Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973-1982

Data from the Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute were utilized to estimate the incidence of adenocarcinoma of the gastric cardia and distal stomach in the US in order to determine whether the epidemiological features of these diseases differ. Based upon 12,562 histologically confirmed cases identified, the annual incidence of gastric cardia adenocarcinoma was 1.1 per 100,000 people and for the distal stomach 3.8 per 100,000. The male-to-female ratio for adenocarcinoma arising in the cardia was 7.0, versus 2.2 for that arising in the distal stomach. The sex ratio shifted across age groups for the gastric cardia and was highest for the 50-59 year age group, but remained relatively stable across age groups for cancers of the distal stomach. Over the decade studied, the sex ratio decreased from 8.0 to 4.6 for gastric cardia tumours, but remained constant for adenocarcinoma of the distal stomach. Blacks were 2.5 times more likely to develop adenocarcinoma of the distal stomach than whites, but had a 50% lower risk of gastric cardia tumours than whites. These results support an emerging concept that adenocarcinoma of the gastric cardia, gastro-oesophageal junction and distal oesophagus may comprise a group of disease which is aetiologically distinct from distal gastric tumours.     

Transhiatal esophagus resection without thoracotomy for carcinoma: complications, hospital mortality and prognosis in 115 patients

OBJECTIVE: To evaluate the short-term and long-term clinical outcome of transhiatal oesophagectomy without thoracotomy for cancer. DESIGN: Retrospective. METHODS: In the period January 1993-August 1996, 115 patients underwent a transhiatal oesophagectomy with curative intent for adenocarcinoma or squamous cell carcinoma of the middle or distal oesophagus or oesophagogastric junction. There were 87 men and 28 women with a median age of 65 years (range: 37-83). Median duration of postoperative follow-up was 27 months (range: 1-74) for all patients, and 45 months (range: 30-74) for those alive at final follow-up. RESULTS: No emergency thoracotomies were necessary. In-hospital mortality was 3.5% (4 patients). Vocal cord dysfunction (24%) and pulmonary complications (23%) were the most frequent early postoperative complications. Clinical leakage of the cervical anastomosis occurred in 8 patients (7%). Forty per cent developed a benign anastomotic stricture which was treated by (repeated) endoscopic dilatation. A microscopically radical resection was achieved in 73% of the patients. Overall survival was 45% at 3 years. CONCLUSION: Transhiatal oesophagectomy without thoracotomy can be considered a safe procedure for resectable cancer of the midoesophagus, the distal oesophagus or the oesophagogastric junction. Long-term oncological treatment results were in line with the data reported for oesophageal resections via a transthoracic approach.     

Esophagus resection and reconstruction without thoracotomy; initial results

From November 1, 1986 to December 1, 1989, 100 patients with squamous cell carcinoma (n = 35), adenocarcinoma (n = 61) or 'other' carcinoma (n = 4) of the oesophagus or the gastroesophageal junction were resected and reconstructed. There were 71 men and 29 women with a mean age of 63 years (35-77 yrs). In 80 patients the tumour was localised in the distal oesophagus or the gastroesophageal junction. In 20 patients the tumour was localised more proximally. In all patients the oesophageal resection was performed transhiatally without thoracotomy with blunt dissection. Reconstruction was performed with a stomach tube (n = 84) or colonic interposition (n = 16). Postoperative pulmonary complications were seen in 25% of the patients. Leakage of the cervical anastomosis was seen in 6 patients. In-hospital mortality was 4%. Oesophageal resection without thoracotomy appears to be an operation with reduced morbidity leading to a marked decrease in postoperative mortality.     

The LMI test in colon, breast and lung cancer long survivors.

Cell-mediated immunity towards tumour antigens (cytosols) of the same histotype and site was evaluated by means of the LMI test in long survivors after surgical resection of adenocarcinoma of the colon, infiltrating ductal carcinoma of the breast, and squamous-cell carcinoma of the lung. A positive migration index (MI less than 85.0) was observed in 17/65 (26.2%) colon survivors, 7/18 (38.9%) breast survivors, and 1/19 (5.3%) lung survivors. 24.5% of all long survivors displayed an immunological memory of the antigen to which they had been exposed.     

