Subscribe to RSS
DOI: 10.1055/s-2001-11182
Diagnosis of Esophagogastric Tumors
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/endoscopy/200101/lookinside/thumbnails/10.1055-s-2001-11182-1.jpg)
The incidence of esophageal tumors, and of adenocarcinoma in particular, has risen markedly in recent years in the developed countries. The use of a variety of histopathological and biological markers is now offering promising prospects for the future. Vertical tumor invasion, intratumoral microvessel density, antimucin monoclonal antibodies, flow cytometry, telomerase activity, and overexpression of cyclin D1 have been correlated with the staging and prognosis of esophageal carcinomas. By combining these markers with Lugol staining, a practical new method of staging esophageal tumors may become available in the coming years.
As is well known, Barrett's mucosa is a preneoplastic condition. Discussions in the literature concerning short forms of Barrett's esophagus and their relationship to inflammation of the gastric cardia appear to describe two different scenarios - a gastroesophageal reflux condition for short forms of Barrett's esophagus, and an inflammatory phenomenon (perhaps unrelated to Helicobacter pylori infection) for inflammation of the gastric cardia. Cost-benefit studies of follow-up procedures in Barrett's esophagus have yet to be conducted, and considerable efforts - mainly using biological markers - are being made to identify those patients who are at greatest risk.
Although the frequency of gastric tumors has declined in recent years, many as yet unclear aspects of these tumors have been studied. Technological progress has not led to substantial changes in the diagnostic procedures used, although autofluorescence methods and three-dimensional reconstruction have been analyzed. Laparoscopy, preferably combined with the use of ultrasound probes, may be a valuable tool for staging. The suggestion that endoscopy should be avoided in young patients (the “treat but do not scope” approach) has been seriously questioned, as it may lead to early cancer being overlooked. There is thought to be an intermediate stage of gastric cancer (between the early and advanced stages) in which the muscularis propria, but not the serosa, is invaded. Endoscopic ultrasonography is becoming increasingly established as a basic tool for the staging of gastric cancer. Gastric MALT lymphoma can be cured by H. pylori eradication therapy in many cases, but there is still uncertainty regarding the limitations of this approach.
References
- 1 Daly J M, Fry W A, Little A G, et al. Esophageal cancer: results of an American College of Surgeons patient care evaluation study. J Am Coll Surg. 2000; 19 562-572
- 2 Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med. 1999; 13 883-890
- 3 Lagergren J, Nyren O. No association between colon cancer and adenocarcinoma of the oesophagus in a population-based cohort study in Sweden. Gut. 1999; 44 819-821
- 4 Tajima Y, Nakanishi Y, Ochiai A, et al. Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer. 2000; 88 1285-1293
- 5 Millikan K W, Mall J W, Myers J A, et al. Do angiogenesis and growth factor expression predict prognosis of esophageal cancer?. Am Surg. 2000; 66 401-405
- 6 Shih C H, Ozawa S, Ando N, et al. Vascular endothelial growth factor expression predicts outcome and lymph node metastasis in squamous cell carcinoma of the esophagus. Clin Cancer Res. 2000; 6 1161-1168
- 7 Torres C, Wang H, Turner J, et al. Prognostic significance and effect of chemoradiotherapy on microvessel density (angiogenesis) in esophageal Barrett's esophagus-associated adenocarcinoma and squamous cell carcinoma. Hum Pathol. 1999; 3 753-758
- 8 Sagara M, Yonezawa S, Nagata K, et al. Expression of mucin 1 (MUC1) in esophageal squamous-cell carcinoma: its relationship with prognosis. Int J Cancer. 1999; 84 251-257
- 9 Watanabe M, Kuwano H, Tanaka S, et al. Flow cytometric DNA analysis is useful in detecting multiple genetic alterations in squamous cell carcinoma of the esophagus. Cancer. 1999; 85 2322-2328
- 10 Koyanagi K, Ozawa S, Ando N, et al. Telomerase activity as an indicator of malignant potential in iodine-nonreactive lesions of the esophagus. Cancer. 2000; 88 1524-1529
