Incidence of carcinoma of the oesophagus and gastric cardia. Changes over time and geographical differences.
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Abstract:
The incidence of adenocarcinoma of the oesophagus is rising in many western countries including Sweden.We have studied the latest data concerning this as well as trends in the incidence of squamous cell carcinoma and adenocarcinoma of gastric cardia. Data was extracted from the Swedish cancer registry and analyzed regarding gender, age, region, histology and location of tumour.The results show an increasing incidence of adenocarcinoma in both oesophagus and gastric cardia. Squamous cell carcinomas show a more stable development with a slight decrease of incidence. Adenocarcinoma is now the most common histological type of cancer in the oesophageal/cardia region in Sweden. Results also suggest a possible drift in location of adenocarcinoma from gastric cardia towards oesophagus. Overall a higher incidence was found in the male population and no trends in patient age at onset could be found. Squamous cell carcinoma is still slightly more common in urban regions.Keywords:
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Squamous carcinoma
A 15-year-old boy with well-differentiated squamous cell carcinoma of the lower esophagus is reported because of its rarity. The patient presented with dysphagia for 3 months and weight loss. The case was treated with radical excision, with excellent immediate response.
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For decades, the incidence rates for squamous cell carcinoma of the esophagus and adenocarcinoma of the distal stomach have been declining while the rates for adenocarcinomas of the esophagus and gastric cardia have increased profoundly. Recent studies have shown that the gastroesophageal junction (GEJ) is regularly exposed to concentrated gastric acid and to a variety of nitrosating species, noxious agents that may contribute to carcinogenesis in this region. For adenocarcinomas that straddle the GEJ, it can be difficult to determine whether the tumor originated in the esophagus or in the gastric cardia. This classification problem hampers studies on the epidemiology and pathogenesis of GEJ tumors. Current concepts in the prevention of cancers of the distal esophagus and proximal stomach have emerged from advances in our understanding of the specific molecular events that occur during the evolution of these tumors. This report reviews those events and focuses on current concepts in the prevention of adenocarcinomas at the GEJ. The similarities and differences in risk factors, molecular pathogenesis, and in preventive strategies for adenocarcinomas of the esophagus and gastric cardia are highlighted.
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Objective:To study the diagnosis and surgical treatment for synchronous double cancers of the esophagus and cardia.Methods:The clinical data of 21 patients of synchronous esophagus and cardia cancers underwent surgical treatment were collected and analyzed.Results:For 20 patients receiving follow-up,one-year survival rate was 70.0%(14/20),three-year survival rate was 47.1%(8/17),and five-year survival rate was 16.7%(2/12).Conclusion:Early diagnosis and extensive radical operation improves the life time of synchronous esophagus and cardia cancers.
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The report concerns the findings of autopsies performed at the Institute of Pathology, The University of Düsseldorf, where 68 patients with cancer of the distal esophagus and 117 patients with cancer of the cardia were observed between 1950 and 1982. The total number of autopsies during this 33-year observation period was 46,593. The male:female ratio was 5.8:1 in cancer of the distal esophagus, and 4.3:1 in cancer of the cardia. During the observation period, cancer of the distal esophagus accounted, on average, for about 40% of all esophageal cancers, whereas the percentage of cancers of the cardia among all gastric cancers was 15.4% on average. While the incidence of gastric cancer has decreased overall, a relative increase in cancers of the cardia has been found, especially in the last 8 years. In histological terms, most of the malignomas of the distal esophagus were squamous cell carcinomas (84%), and most of the cancers of the cardia were adenocarcinomas (96%). Tumor spread and lymphogenous and hematogenous metastasizing are discussed, and the findings are compared with the literature.
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Objective To explore the relationship between living habits,genetics and esophagus cardia carcinoma.Methods To chose cases with esophagus cardia carcinoma from gastrointestinal examination.Results 335 cases with esophagus cardia carcinoma were diagnosed from January 2005 to December 2008.Among them,302 cases were correlative with diet(90.5%),and 33 cases with genetics(9.85%).Conclusion Esophagus cardia carcinoma has a close relation with diet,and is also relative to genetics.
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Objectives To analyse the expression of eyclooxygenase 2(COX-2)in carcinomas of cardia and distal esophagus.Methods Tumor sections of 210 patients with adenocareinoma of distal esophagus and 213 patients with adenoearcinoma of gastric cardia were immunohistochemically stained using a COX-2monoclonal antibody.Results COX-2 expression in adenocareinoma of distal esophagus was significantly higher than that of gastric cardia(χ2=14.367 and 63.907,P＜0.05).The main position of COX-2 expression in gastric cardia Was the margin of the tumor,and the center of the tumor was in distal esophagus.Conclusion Adenocarcinomas of the gastric and distal esophagus may be two different tumors.
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Cyelooxygenase 2; Adenocarcinoma of gastric cardia; Adenocarcinoma of distal esophagus
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Barrett's esophagus
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Between 1950 and 1964, 596 patients with carcinoma of the esophagus or gastric cardia were hospitalized at the National Cancer Institute in Milan. 224 patients were surgically explored and resection was performed in 137. The resectability rate was higher for tumors of the lower esophagus and gastric cardia than for tumors of the upper and middle esophagus. 36 patients died after resection of the tumor (26.2%). The mortality rate decreased from 38% in 1950–54 to 17% in 1960–64, and it was evident that the larger the tumor the higher was the mortality rate. 17 patients (12.4%) survived 5 years or more. The survival rate was significantly higher in localized tumors, in women, and in carcinomas of the lower esophagus and gastric cardia. Some good results were also obtained for carcinomas of the middle esophagus. Surgery (intubations and bypasses) proved to be a better palliative than radiotherapy for tumors of the lower esophagus and gastric cardia, and gave good results in many cases of carcinoma of the middle esophagus too. Carcinomas of the upper esophagus were better managed by the radiologist than by the surgeon and radiotherapy gave here its best results.
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Our experience in treating carcinoma of the esophagus and cardia of the stomach with a concentrated, abbreviated course of irradiation followed by early operation is reported. The treatment protocol consists of three consecutive 800 R cobalt 60 teletherapy treatments on successive days followed by esophagogastric resection in ten to fourteen days. This treatment was used routinely in 70 consecutive patients seen between 1964 and 1971. Seven patients are living; 5 have survived more than two years postoperatively. These 5 patients all had unusually favorable tumors with no involved lymph nodes found in the resected specimen. Since the only good results occurred in unusually favorable cases, it is difficult to substantiate significant benefit from the addition of this form of radiation therapy to surgical treatment. The routine use of preoperative irradiation has been discontinued. arcinoma of the esophagus and of the cardia of the stomach are two malignancies that are among the most discouraging to treat C successfully. This fact, associated with the technical complexity of reestablishing continuity in this part of the alimentary canal, has led to a
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