Consequences of caustic damage of the esophagus]

Following ingestion of a highly concentrated acetic acid solution, three women aged 29, 23 and 25 years old, suffered damage to the oesophagus and the stomach, respiratory and renal insufficiency and haemolysis. After intensive treatment, gastric tube reconstruction was carried out in 2 of these patients, and the third woman required repeated dilatations of the oesophageal stricture from 6 weeks after ingestion onwards. This resulted in a normal passage of solid food in all women. A 58-year-old man who had ingested caustic soda at 4 years of age, presented with increasing problems associated with swallowing food. A squamous cell carcinoma was diagnosed and treated with chemotherapy, oesophagus-cardia resection and gastric tube reconstruction. After 2 years the tumour has not recurred. Ingestion of corrosive substances can lead to serious damage of the gastrointestinal tract. Early endoscopy is important in establishing the extent of the injury. During the acute phase, intensive care admittance is often necessary and resection of the oesophagus is also necessary in some cases. Subsequent treatment can vary from endoscopic dilations to gastric tube reconstruction following resection of the oesophagus.     

A Rare Case of Medullary Carcinoma of the Colon Presenting as Intussusception in an Adult with Rectal Bleeding

Medullary carcinoma is a recently recognized rare subtype of colorectal cancer resembling both poorly differentiated adenocarcinoma and neuroendocrine tumors. Medullary carcinoma most commonly presents in the proximal colon and can be differentiated from other right-sided malignant lesions by histology and immunochemical markers. We present here a rare case of an adult patient with rectal bleeding who was found to have an intussusception due to underlying medullary carcinoma of the splenic flexure. A 72-year-old woman presented to our GI clinic with rectal bleeding. Colonoscopy revealed a necrotic mass of the sigmoid colon, later determined by CT to be a colo-colonic intussusception at the level of the splenic flexure. Patient underwent diagnostic laparoscopy with findings of a large splenic flexure mass, which was resected and found to be medullary carcinoma of the colon. The tumor was poorly differentiated and exhibited microsatellite instability but was discovered at an early stage and thus did not require any adjuvant chemotherapy. Unlike most previously reported cases of medullary carcinoma, our patient presented with a left sided tumor. To our knowledge, this is the first report of a medullary colon cancer presenting with intussusception.     

Hypoalbuminemia is a predictor of delayed postoperative bowel function and poor surgical outcomes in right-sided colon cancer patients

PURPOSE: To determine the relationship between preoperative serum albumin and postoperative bowel function as well as surgical outcomes in right-sided colon cancer patients. METHODS: This retrospective study in a university hospital included 84 patients who underwent elective right hemicolectomy for adenocarcinoma of the right-sided colon between January 2004 and December 2005. The patients had a preoperative serum albumin assessment. Serum albumin less than 3.5 g/dL was regarded as hypoalbuminemia. Postoperative outcomes were classified into mortality, morbidity (infectious and noninfectious complications), time to first bowel movement, time to resume normal diet, and hospital stay. RESULTS: Forty males (48%) and forty-four females (52%) with a mean age of 64 (range, 27-89) years were included. Forty-eight patients (57%) had hypoalbuminemia. No 30-day postoperative mortality occurred. All 14 postoperative complications occurred in hypoalbuminemic cases. Therefore, 29% of the hypoalbuminemics had complications whereas none occurred in nonhypoalbuminemics (p=0.001). In univariate analysis, hypoalbuminemia and postoperative complications were the risk factors for delayed postoperative recovery of bowel function and prolonged length of hospital stay. In multivariate analysis, hypoalbuminemia was the significant risk factor for postoperative complications (p<0.001) and delayed time to first bowel movement (p=0.018) whereas postoperative complications were the significant risk factor for delayed time to resume normal diet (p<0.001) and prolonged hospital stay (p<0.001). CONCLUSION: Hypoalbuminemia is a potential predictor of delayed recovery of bowel function postoperatively and significantly associated with postoperative complications in right-sided colon cancer patients undergone right hemicolectomy.     

Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries

BACKGROUND: In many western countries an increase in incidence of adenocarcinoma of the oesophagus and/or gastric cardia have been reported. The aim of this study was to describe and compare trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in several areas of Europe, 1968-1995, using Eurocim (a database of cancer incidence and mortality data from 95 European cancer registries). METHODS: Time-trends in age-standardized incidence rates of adenocarcinomas of the oesophagus and gastric cardia are described in 11 population-based cancer registries from 10 countries in North, South, East, West and Central Europe, 1968-1995. The statistical significance of the time-trends in incidence was assessed using Poisson regression analysis. RESULTS: An increase in incidence of adenocarcinomas of the oesophagus and gastric cardia was observed in Northern Europe (Denmark), Southern Europe (Italy, Varese), Eastern Europe (Slovakia) and Western Europe (England and Wales, Scotland). In Central Europe (Switzerland, Basel) and in the cancer registries of Iceland (Northern Europe), France, Bas-Rhin and Calvados, Southern Ireland, and the Netherlands, Eindhoven (Western Europe) no rise in incidence was observed. The increase in incidence of adenocarcinomas of the oesophagus and gastric cardia was accompanied by a decrease in incidence of both adenocarcinomas and non-adenocarcinomas of the non-cardia part of the stomach in almost all of the 11 cancer registries studied. Increased histological verification of tumours of the oesophagus and stomach and improvement in precision of histological diagnosis may partly explain the increase in incidence of adenocarcinomas in some registries. CONCLUSIONS: This study, using Eurocim data, supports the findings from other time-trend studies of population-based cancer registries in western countries.     

Second primary gastric cancers in a region with an overall high risk of gastric cancer

ObjectiveTo compare the incidence rates of gastric cancer among cancer survivors with those in the general population, and estimate the probability of a gastric second primary cancer being diagnosed 10 years after any other first primary cancer.MethodA cohort of first primary cancers (other than gastric) diagnosed in Northern Portugal between 2000 and 2006 (n = 64,648) was followed until 31/12/2012 for gastric second primary cancers. Incidence rates, standardized incidence ratios and the cumulative incidence of gastric second primary cancers were calculated.ResultsOverall, 330 patients developed gastric second primary cancers (21.2% within two months). The incidence rate of gastric second primary cancers was higher within two months of the first primary cancer (standardized incidence ratios: 5.20 in males and 7.89 in females), particularly among survivors of cancers of the oesophagus, colon and rectum, than in the remaining period (standardized incidence ratios: 0.64 in males and 0.74 in females). The 10-year risk of a gastric second primary cancer was 0.6% (males: 0.7%; females: 0.4%).ConclusionThe incidence rate of gastric second primary cancers among cancer survivors was higher than in the general population only soon after the first primary cancer, and lower thereafter. Despite the high mortality, the probability of a gastric second primary cancer within 10-years of the first primary cancer was 0.6%.     

管状胃技术在26例食管、贲门癌根治术中的应用分析

目的 评价管状胃技术在食管、贲门癌根治术中的临床应用效果.方法 选取2007年1月至2010年6月收治的食管、贲门癌患者50例,按采取的手术方法不同分为管状胃组(26例)和胸腔胃组(24例).管状胃组中食管癌21例,贲门癌5例;术中左颈部吻合1例,主动脉弓上吻合11例,主动脉弓下吻合9例,贲门癌根治5例.胸腔胃组食管癌20例,贲门癌4例;术中左颈部吻合1例,主动脉弓上吻合11例,主动脉弓下吻合8例,贲门癌根治4例.观察两组患者手术后吻合口瘘发生率、手术时间、术后住院时间等临床指标.结果 两组患者均顺利完成手术,两组均无吻合口瘘发生.胸腔胃组术后发生肺部感染气管切开3例,死亡1例.管状胃组与胸腔胃组手术时间分别为(175±11)、(182±6)min,术后住院时间分别为(16.8±9.8)、(17.0±11.3)d,差异均无统计学意义(t=1.556,P=0.072;t=1.495,P=0.068).结论 管状胃在食管癌手术中并发症发生率较低,不增加手术时间和住院时间,可改善患者的生活质量,具有较好的临床应用价值.