- 11 Kagawa Y, Yoshida K, Hirai T, et al. Microsatellite instability in squamous cell carcinomas and dysplasias of the esophagus. Anticancer Res. 2000; 2 213-217
- 12 Safatle-Ribeiro A V, Ribeiro U J r, Sakai P, et al. Integrated p53 histopathologic/genetic analysis of premalignant lesions of the esophagus. Cancer Detect Prev. 2000; 24 13-23
- 13 Tanaka M, Nonogaki S, Alberti V N, Forones N M. p53 in epidermoid cancer of the esophagus. Hepatogastroenterology. 1999; 46 1765-1768
- 14 Toyoda H, Nakamura T, Shinoda M, et al. Cyclin D1 expression is useful as a prognostic indicator for advanced esophageal carcinomas, but not for superficial tumors. Dig Dis Sci. 2000; 45 864-869
- 15 Shiozaki H, Doki Y, Kawanishi K, et al. Clinical application of malignancy potential grading as a prognostic factor of human esophageal cancers. Surgery. 2000; 127 552-561
- 16 Arber N, Gammon M D, Hibshoosh H, et al. Overexpression of cyclin D1 occurs in both squamous carcinomas and adenocarcinomas of the esophagus and in adenocarcinomas of the stomach. Hum Pathol. 1999; 3 1087-1092
- 17 D'Errico A, Barozzi C, Fiorentino M, et al. Role and new perspectives of transforming growth factor-alpha (TGF-alpha) in adenocarcinoma of the gastro-oesophageal junction. Br J Cancer. 2000; 82 865-870
- 18 Menzel J, Hoepffner N, Nottberg H, et al. Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study. Endoscopy. 1999; 31 291-297
- 19 Mallery S, Van Dam J. Increased rate of complete EUS staging of patients with esophageal cancer using the nonoptical, wire-guided echoendoscope. Gastrointest Endosc. 1999; 5 53-57
- 20 Shinkai Y, Niwa Y, Arisawa T, et al. Evaluation of prognosis of squamous cell carcinoma of the esophagus by endoscopic ultrasonography. Gut. 2000; 47 120-125
- 21 Yamamuro E M, Cecconello I, Iriya K, et al. Lugol dye endoscopy for analysis of esophageal mucosa in achalasia. Hepatogastroenterology. 1999; 46 1687-1691
- 22 Fagundes R B, de Barros S G, Putten A, et al. Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk for squamous cell carcinoma of the esophagus. Endoscopy. 1999; 31 281-285
- 23 O'Connor J B, Falk G W, Richter J E. The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's Esophagus Registry. Am J Gastroenterol. 1999; 94 2037-2042
- 24 Thurberg B L, Duray P H, Odze R D. Polypoid dysplasia in Barrett's esophagus: a clinicopathologic, immunohistochemical, and molecular study of five cases. Hum Pathol. 1999; 3 745-752
- 25 Polkowski W, van Lanschot J J, ten Kate F J, et al. Intestinal and pancreatic metaplasia at the esophagogastric junction in patients without Barrett's esophagus. Am J Gastroenterol. 2000; 95 617-625
- 26 Sharma P, Weston A P, Morales T, et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut. 2000; 46 9-13
- 27 Rudolph R E, Vaughan T L, Storer B E, et al. Effect of segment length on risk for neoplastic progression in patients with Barrett esophagus. Ann Intern Med. 2000; 132 612-620
- 28 Weston A P, Badr A S, Hassanein R S. Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma. Am J Gastroenterol. 1999; 94 3413-3419
- 29 Nilsson J, Skobe V, Johansson J, et al. Screening for oesophageal adenocarcinoma: an evaluation of a surveillance program for columnar metaplasia of the oesophagus. Scand J Gastroenterol. 2000; 35 10-16
- 30 Provenzale D, Schmitt C, Wong J B. Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999; 94 2043-2053
- 31 Gimenez A, Minguela A, de Haro L M, et al. DNA ploidy status and proliferative activity as markers of malignant potential in Barrett's esophagus: flow cytometric study using routinely paraffin-embedded tissue. World J Surg. 2000; 24 72-77
- 32 Younes M, Lechago J, Chakraborty S, et al. A Relationship between dysplasia, p53 protein accumulation, DNA ploidy, and Glut1 overexpression in Barrett metaplasia. Scand J Gastroenterol. 2000; 35 131-137
- 33 Sarbia M, Bektas N, Muller W, et al. Expression of cyclin E in dysplasia, carcinoma, and nonmalignant lesions of Barrett esophagus. Cancer. 1999; 86 2597-2601
- 34 Chinyama C N, Marshall R E, Owen W J, et al. Expression of MUC1 and MUC2 mucin gene products in Barrett's metaplasia, dysplasia and adenocarcinoma: an immunopathological study with clinical correlation. Histopathology. 1999; 35 517-524
