequent development of oesophageal cancer. Using terms for biomarkers and oesophageal cancer, Medline, EMBASE and Web of Science were systematically searched for longitudinal studies, published until April 2016, which assessed the association between nontissue biomarkers and subsequent oesophageal cancer risk. Random effects meta-analyses were used to calculate pooled relative risk (RR) and 95% confidence intervals (CIs), where possible. A total of 39 studies were included. Lower serum pepsinogen I concentrations were associated with an increased risk of oesophageal squamous cell carcinoma (n=3 studies, pooled RR=2.20, 95% CI: 1.31-3.70). However, the association for the pepsinogen I : II ratio was not statistically significant (n=3 studies, pooled RR=2.22, 95% CI: 0.77-6.40), with a large degree of heterogeneity observed (I=68.0%). Higher serum glucose concentrations were associated with a modestly increased risk of total oesophageal cancer (n=3 studies, pooled RR=1.27, 95% CI: 1.02-1.57). No association was observed for total cholesterol and total oesophageal cancer risk (n=3 studies, pooled RR=0.95, 95% CI: 0.58-1.54). Very few studies have assessed other biomarkers for meta-analyses. Serum pepsinogen I concentrations could aid early detection of oesophageal squamous cell carcinoma. More prospective studies are needed to determine the use of other nontissue biomarkers in the early detection of oesophageal cancer.

Early diagnostic potential of APC hypermethylation in esophageal cancer.

BackgroundThe hypermethylation of APC gene is observed in various cancers, including esophageal cancer (EC). However, the association between APC methylation and the initiation and progression of EC is poorly understood.Purpose and methodsThe current study systematically reviewed studies on abnormal methylation of APC in EC and quantitatively synthesized 18 studies by meta-analysis involving 1008 ECs, 570 Barrett’s esophagus (BE), and 782 controls.ResultsOur results showed higher methylation of APC in EC (OR = 23.33, P < 0.001) and BE (OR = 9.34, P < 0.001) than in normal controls. Whereas APC methylation in EC was similar to that in BE (P = 0.052), it was not associated with tumor stage (P = 0.204). Additionally, APC methylation was not significantly associated with overall survival (OS) and relapse-free survival (RFS) in patients with EC. The performance of APC methylation for the detection of EC and BE achieved areas under the receiver operating characteristic curves of 0.94 and 0.88, respectively.ConclusionOur results imply that APC methylation detection is a potential diagnostic biomarker for EC and BE.

An adhesion based approach for the detection of esophageal cancer.

Esophageal cancer has a 5 year survival rate of ∼20%. This dismal prognosis is due, in part, to the fact that esophageal cancer often presents at a late stage. Thus, there is a critical need for assays that enable the early detection of cancerous tissue within the esophagus. The luminal surface of the esophagus expresses signature molecule(s) at sites of transformation providing an avenue for the development of in situ assays that detect neoplastic growth within the esophagus. An attractive approach, receiving increased attention, is the endoscopic administration of particles conjugated with ligands to signature molecules present on transforming tissue. Detection of the particles within the esophagus, post-washing, would indicate the presence of the signature molecule and thus transforming tissue. In this work, we utilized cancerous and normal esophageal cells to provide in vitro proof of principle for this approach utilizing ligand-conjugated microspheres and demonstrate the need, and provide the framework for, engineering this technology. Specifically, the study (i) reveals selective increased expression of signature molecules on cancerous esophageal cells relative to normal cells; (ii) demonstrates selective binding of ligand-conjugated microspheres to cancerous esophageal cells relative to normal cells; (iii) demonstrates that the selective recognition of cancerous, relative to normal esophageal cells, is highly dependent on the biophysical design of the assay; and (iv) advocates utilizing the knowledge from the field of cell adhesion as a guide for the effective development of ligand-conjugated particle-based schemes that seek to detect esophageal oncogenesis in situ.