Abstract：

Objective To evaluate the clinical application of gastric tube in radical operation for patients with esophageal or cardial carcinoma. Methods From January 2007 to June 2010,50 patients with esophageal or cardial carcinoma were enrolled. Based on surgical methods, they were divided into the gastric tube group (26 cases) and the traditional way group (24 cases). Among the gastric tube group, 21 patients had esophageal carcinoma,and the other 5 patients had cardial carcinoma,and 1 patient was treated with anastomosis in the left neck, 11 patients with anastomosis in upper aortic arch,9 patients with anastomosis in lower aortic arch and 5 cardial carcinoma patients underwent radical resection. Among the traditional way group, 20 patients had esophageal carcinoma,and the other 4 patients had cstdial carcinoma, 1 patient wastreated with anastomosis in the left neck, 11 patients with anastomosis in upper aortic arch, 8 patients with anastomosis in lower aortic arch and 4 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of the two groups were observed. Results All surgeries were successfully performed. There was no anastomotic leakage case in the two groups, while there were 3 cases pulmonary infection and 1 case death in the traditional way group. There was no statistical difference in operation time [(175 ± 11) min vs. (182±6) min, t = 1.556, P = 0.072] and length of stay in hospital [(16.8 ±9.8) d vs.(17.0 ± 11.3) d,t = 1.495,P= 0.068] between the gastric tube group and the traditional way group. Conclusion Gastric tube has good value in clinical application with fewer complications and without prolonging operation and hospitalization time, which can surely ameliorate quality of life.     

Iron-deficiency anaemia: a sign that requires an adequate explanation

In three patients, aged 79, 58 and 59 years, respectively, iron-deficiency anaemia (IDA) was diagnosed. All three had a right-sided colonic adenocarcinoma. In the first patient, a cardiologic cause was looked for instead of a simple laboratory investigation of the anaemia. The second patient received iron supplementation without sufficient diagnostic evaluation, and in the third patient the abdominal X-ray was inadequate for evaluation of the ascending colon; moreover, she responded well to iron supplementation therapy. IDA is a common problem in clinical practice that may have various causes. In the Netherlands, gastrointestinal bleeding is the major cause of IDA in men and women over 50 years of age. The three patients described illustrate that IDA should be considered a clinical sign. An accurate evaluation of the IDA to detect a convincing explanation is therefore necessary. Various causes can be found on duodenoscopy and colonoscopy, e.g. neoplasms, ulcers, angiodysplasia or polyps. Carcinoma of the ascending colon is a frequent cause of IDA, especially in those over 50 years of age and without upper gastrointestinal symptoms. Evaluation to exclude a right-sided carcinoma of the colon has a high priority in these cases.     

Granulocyte colony-stimulating factor-producing ascending colon cancer as indicated by histopathological findings: report of a case

Various types of granulocyte colony-stimulating factor (G-CSF)-producing malignant tumors have been reported. However, a G-CSF-producing colorectal cancer is rare. We present a case of G-CSF-producing ascending colon cancer. An 81-year-old man was referred to our hospital with right lower abdominal pain. A colon fiberscopy revealed an ascending colon tumor, and histological examination revealed tubular adenocarcinoma. He was admitted due to worsening abdominal pain. Although laboratory data showed an elevated white blood cell (WBC) count of 17000/mm3 with 77.8% neutrophils, elevated C-reaction protein (CRP) was insignificant (1.06 mg/dL), and he was afebrile. Because computed tomography indicated that the tumor penetrated into surrounding tissue, a semi-urgent ileocecal resection was performed. An abscess was not located. The tumor was staged as T3N2aM0 and as stage IIB according to the TNM classification. Microscopically, significant neutrophil infiltration between cancer cells was observed, suggesting the presence of a G-CSF-producing tumor. Immunohistochemical staining using a G-CSF antibody revealed cytoplasmic staining in cancer cells. The serum concentration of G-CSF upon admission was 334 pg/mL. After surgical resection, the WBC count decreased to within a normal range. These findings confirmed the diagnosis of G-CSF-producing ascending colon cancer. The prognosis of G-CSF-producing tumors is considered to be poor. Early diagnosis and surgical treatment are needed for patients with G-CSF-producing tumors, and continuous careful follow-up is required.     

