We report here a case of superficial esophageal basaloid squamous cell carcinoma (BSC) that presented with a rare form. The patient was a 64-year-old man with a two-month history of dysphagia. Barium esophagography showed a polypoid tumor in the middle esophagus, measuring 2.5 cm in diameter and esophagoscopy demonstrated the lesion as protruding tumor with peduncle. The case was diagnosed as poorly differentiated squamous cell carcinoma by analyzing the biopsy specimen and computed tomogram demonstrated one abdominal lymph node metastasis. The patient underwent thoracic esophagectomy with three-field lymph node dissection. In the respected specimen, the tumor shape was similar to a mushroom, and the histological diagnosis was BSC invading the submucosal layer.
As society ages, the elderly are increasingly affected by esophageal cancer. We reviewed the data of the elderly patients 80 years of age or older, who underwent surgery for esophageal cancer to evaluate the safety of surgery in this particular patient population.Nine patients aged 80 or above who underwent surgery for esophageal cancer in our department between 1999 and 2009 were included in this study. We analyzed their preoperative assessment, concurrent disorders, surgical techniques, postoperative course and complications. The patients' mean age was 82 years. Four patients had concurrent hypertension, two had concurrent diabetes, two had concurrent cerebral infarction, and two had undergone a malignant tumor operation. Three had obstructive pulmonary dysfunction, one had restrictive pulmonary dysfunction, and one had mixed pulmonary dysfunction. Clinical stage of esophageal cancer was graded as Stage I in one, Stage II in five, and Stage III in three patients. Four patients underwent esophagectomy with right thoracotomy and two-field lymph node dissection (LD), one underwent esophagectomy with right thoracotomy and three-field LD, one underwent esophagectomy with left thoracoabdominal incision and two-field LD, one underwent esophagectomy with left thoracotomy and two-field LD and two underwent transhiatal esophagectomy. Postoperative complications occurred in seven patients; however, no severe pneumonia or anastomotic leakage was noted. All patients were discharged with improved conditions. The mean postoperative hospital stay was 33 days. Esophageal cancer surgery can be performed safely in the oldest of elderly patients with appropriate preoperative assessment, selection of the optimal surgical technique, and pre- and postoperative patient management.
A 73-year-old male patient presented with unresectable advanced esophageal cancer and metastases in the left axillary, the thoracic and the paraaortic lymph nodes, which were treated with docetaxel/nedaplatin (CDGP)/5-fluorouracil (5-FU) therapy. CDGP was administered in multiple divided doses, because the patient exhibited decreased renal function. One cycle of chemotherapy consisted of CDGP (20 mg/body/day) and 5-FU (750 mg/body/day) from days 1 to 5, docetaxel (60 mg/body) on day 1, followed by a three-week interval. The patient underwent four cycles of chemotherapy. Upper gastrointestinal endoscopy was performed after the completion of the third cycle, when the patient exhibited no evidence of a primary tumor, and no cancer cells were detected via biopsy. The efficacy of the chemotherapy was maintained after the fourth cycle, indicating a complete response(CR). Computed tomography was performed after the first cycle and showed a reduction of the primary tumor(CR) and lymph node metastases. After the fourth cycle, enlarged lymph nodes were remarkably reduced, which was assessed as a partial response(PR). The reported adverse events were Grade 1 pyrexia, Grade 3 diarrhea and Grade 2 leukopenia. Therefore, docetaxel/CDGP/5-FU therapy is a promising regimen for advanced esophageal cancer in association with a lower incidence of nephrotoxicity and hepatotoxicity.
