Gastric cancer: endoscopic diagnosis and staging

Gastric cancer is common and is a cause of severe morbidity and mortality. Early diagnosis can improve the chances of cure and prolong survival because prognosis is inversely related to the disease stage. Endoscopy plays an important role in diagnosis. Emerging adjunct technologies such as image-enhanced endoscopy and magnification endoscopy aid in early cancer detection. Endoscopic ultrasonography is an additional useful tool for preoperative staging. Endoscopy for screening, except for high-risk patients, and outside areas of high prevalence, remains controversial.     

Endometriosis: pathogenesis, diagnosis, therapy and association with cancer (review)

Endometriosis is a painful reproductive and immunological disease afflicting about 7-10% of women worldwide. It is one of the most frequent benign gynaecological diseases; however, little is known about the pathogenetic processes leading to the development and maintenance of this disease and the currently available therapeutic strategies are unsatisfactory. The goal of this article is to review the most recent advancements in the pathogenesis, diagnosis and therapy of this disease. The risk for cancer among women with endometriosis will be analyzed in light of the most recent epidemiological and functional studies focused on this disease.     

Angiographic and endoscopic diagnosis of pancreatic cancer

The report discusses the results of 60 angiographic and 25 angioscintigraphic examinations of the pancreas, 129 endoscopic retrograde pancreatocholangiographic examinations and 226 standard and combined laparoscopies carried out in 276 cases of diseases of the pancreas and extrahepatic biliary ducts. Pancreatic cancer was identified in 119 cases. Angiographic and angioscintigraphic examination established the correct diagnosis of pancreatic carcinoma in 85.2% of patients, endoscopic retrograde pancreatocholangiography--93.9%, and complex examination (angiography, endoscopic retrograde pancreatocholangiography and laparoscopy) in 98.7%.     

Postchemotherapy esophagitis: the endoscopic diagnosis and its impact on survival

Eighteen cancer patients receiving intensive chemotherapy developed leukopenia, fever, dysphagia, and oropharyngeal soreness. Superficial esophageal ulceration suggestive of esophagitis was demonstrated by radiographic examination in 33% of the patients (5/15). Upper gastrointestinal endoscopy revealed superficial ulceration and white mucosal patches in all patients. There was no morbidity associated with the endoscopic procedures. Sixty-one percent of the patients (11/18) had monilia albicans cultured from the oropharyngeal cavity, and 50% (9/18) had monilia cultured from the esophageal lesions. The evolution of the esophagitis correlated well with the survival of the patients. The monilial esophagitis persisted in six patients who all died within 24 days of systemic moniliasis. After initial improvement five additional patients succumbed; three of them from severe fungal infection. There was resolution of the esophagitis in the remaining seven patients who survived longer. However, two of them had recurrent monilial esophagitis and succumbed to systemic candidiasis. The other five have remained free of esophagitis, their underlying malignancies have remained under control, and so far they have survived an average of one and a half years. Endoscopy is more accurate than radiography in detecting postchemotherapy esophagitis. This complication can be fatal, since it is often followed by systemic candidiasis.     

Novel endoscopic diagnosis for bladder cancer

Advances in endoscopic imaging technology may improve sensitivity for the detection of bladder cancer and provide a more complete understanding of the urothelial landscape, and it also may lead to improved short‐term and long‐term cancer control. Fluorescence cystoscopy requires intravesical administration of a photosensitizing agent (5‐aminolevulinic acid or hexaminolevulinate), and imaging with a blue‐light endoscopy system demonstrably improves the detection of papillary and flat bladder lesions compared with conventional white‐light cystoscopy. Prospective phase 3 clinical trials have demonstrated improved diagnostic ability, enhanced tumor resection, and a small but significant reduction in recurrence‐free survival. Optical coherence tomography delineates subsurface microarchitecture information about bladder lesions in real time and has the ability to discriminate between noninvasive and invasive cancers. Narrow‐band imaging may augment white‐light cystoscopy by providing increased contrast between normal and abnormal tissue on the basis of neovascularity. Confocal laser endoscopy has been applied to the urinary tract using thinner probes adapted from use in gastrointestinal malignancies and provides exquisite images at microscopic resolution. More technology is on the horizon that may further enhance our ability to detect and accurately stage bladder tumors and distinguish benign from malignant or dysplastic lesions. Cancer 2015;121:169–78 . © 2014 American Cancer Society.     