Treatment of large, esophageal perforations and mediastinitis with a covered, removable metallic endoprosthesis and mediastinal drainage

The application of covered metallic stents in the treatment of benign strictures and perforations is still in the early stages, because their removal is difficult and may cause tissue proliferation. The therapeutic effect and the efficiency of a new method for the extraction of a removable metallic stent were examined in three patients treated for oesophageal perforation. Two of the three patients were dilated with a balloon catheter because of corrosive oesophageal stenosis, and the oesophagus was perforated. In one patient mediastinal drainage, and jejunostomy and in the other primary suturing and drainage were performed. Sepsis and mediastinitis developed due to the oesophageal perforation and the fistula caused by the mediastinal drain in the first patient, and the insufficiency of the suture in the second patient. The oesophageal defects were sealed on day 8 and 10 after the perforation, and surgery by a covered stent. In the third patient, the oesophageal rupture caused by the dilatation and the attempt to stent a malignant obstruction was sealed with a covered stent within 2 hours. Parenteral nutrition and broad-spectrum antibiotic therapy were started. Three days after the interventions, swallowing tests with water-soluble contrast medium (Gastrografin) did not reveal any extravasations. Feeding via a nasogastric tube, and later oral feeding was started. After transient mediastinal drainage, the stents were removed on day 35 and 74 after implantation. Both openings healed completely. Restenoses above the stents were dilated again. The rupture of the malignant oesophagus in the third patient, following early, permanent stenting, healed without drainage and with no complications. Even with mediastinitis and concomitant sepsis, large oesophageal perforations can be treated successfully with removable, covered metallic stents and adequate mediastinal drainage.     

The potential pitfall of attributing iron deficiency anaemia to ulceration in a Barrett's oesophagus.

We report a 58-year-old man with recurrent ulceration in a Barrett's oesophagus whose iron-deficiency anaemia was in fact due to a caecal carcinoma. Recent reports suggest an association between these two disorders. A Barrett's oesophagus should not be blamed for iron deficiency unless neoplasms of the colon have been excluded.     

MDM2-309多态与食管、胃及其双原发癌的发病关联

目的探讨MDM2-309基因多态性与食管、胃及其双原发癌发病风险的关系。方法采用聚合酶链反应-限制性片段长度多态性方法(PCR-RFLP),检测食管、胃及其双原发癌患者和正常对照个体的MDM2-309基因型,并记录研究对象上消化道癌家族史情况,结合分析其与食管胃双原发癌的发病关联。结果食管鳞癌组中,G/T基因型频率(25.6%)明显低于正常对照组(54.9%)(P=0.00);胃腺癌患者组中,G/G基因型频率(31.6%)明显高于正常对照组(16.2%)(P=0.005);食管胃双原发癌患者及正常对照组中MDM2-309位点3种基因型分布频率未见统计学差异。结论 MDM2-309G/T基因型可降低食管癌发病风险,G/G基因型可增加胃腺癌发病风险,未发现MDM2-309多态与食管胃双原发癌发病风险相关。     

Carcinoma of the colon in asbestos-exposed workers: analysis of asbestos content in colon tissue.

Epidemiological studies have indicated an increased incidence of carcinoma of the colon in asbestos workers. The present study evaluated the colon tissue asbestos burden, by light and electron microscopic analytic techniques, in patients with a history of occupational asbestos exposure and colon cancer. Asbestos fibers and/or asbestos bodies were present in colon tissue from 14 of 44 (31.8%) asbestos workers with colon carcinoma (range 142,199 to 15,231, 543 fibers/g/wet weight, mean 2,517,823). Chrysotile was identified in 9 patients and amosite in 3 patients. Both amosite and chrysotile were found in the colonic wall in one individual. Other forms of asbestos (e.g., crocidolite, tremolite, or anthophyllite) were not found. Asbestos fibers and asbestos bodies were not found in colon tissue from 20 control patients (colon carcinoma and no asbestos exposure). Asbestos fibers frequently enter and reside in the wall of the colon and are often intimately associated with tumor tissue at the site of colon carcinoma in workers with asbestos exposure and colon carcinoma.     

