Cancer of the nasopharynx

Nasopharyngeal cancer (NPC) is quite rare throughout Europe, accounting for an annual incidence rate below 1 per 100.000, whereas the highest risk area is South East Asia. A predominant occurrence in males is to be noted. NPC is an etiologically multifactorial disease, most probably involving viral, genetic and environmental factors. Carcinomas of the nasopharynx can be divided into two major histotypes: keratinizing squamous cell carcinomas (WHO-type 1) and non-keratinizing carcinomas (WHO-type 2). The histological type is a prognostic factor and it has a clear impact on the outcome of treatment. Standard therapeutic option for early stages of NPC is radiation, while an integration of radiation therapy and chemotherapy is indicated in more advanced stages.     

Cancer of the esophagus and stomach: 3-year evaluation

Esophagus cancer has a very bad pathological prognosis. Risk factors considered are: smoking consumption and deficiency of vitamins A and C. The mortality rates of cancer of the stomach vary notably according to geographic region. Factors such as genetics, races, smoking, socioeconomic conditions are some of stomach cancer development. 646 symptomatic patients were studied in the gastroenterology unit at. J.M. Cullen hospital. Histopathologically, 22 (3.3%) cancer of the esophagus and 13 (2%) cancers of stomach were detected. All esophagus cancers were squamous cells; 82% were males and 18% females. 50% were located on the middle third zone. 92.3% of stomach cancers were adenocarcinoma; 83% were males and 17% females. A 50.8% were located in corporo-fundic zone. All the cancers both of the esophagus as well as of the stomach, were in the advanced phase. The cancer of esophagus has appeared most frequently among cancers of the tract in our hospital, with significant difference among province and national registers.     

Cancer of the esophagus and gastric cardia: recent advances.

Esophageal cancer and cancer of the gastric cardia, in particular adenocarcinomas, have shown a rapid and largely unexplained increase in incidence in many developed countries around the world. These diseases have a poor prognosis and current therapies have a modest impact on survival. This review presents recent advances in the epidemiology, etiology, diagnosis, staging, prevention and treatment of resectable and advanced disease. Although significant progress has been made in these areas of research and patient management over the past years, prognosis for most patients diagnosed with esophageal cancer or cancer of the gastric cardia remains poor. New diagnostic procedures, improved surgical procedures, combined treatment modalities and new treatment modalities are being evaluated and may be expected to contribute to improved patient outcomes and better palliation of symptoms in the future.     

Fungal colonization of the esophagus in alcoholic liver disease

OBJECTIVES: Little is known about the fungal colonization of the esophagus. Since alcoholic liver disease (ALD) patients are prone to fungal esophagitis, we have investigated the esophageal fungal colonization of this patient group. METHODS: One hundred consecutive ALD patients were enrolled in this prospective study. 22 patients with dyspeptic symptoms acted as controls. After taking an oropharyngeal swab, patients underwent an upper gastrointestinal endoscopy and surface material was obtained from the esophagus for direct smears and culture. RESULTS: In the ALD group pseudohyphae were found in 21.5% and yeast forms in 6.4% of the direct smears. The culture was positive in 40.8% of the ALD patients, the isolated strains were: 30 C. albicans, 2 C. kefyr, 2 C. krusei, 1 C. zeylanoides and in 3 cases the species could not be identified. 41.9% of ALD patients and 13.6% of control patients (p = 0.013) had fungi in their esophagus. Significantly more ALD patients had fungal esophagitis than in the control group (19.3% vs. 0%, p = 0.021), the rate of fungal colonization was also higher, but the difference was not significant (22.5% vs. 13.6%). A significantly higher rate of fungal esophagitis and esophageal colonization was found in patients with fungi in their oropharyngeal swabs (p = 0.00001). CONCLUSIONS: Fungal colonization of the esophagus is frequent in ALD patients. Its presence might have clinical significance in the case of liver transplantation.     

Triple cancer in liver, esophagus and urinary bladder: indications and problems of hepatectomy

In patients with multiple cancers and chronic liver damage, it is difficult to decide on the operative procedures. We describe a 70-year-old man with triple cancer: liver, esophageal and urinary bladder. The patient had the complication of chronic hepatitis C and mild liver damage. He received curative resections of all cancers. In patients with multiple cancers, including hepatocellular carcinoma accompanied by liver damage, the treatment strategy should be decided after clarifying the relationship between the staging of multiple cancers and liver function.     