Endometriosis and Ovarian Cancer: an Integrative Review (Endometriosis and Ovarian Cancer)

Despite being initially considered a benign disease, it is widely thought nowadays that endometriosis and especially ovarian endometriomas are neoplastic conditions with the potential to become malignant. This review was conducted to summarize, in a concise and systematic manner, the available scientific data relating endometriosis to ovarian cancer, published in the past five years. After reading abstracts and applying our predefined inclusion and exclusion criteria, a final list of 11 scientific papers was obtained and subjected to review. Endometriosis is associated with an increased risk of developing epithelial ovarian cancer (EOC), mainly of endometrioid and clear cell subtypes. This might be by virtue of the high estrogen concentration with the disease, which leads to malignant proliferation of endometriotic cysts, or be due to mutations in the ARID1A gene and consequent loss of BAF250a expression. The iron produced in the fluid of endometriotic cysts promotes oxidative stress, which in turn may cause genetic mutations and malignant progression of ovarian cysts.     

Early diagnosis of pancreatic cancer: re-evaluation of endoscopic retrograde cholangiopancreatography

Of the 215 pancreatic ductal cancer patients for these 13 years, 154 cases undergoing ERCP were analysed. ERPs of the pancreatic cancers were classified into 4 types. 1) stenosis of the main pancreatic duct (M.P. D.) 2) obstruction of the M.P.D. 3) dilatation of the M.P.D. 4) abnormal pancreatic field (normal caliber of the M.P.D.) Most of the pancreatic cancers belonged to type 1) or 2). 7 cases were small pancreatic cancers less than 2 cm in diameter. Its pancreatograms showed type 1) or 2) and almost the same as the advanced ones. So it was easy to detect these types even in early stage. But there were a few small pancreatic cancers of which the pancreatogram showed type 4), and these cases were difficult to detect by other imaging modalities (U.S. or C.T.). Even these were easy to detect by ERCP. ERCP is the most potent diagnostic modality for an early pancreatic cancers.     

Principles of radiographic and endoscopic diagnosis of colorectal cancer

An evaluation of the potential of X-ray and endoscopy diagnosis and preoperative staging of colorectal cancer has shown that the best results are to be obtained by their complex multistage and purposeful use. Timely examination heeding the specific features of either component will permit detection and identification of colorectal tumors according to International TNM classification.     

Gene expression of colorectal cancer: preoperative genetic diagnosis using endoscopic biopsies

In colorectal cancer, to predict the response to chemo- and/or radio-therapy or the existence of lymph node metastasis preoperatively, a more competent diagnostic system is required, in addition to conventional diagnosis based on morphology and pathology. The application of gene expression profiling to preoperative cancer diagnosis using endoscopic biopsies could enable the selection of a more appropriate therapy for patients. In this study, we evaluated the feasibility of gene expression profiling using preoperative biopsies of colorectal tumors in a clinical setting, by investigating the influence of intra-tumor heterogeneity on the profiles and testing the prediction ability of tumor malignancy. Under endoscopic examination, two biopsies were sampled from each of 10 colorectal cancers and 10 adenomas, and their gene expression data were obtained using cDNA microarrays. The intra- and inter-tumor heterogeneities of the profiles were compared with unsupervised clustering analysis. Molecular prediction of tumor malignancy using biopsies was performed with the supervised classification algorithm. In clustering analysis, almost all paired biopsies from the same tumors joined each other. Pearson's correlation coefficients of the profiles between biopsies from the same tumors (mean, 0.83) were significantly greater than those of the profiles between biopsies from other cancers (mean, 0.58) (p<0.0001). In the supervised classification method, malignancy was correctly predicted in 39 out of 40 biopsies with 8-71 informative genes. Gene expression profiling using endoscopic biopsies of colorectal tumors revealed that the intra-tumor heterogeneity was smaller than the inter-tumor heterogeneity and tumor malignancy was correctly predicted. Our findings suggest that the technique of gene expression profiling accurately represents the biological properties of colorectal cancer and could help the preoperative diagnosis of this disease.     

Papillary tumors of the upper urinary tract: endoscopic methods of diagnosis and treatment

53 patients (31 males and 22 females, age 16-82 years) suspected to have a papillary tumor of the upper urinary tract (UUT) underwent transurethral uretheronephroscopy (n = 49) and percutaneous nephroscopy (n = 4). Preoperative examination included clinical, x-ray, radionuclide, CT and cytological investigations. 11 patients with solitary papillary UUT tumors were studied endoscopically. Transurethral uretheronephroscopy and percutaneous nephroscopy detected UUT tumors in 31 (58.5%) patients. Postoperative period was uneventful. 3, 6, 12 months and later after endoscopic removal of UUT tumors a control examination was made (excretory urography, ultrasound examination, repeated rigid or fibrouretheroscopy, urinary cytological test). 2-8 years after endoscopic removal of the tumors 5 patients were free of the tumors, 5 patients withdrawn from the study. One woman with a recurrent tumor was reoperated endoscopically. The conclusion is that endoscopic methods are most precise and specific for diagnosis of papillary UUT tumors and should terminate preoperative examination to determine therapeutic policy. In indications for organ-saving therapy, endoscopic methods can serve as a method of choice in the treatment of the above patients.     