- 35 Van Laethem J L, Peny M O, et al. et al . Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's oesophagus. Gut. 2000; 46 574-577
- 36 Garewal H, Ramsey L, Sharma P, et al. Biomarker studies in reversed Barrett's esophagus. Am J Gastroenterol. 1999; 94 2829-2833
- 37 Gotoda T, Saito D, Kondo H, et al. Endoscopic and histological reversibility of gastric adenoma after eradication of Helicobacter pylori. J Gastroenterol. 1999; 34 91-96
- 38 Zullo A, Romiti A, Rinaldi V, et al. Gastric pathology in patients with common variable immunodeficiency. Gut. 1999; 45 77-81
- 39 Kikuchi S, Hiki Y, Sakakibara Y, Kakita A, Kuwao S. Measuring the tumor volume of gastric carcinoma by computer image analysis: clinical significance. World J Surg. 2000; 24 603-607
- 40 Ohashi S, Segawa K, Okamura S, et al. The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer. Gut. 1999; 45 599-604
- 41 Smith A, John T G, Garden O J, Brown S P. Role of laparoscopic ultrasonography in the management of patients with oesophagogastric cancer. Br J Surg. 1999; 86 1083-1087
- 42 Feussner H, Omote K, Fink U, et al. Pretherapeutic laparoscopic staging in advanced gastric carcinoma. Endoscopy. 1999; 31 342-347
- 43 Abe S, Izuishi K, Tajiri H, et al. Correlation of in vitro autofluorescence endoscopy images with histopathologic findings in stomach cancer. Endoscopy. 2000; 32 281-286
- 44 Kitahara F, Kobayashi K, Sato T, et al. Accuracy of screening for gastric cancer using serum pepsinogen concentrations. Gut. 1999; 44 693-697
- 45 Mayinger B, Reh H, Hochberger J, Hahn E G. Endoscopic photodynamic diagnosis: oral aminolevulinic acid is a marker of GI cancer and dysplastic lesions. Gastrointest Endosc. 1999; 5 242-246
- 46 Bramble M G, Suvakovic Z, Hungin A P. Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to gastroscopy. Gut. 2000 ; 46 464-467
- 47 Wayman J, Hayes N, Raimes S A, Griffin S M. Prescription of proton pump inhibitors before endoscopy: a potential cause of missed diagnosis of early gastric cancers. Arch Fam Med. 2000; 9 385-388
- 48 Breslin N P, Thomson A B, Bailey R J, et al. Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia. Gut. 2000; 46 93-97
- 49 Bini E J, Rajapaksa R C, Valdes M T, Weinshel E H. Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test?. Am J Med. 1999; 106 613-618
- 50 Nakamura K, Kamei T, Ohtomo N, et al. Gastric carcinoma confined to the muscularis propria: how can we detect, evaluate, and cure intermediate-stage carcinoma of the stomach?. Am J Gastroenterol. 1999; 94 2251-2255
- 51 Yoshimura T, Shimoyama T, Fukuda S, et al. Most gastric cancer occurs on the distal side of the endoscopic atrophic border. Scand J Gastroenterol. 1999; 34 1077-1081
- 52 Cammarota G, Cianci R, Pirozzi G, Gasbarrini G. Minimal endoscopic aspects of gastric low-grade malt-lymphoma. Hepatogastroenterology. 1999; 46 2818-2822
- 53 Morgner A, Lehn N, Andersen L P, et al. Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma: complete remission after curing the infection. Gastroenterology. 2000; 118 821-828
- 54 Steinbach G, Ford R, Glober G, Sample D, et al. Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: an uncontrolled trial. Ann Intern Med. 1999; 131 88-95
- 55 Weston A P, Banerjee S K, Horvat R. Prospective long-term endoscopic and histologic follow-up of gastric lymphoproliferative disease of early stage IE low-grade B-cell mucosa-associated lymphoid tissue type following Helicobacter pylori eradication treatment. Int J Oncol. 1999; 15 899-907
- 56 Chang D K, Chin Y J, Kim J S, et al. Lymph node involvement rate in low-grade gastric mucosa-associated lymphoid tissue lymphoma: too high to be neglected. Hepatogastroenterology. 1999; 46 2694-2700
- 57 Kojima T, Takahashi H, Parra-Blanco A, et al. Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection. Gastrointest Endosc. 1999; 5 516-522
- 58 DeMatteo R P, Lewis J J, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000; 231 51-58
M. Moretó,M.D.
Gastroenterology Unit
Hospital de Cruces
Plaza de Cruces
48903 Baracaldo
Spain
Fax: Fax:+ 34-94-60063558
Email: E-mail:mmoretoc@meditex.es