Cancer of the esophagus (II): the results of surgery, anatomicopathological study and patient survival]

We present a retrospective study of 68 esophageal cancer patients treated with surgery between 1975 and 1991. Results showed a resectability of 73.5% with the most frequent surgical approach being a Lewis esophagectomy. The mean hospitalization time was 24.7 days with a postoperative mortality of 7.3%. Other complications included anastomotic leakage, wound infection, sepsis and pulmonary disorders. Over-all survival at 3 years was 17.3%, reaching 24% in resected patients. Survival according to lymph node involvement was 13.4% for lymph node positive patients and 34.5% for node negative patients. According to histopathologic stage, survival rates were 34.6% and 8.59% for early and advanced tumor respectively, the difference being statistically significant using the Mantel-Haenszel test.     

Small cell carcinoma of the esophagus: a multicentre Rare Cancer Network study

Small cell carcinoma of the esophagus (SCCE) is a rare and aggressive malignant tumor with a poor prognosis. The aims of this retrospective study were to analyze the epidemiology, clinical characteristics, and treatment outcomes of these patients. Between 1994 and 2004, 24 patients with SCCE from several centers were reviewed for data on demographics, presenting symptoms, diagnosis, disease stage, type of treatment, and outcome. SCCE occurs in the sixth decade: median age (interquartile range [IQR]): 65 (59–69) years with a male predominance (63%). The most common complaining symptoms were rapidly progressive dysphagia (79%), weight loss (54%), and retrosternal/epigastric pain (46%). The tumor arises primarily in the middle (52%) or in the lower (35%) third of the esophagus. History of tobacco and alcohol exposure was present in 90% and 70% of case, respectively. Extensive disease was present in 13 cases (54%) at initial diagnosis. The overall median survival (IQR) was 11 (8–20) months for all 24 patients, and the 2‐year overall survival was 25.1%. Four patients were alive more than 2 years after treatment. Chemotherapy increased the survival compared with symptomatic management in extensive disease (median survival [IQR]: 9.5 [6–14] vs. 6 [4–7] months, P= 0.05). In limited disease, concurrent chemo‐radiotherapy was more effective than non‐concurrent treatment (median survival [IQR]: 36 [14–93] vs. 11 [9–15] months, P= 0.04). Two patients were treated by surgery and chemoradiation therapy with a survival of 35 and 66 months. Chemotherapy is the cornerstone of treatment of SCCE in all stage. For limited disease SCCE, concurrent chemo‐radiotherapy is the primary choice compared with sequential approach. The role of surgery was not assessable in our study.     

Cancer of the esophagus (I): its epidemiological, clinical and diagnostic assessment according to histological type]

From 1975 to 1991, sixty-eight patients were treated with surgery for esophageal cancer at the Clínica Universitaria de Navarra. This study involves an analysis of epidemiologic and predisposing risk factors in relation with the histologic type of tumor: epidermoid carcinoma vs. adenocarcinoma. The difference in mean age of males (60.5 yrs.) as compared with that of females (48.7 yrs.) was statistically significant (p < 0.05). Likewise, the mean age of patients with epidermoid carcinoma (57.8 yrs.) was significant lower (p < 0.01) as compared with that of those with adenocarcinoma (66.3 yrs.). Smoking and alcoholism were common in the group of patients with epidermoid carcinoma, while Barrett's esophagus and hiatal hernia were frequently seen in patients with adenocarcinoma. Dysphagia was the most frequent symptom both at the start of disease (75%) and with the diagnosis established (96.7%). There was no significant difference in the symptomatology of patients with one type of tumor or the other. The efficacy of ancillary diagnostic procedures such as barium swallow, esophagoscopy, computerized tomography and biopsy were likewise assessed. The most frequent site of tumor was at the middle third, with majority of patients being at clinical stage 1-2 of disease at the time of diagnosis.     

Endoscopy of the esophagus, stomach and duodenal bulb

The authors report on the position of the endoscopy of oesophagus, stomach and duodenal bulb within the diagnostic endoscopy. The therapeutic endoscopy including polypectomy remains widely not taken into consideration. They particularly deal with the endoscopic-bioptic diagnosis of the stenoses of the oesophagus, the gastric ulcers and the early carcinoma of the stomach. It is referred to the importance of the endoscopy for the diagnostics of varicose veins of the oesophagus and of duodenal ulcers. For the clinician references to the clinical elaboration of the endoscopic and bioptic findings are given.