Incidence of Esophageal Cancer in Madina Hospital, Somalia

Background: Esophageal cancer is a significant and increasing health problem. In 2005, there were 497,700 new cases, and the prevalence is expected to double by 2025. It also remains a deadly disease, with 416,500 people estimated to have died from esophageal cancer in 2005. Our aim was to identify the frequency of esophageal carcinoma in Madina Hospitals.Methods: This is a cross sectional study investigating the frequency of esophageal carcinoma in Somalia between 2010 and 2015.Results: The study group consisted of 300 patients with esophageal cancer of whom 162 (54%) were males revealing that the disease has a slight male predominance. The mean age was 67±7.7 (range: 54-80) years. The diagnosis was made by barium meal series in 87% of the patients, whereas 10% were diagnosed via computerized tomography (CT) scan, and 2% were diagnosed with endoscopy. Seventy-eight (26%) patients underwent surgery while the remaining registered patients went into palliative treatment due to the detection of a late stage or metastatic cancer at primary diagnosis.Conclusions: Endoscopic screening for all who can afford may lead to early detection of esophageal cancer, and early treatment as well as the provision of staging methods in the hospital to stage the disease and prioritize management of the disease may reduce morbidity &amp; mortality of this condition.International Journal of Human and Health Sciences Vol. 01 No. 01 January’17. Page : 30-33

Hypopharyngeal cancer associated with synchronous oesophageal cancer: risk factors and benefits of image-enhanced endoscopic screening.

To explore the risk factors associated with the occurrence of synchronous oesophageal cancer in patients with hypopharyngeal cancer, and to investigate the roles of image-enhanced endoscopic screening in the prediction and diagnosis of early oesophageal cancer. The clinical characteristics of patients with hypopharyngeal cancer (n = 160) were analysed. All patients underwent laryngoscopic and gastroscopic examination using image-enhanced endoscopic techniques before treatment. Of 160 hypopharyngeal cancer patients, 43 (27 per cent) had synchronous oesophageal cancer. Heavy drinking (odds ratio = 4.787, p = 0.029) and local invasion of three or more anatomical sites (odds ratio = 14.391, p = 0.000) were independent risk factors for synchronous oesophageal cancer. Narrow-band imaging laryngoscopy could detect more invaded anatomical sites than ordinary white light endoscopy (t = 8.532, p = 0.000). More early oesophageal cancer cases were detected with Lugol chromoendoscopy than with non-Lugol iodine staining examination (χ2 = 4.925, p = 0.026). Synchronous oesophageal cancer is common in patients with hypopharyngeal cancer. The heavy drinking patients with hypopharyngeal cancer should undergo intensive monitoring. Image-enhanced endoscopic screening is helpful in the prediction and early detection of second primary oesophageal cancer.

MiR-486 functions as a tumor suppressor in esophageal cancer by targeting CDK4/BCAS2.

Esophageal cancer is a common tumor for which morbidity and mortality are high worldwide. We aimed to study alterations in miR-486 expression in esophageal cancers, and the effect miR-486 on esophageal cancer cell function and behavior. We collected esophageal cancer tissues/corresponding normal tissues from 20 patients and utilized three esophageal cancer cell lines and normal esophageal epithelial cells, and the expression of miR-486, CDK4 and BCAS2 was detected by qRT-PCR. Western blotting was used to detect the expression of CDK4 and BCAS2 protein. Then, we overexpressed miR-486 in esophageal cancer cell line EC9706. A series of cell functional analyses, including cell growth, cell cycle, apoptosis, migration and invasion were performed in esophageal cancer cells using colony formation assay, flow cytometry, Transwell and scratch assays, respectively. Dual-Luciferase reporter gene assay was used to detect the target genes of miR-486. We found that the expression of miR-486 in esophageal cancer tissues and cell lines was significantly lower than that in the normal tissues and normal esophageal epithelial cell line. Overexpression of miR-486 significantly inhibited the colony formation ability, induced G0/G1 phase arrest and apoptosis and suppressed cell migration and invasion in the EC9706 cells. Using bioinformatics and luciferase reporter assay, we identified that CDK4 and BCAS2 may be target genes of miR-486 and levels of CDK4 and BCAS2 were both significantly higher in the esophageal cancer tissues and cell lines than levels in the normal tissues and cells. Furthermore, knockdown of CDK4/BCAS2 coincided with the suppressive effects of miR-486 in esophageal cancer cells. Expression of apoptotic signaling molecules p21 and caspase-3 was upregulated in the CDK4/BCAS2-knockdown groups. These results suggest that miR-486 may suppress tumor cell growth and metastasis in esophageal cancer by targeting CDK4/BCAS2. The newly identified miR-486/CDK4/BCAS2 pathway provides further insight into the development and progression of esophageal cancer, which is of great significance to the early diagnosis and detection of esophageal cancer.