Multiple sebaceous tumors with colon cancer--Muir-Torre syndrome

The Muri-Torre syndrome is an autosomal-dominant genodermatosis. The criteria of the diagnosis is the occurrence of at least one sebaceous skin tumour and at least one malignant internal tumour. Skin tumours must be considered as very important signs because they may precede visceral malignancies. The authors present the case of a 62 years old man. Three tumours were excised from three different locations of his trunk in the Plastic Surgery Ward of our hospital. The tumours proved to be sebaceous adenoma, sebaceous epithelioma and sebaceous carcinoma by histology. Because of this result, we had conducted a detailed tumour screening which found a non-symptomatic malformation of the proximal colon tract. Histology of the resected colon part revealed adenocarcinoma. With the presentation of this case the authors call attention on the fact, that in case of the diagnosis of a sebaceous skin tumour, careful tumour screening could be lifesaving.     

大肠癌因症就诊早期诊断技术成本效果分析

该研究对大肠癌因症就诊早诊断技术进行成本效果分析。结果显示：（１）实施早诊断技术的卢湾区组（ｎ＝２２７），在肛肠病人中大肠癌检出率为４．３５％，大肠癌早期（Ａ期）率达２６．８７％，较对照组（ｎ＝１３６）早期率７．３５％高出２．６６倍，两组大肠癌期别构成有显著差别（Ｐ＜０．０１）。卢湾区组每例早期大肠癌的诊断。管理成本为１２　４８０．６２元，由于治疗费用较中晚期癌减少９５２１．３５元，则实际检出成本可降至２９５９．２７元；（２）卢湾区组可创造间接效益７１４　１２０．００元，并可节约潜在的大肠癌诊断治疗费用８２８ １９０．８０元２（３）早诊断干预措施换回一个健康生命年（ＤＡＬＹ）的成本为７２７．０３美元。作者认为，大肠癌因症就诊早诊断技术是开展大肠癌早发现的有效技术，其成本费用是经济合理的，在临床实践中切实可行，是一项符合我国国情的适宜技术。     

Krukenberg tumor: a clinico-pathological study of 5 cases

BACKGROUND: Krunkenberg tumor is defined as the ovarian metastases of a primary digestive tumor composed of a signet ring cells. AIM: Describe the different characteristics of Krukenberg's tumor to improve diagnostic criteria and the therapeutic approche. METHODS: Five cases of Krukenberg tumor are diagnosed in 5 year period between 2002 and 2005. The clinico-pathological feature are reported. RESULTS: The patient age was ranged from 31 to 58 years. Most ovarian tumors were diagnosed synchronously (3 cases). It was a gastric carcinoma in 3 cases and a colonic carcinoma in 2 patients. Histological diagnosis wass easy. We found in 2 cases a metastasis of colonic mucinous adenocarcinoma with signet ring-cell, in 2 other cases it was a gastric adenocarcinoma with exclusively signet ring cell and in the later case it was a gastric moderately differentiated adenocarcinoma with signet ring cell component. Surgical treatment was given in only 3 patients. CONCLUSION: Prognosis is always unfavourable. The only hope for improved prognosis is to search for ovarian metastasis in all cases of digestive tumor.     

间置空肠远端悬垂胆管十二指肠吻合术15例分析

目的间置空肠胆管十二指肠吻合术,存在着胆肠逆流问题至今仍未能理想地解决,为了解决这一难题,设计了间置空肠远端悬垂法。研究方法间置空肠远端悬垂法,就是将长2.5cm左右间置的空肠远端悬垂于十二指肠内2.5cm。术中测试胆道内压及测定胆汁生化成分并与术后所测的结果作对比;术后作钡餐检查及T管胆道造影,另还进行术后随访观察。结果临床应用15例胆石症患者,经术后胆道内压力测定均较术前明显下降。术后钡餐检查,令患者取多种体位未见有胆肠逆流的征象出现。胆管造影见间置肠管蠕动良好,不断地将造影剂自胆道推向十二指肠。术后随访14例无反流性胆管炎及结石复发的临床表现。结论间置空肠远端悬垂胆管十二指肠吻合术,具有强大的防胆肠反流的功能,同时又避免了现存的一些防胆肠反流术式的缺点,在临床上具有广泛的应用前景。