Purpose: Development and introduction into clinical practice of the reliable and functionally valuable, simple in performance cervical esophago-gastric anastomosis after esophagectomy due to cancer of the thoracic site of esophagus resulting in reduction of the number of failure and cicatricial stenosis, decrease in pathological signs of pharyngeal and/orgastroesophageal reflux. Methods: Clinical investigation was performed on 212 patients with cancer of thoracic esophagus during the period from 2000 to 2008. Esophagectomy by trans-thoracic approach was performed on 33 patients, and trans-hiatus - on 179 ones. The one-stage esophageal plasty with isoperistaltic tube from the greater curvature of stomach, transposition of the graft through the bed of the esophagus removed (posteriomediastinal approach) and manual formation of the cervical esophago-gastric anastomosis (EGA). The patients were divided into 2 groups in relation to the type of cervical EGA formation: group 1 included 55 (25.9%) patients who were made cervical EGA end-to-end after esophago-gastrectomy during the period from 2000 to 2003; group II comprised of 157 (74.1%) patients were performed antireflux cervical EGA end-to-side developed in our center after esophagectomy from 2004. Results: Comparative analysis of the results of cervical EGA formation between groups showed sharp reduction of the number of suture failures from 23.5% to 6.1%, of EGA stricture from 33.3% to 4.4%, of reflux-esophagitis from 72.5% to 3.4%, of aspiration complications from 21.6% to 1%, respectively. The lethality was 6.6%. The cause of death was not related to the methods of EGA formation and its complications in all the cases. Conclusions: The formation of the cervical EGA according to the developed technique allowed avoidance of severe complications of the suture failure in anastomosis, minimization of the frequency of stenosis, avoidance of marked gastrointestinal reflux in the long-term period. The formation of gastro stoma in the oral end of the graft gives opportunity to begin early enteric nutrition, to avoid oral nutrition for a long period, the manner of its formation prevents leakage of the stomachic contents beside the tube and skin maceration, without necessity of stoma closing with special methods.
Cancer is the third leading cause of premature death in Kazakhstan. Every year more than thirty thousand Kazakhstani people are diagnosed with cancer. The present article was undertaken to provide base for the cancer control programs in Kazakhstan. The most common types of cancer are lung, skin, breast and stomach. These four cancers combined account for over 44% of new cases of cancer. Lung cancer is the most common cancer in men accounting for nearly a quarter of cancer cases in men. Breast cancer is by far the most common cancer in women accounting for 20%. Cancer remains mainly a disease of older Kazakhstanis. The largest proportion of cancer deaths for both men and women were from lung cancer mainly caused by smoking. Deaths from cancers of the lung, stomach, breast and esophagus together accounted for almost a half (46%) of all cancer deaths. With an estimated 186.7 new cases and 166.7 deaths in 2006, cancer remains an important public health problem in Kazakhstan. The incidence of lung cancer, and several other forms of cancer, could be reduced by improved tobacco control and healthy lifestyle.
Background: The early detection of gastric cancer is important issue for improving the survival rate. As a serum marker, Carcinoembryonic antigen (CEA) and CA19-9 in serum is widely used. But their limited sensitivity is not suiTable for screen method. Methods: In this study, titer of CEA-IgM complexes was measured in serum from 86 patients with primary gastric cancer who underwent surgery. 48 of the tumors (56%) were Stage IA, 10 (12%) were Stage IB, 6 (7%) were Stage II, 11 (13%) were Stage III, 11 (13%) were Stage IV. Serum samples from 23 patients found to have no tumors with gastritis were analyzed as non-gastric cancer group. In each serum sample, CEA and CEA-IgM complexes were measured. Results: By CEA-IgM tests, overall sensitivity was 20% (17/86), Stage IA 19% (9/48), Stage IB 30% (3/10), Stage II 0% (0/6), Stage III 17% (3/11) and Stage IV 2% (2/11), while false positive rate was 9% (2/23). By conventional CEA test, overall sensitivity was 5% (4/86), with Stage IA, IB 2% (1/58). Moreover, CEA-IgM complexes detected differentiated adenocarcinoma with overall sensitivity 38% (11/29), more than undifferentiated adenocarcinoma of gastric cancer. Conclusion: CEA-IgM might open a new possibility of detecting gastric cancer by serum in early stages, especially of differentiated adenocarcinoma.
A case of long-term treatment with FOLFIRI plus cetuximab was presented. A 77-year-old Japanese male was introduced FOLFIRI plus cetuximab as second line treatment. Although the CT revealed partial response, dermatologic adverse event was rather severe and eventually the case required cetuximab cessation. During the FOLFIRI without cetuximab period, CT evaluation revealed disease progression, but after the re-introduction of cetuximab, partial response was observed again. The course of this case would suggest the importance of appropriate cessation of cetuximab in order to balance the efficacy and toxicity, resulting in long treatment period like OPTIMOX strategy.