Endometriosis and ovarian cancer

Endometriosis is the leading cause of morbidity among premenopausal women and the complex pathogenesis of this disease remains controversial despite extensive research. This disease represents one of the most common gynecological problems. It is generally believed that this disease is due primarily to retrograde menstruation or transplantation of shed endometrium. Based on overwhelming data, ovarian endometrioma is considered a neoplastic process, since most endometriosis-associated ovarian carcinoma occur in the presence of atypical ovarian endometriosis. A study comparing patients with typical epithelial ovarian cancer with endometriosis-associated ovarian cancer demonstrated that the patients with the latter disease strongly differ in both biological and histological characteristics. The prevelance of this disease is not completely established, but approximately 15 percent of women suffer from this disease. In addition, we know about the possible links between endometriosis and cancer for almost 100 years. Despite clear evidence revealing that endometriosis increases ovarian cancer risks, it is possible that it may not affect disease progression after the appearance of ovarian cancer. However, despite clear evidence revealing that endometriosis increases ovarian cancer risk, our knowledge of the risk factors is far from established. In our review, we focused on the most recent approaches including possible biomarkers and genetic approaches.     

Radiographic and endoscopic diagnosis of gastric cancers in the esophago-gastric region

The basic study for x-ray diagnosis and endoscopic one of early gastric cancer in the cardiac region was made. 30 cases of early gastric cancer were investigated for this purpose. The half-standing prone right anterior oblique projection and the half-standing supine left anterior oblique one were indispensable in routine x-ray examinations to detect the early gastric cancer in the cardiac region. Such findings as irregularly shaped barium fleck or irregular collection of the barium with faint granularity should carefully be checked up in terms of x-ray diagnosis of early gastric cancers in the cardiac region. Such findings as reddish discoloration and mucosal unevenness should carefully be checked up in terms of endoscopic diagnosis of early gastric cancers in the cardiac region.     

消化道类癌内镜诊治34例临床分析

目的探讨消化道类癌经内镜诊治和手术治疗的适应证。方法结合文献分析消化道类癌的临床表现、内镜下特点及治疗方法。结果34例消化道类癌经内镜确诊,其中食管癌2例,胃类癌8例,十二指肠球部类癌1例,结肠类癌23例(直肠20例,乙状结肠3例)。采用内镜下电灼切除23例,局部切除2例,9例行根治手术。2例术中发现已广泛转移。结论消化道类癌直径≤1 cm应采用内镜下电灼切除,直径在1.1~2 cm可采用EMR黏膜下切除,直径>2.1 cm应采用根治性手术。     

上消化道黏膜下肿瘤内镜诊疗进展

近年来随着内镜技术的飞速发展、人民生活水平、健康意识的提高,胃肠镜、超声内镜等检查也得到相当程度的普及,越来越多黏膜下肿瘤被发现。目前超声内镜（endoscopic ultrasound ,EUS）可直视黏膜下肿瘤大小、起源、局部血流、局部浸润等情况,结合CT检查可观察肿瘤腔内、腔外、远处转移情况,病变可较早被发现,做好较完整的术前评估。既往多行外科手术治疗的黏膜下肿瘤,随着病变较早期即被发现和上消化道各种内镜术的发展,特别是内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)及其衍生技术内镜黏膜下挖除术(endoscopic submueosal excavation,ESE),内镜经黏膜下隧道切除术(submucosal tunneling endoscopic resection,STER),内镜全层切除术(endoscopic full-thickness resection,EFR)的开展,较多于内镜下直接微创治疗,现就上消化道黏膜下肿瘤特别是具有恶性倾向的胃肠间质瘤术前常用诊断方法和内镜下治疗予以综述。     

Esophageal metastasis from breast carcinoma associated with pseudoepitheliomatous hyperplasia: an unusual endoscopic diagnosis

The clinicopathologic findings in a patient who developed dysphagia and obstruction of the middle third of the esophagus 12 years after mastectomy for breast carcinoma are presented. Endoscopic biopsy revealed metastatic breast carcinoma with pseudoepitheliomatous hyperplasia of the overlying esophageal mucosa. To the best of our knowledge, the case represents the first reported association between esophageal metastasis and pseudoepitheliomatous hyperplasia of the esophageal squamous epithelium.     

超声内镜在胃癌诊断和分期中的价值

目的：评估超声内镜在胃癌诊断中的应用价值.方法：106例患者于术前行超声内镜、胃镜检查与组织活检病理检查,并将其分期结果与术后病理学检查分期结果比较.结果：胃镜结合病理活检诊断率93.4%（99/106）,超声内镜诊断率为85.0%（90/106）.两者联合运用诊断率为100%.超声内镜对胃癌术前分期结果准确率达到81.1%（86/106）;淋巴结转移准确率为72.2%（70/97）.结论：超声内镜对诊断胃癌有较高的临床价值,并可有效地判断胃癌的分期和淋巴转移状况.