Imaging and Staging of Esophageal Malignancy

2019 ◽  
Author(s):  
Steven N Hochwald ◽  
Rupen Shah
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Gastroesophageal Junction ◽  
Intermediate Stage ◽  
Cancer Staging ◽  
Cell Types ◽  
Clinical Staging ◽  
Cell Type ◽  
Key Words Esophageal Cancer ◽  
Eighth Edition

Squamous cell carcinoma (SCC) and adenocarcinoma are the two main cell types of esophageal cancer. Esophageal adenocarcinoma is rapidly increasing in incidence in Western countries, particular in elderly white males. Histopathologic cell type affects the survival of clinically and pathologically staged patients, but less so pathologically staged patients following neoadjuvant therapy. The survival of early- and intermediate-stage patients with SCC is worse than for those with similarly staged adenocarcinoma. Unfortunately, patients often present with either cell type of esophageal carcinoma at an advanced stage. Various imaging modalities are necessary to adequately stage patients with esophageal cancer due to the length of the esophagus and patterns of spread that frequently involve the neck, thorax, and abdomen. Despite advances in imaging, the accuracy of clinical staging is limited, which results in different survival profiles for clinical stage groups compared with pathologic stage groups. Since clinical staging based on imaging remains unpredictable and inaccurate, the eighth edition of the AJCC Cancer Staging Manual has now expanded staging to allow for three different opportunities. Separate classifications now include clinical (cTNM), pathologic (pTNM), and postneoadjuvant pathologic (ypTNM) staging. It is hoped that the use of these three stage groups will improve our ability to provide precise care to patients with esophageal cancer. This review contains 2 figures, 9 tables, and 23 references.  Key words: Esophageal cancer, Esophagography, Endoscopic ultrasonography, Invasive esophageal cancer, Staging of esophageal cancer, Gastroesophageal junction carcinoma

RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 39-40
Author(s):  
Tomas Hansen ◽  
Magnus Nilsson ◽  
Daniel Lindholm ◽  
Johan Sundström ◽  
Jakob Hedberg
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

Normal radiological lymph node appearance in the thorax

2018 ◽  
Vol 32 (10) ◽  
pp. 1-6 ◽  
Author(s):  
T Hansen ◽  
M Nilsson ◽  
D Lindholm ◽  
J Sundström ◽  
J Hedberg
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Healthy Subjects ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Swedish Population ◽  
Nodal Stage

SUMMARY Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50–64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P &lt; 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

Pathologic and clinical outcomes in cT2N0 esophageal cancer: A cohort study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 157-157
Author(s):  
Gauri Bhuchar ◽  
Mohammad Altujjar ◽  
Siva Raja ◽  
Sudish C. Murthy ◽  
Daniel Raymond ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cohort Study ◽  
Gastroesophageal Junction ◽  
Cleveland Clinic ◽  
Clinical Staging ◽  
Hazard Ratios ◽  
Pathologic Staging ◽  
Node Positive Disease ◽  
Ct Radiation ◽  
Study Population

157 Background: The management of clinically staged T2N0 (cT2N0) esophageal cancer remains controversial and clinical staging can be inaccurate. We evaluated concordance between clinical and pathologic staging as well as outcomes in a cohort study of patients initially staged as cT2N0. Methods: We conducted a cohort study of consecutive patients with esophageal cancer staged as cT2N0 after imaging (CT, PET scans) and endoscopic ultrasound, who underwent surgical resection and were followed at the Cleveland Clinic from Jan 2000 to Jun 2014. Clinical, chemotherapy (CT), radiation (RT), pathologic, and survival details were evaluated. For statistically significant associations, adjusted hazard ratios (HR) with 95% confidence intervals (CI) and 2-sided p-values are presented. Results: The study population comprised 66 consecutive patients with cT2N0 esophageal cancer. Median age was 60 years; 76% were male; 97% were Caucasian. Gastroesophageal junction was the primary site in 56%; distal esophagus in 29%; middle esophagus in 14%; histology was adenocarcinoma in 62 (94%) cases. 20 patients received preop treatment (Rx): CT+RT (15), CT (5). In patients without preoperative Rx (n = 46, 70%), pathologic staging was > T2N0 in 54% (n = 25; T3 = 17, T4 = 1, N+ = 20), < T2N0 in 37% (n = 17), and T2N0 in 9% (n = 4). No < T2N0 or T2N0 patient received postop Rx. Of 25 > T2N0, 15 received postop Rx: CT+RT (14), CT (1). 5-fluourouracil-cisplatin was the most common CT regimen. Median overall survival (mOS) after 7 years of median follow-up was: overall, 48 mths (34 deaths, 52%); < T2N0/T2N0, 93 mths; > T2N0 with postop Rx, 69 mths; > T2N0 without postop Rx, 15 mths (p > 0.05 for comparison). Only node-positive disease on pathology was associated with mortality (mOS for N+ vs. N- was 28 vs. 118 mths, HR for mortality = 2.74, 95% CI = 1.30-5.76, p = 0.008); T-stage, surgical margins, timing or type of therapy were not. Conclusions: Clinical staging of cT2N0 esophageal cancer is concordant with pathologic staging in less than 10% of patients; a majority are under-staged. Strong consideration should be given to pre- or post-operative treatment in this population. Improvements in clinical staging approaches are urgently needed to avoid over- and under-treatment in this setting.

Accuracy of clinical staging with EUS for early stage esophageal cancer: Are we denying patients beneficial neoadjuvant chemo-radiation?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 163-163
Author(s):  
Carrie Luu ◽  
Norbert Garcia-Henriquez ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Early Stage ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Significant Proportion ◽  
Surgical Pathology ◽  
Clinical Staging ◽  
Cancer Center

163 Background: Esophagectomy alone has been considered the standard of care for early stage esophageal cancer (EC) while neoadjuvant therapy is now standard for locally advanced disease. The choice of treatment therefore hinges on accurate locoregional staging by endoscopic ultrasound (EUS). Our objective is to evaluate the accuracy of EUS performed in a high-volume tertiary cancer center in clinical stage T1N0 (cT1N0) and T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy without neoadjuvant therapy. Methods: A retrospective review of the esophageal cancer database at a single institution was performed. Patients with cT1N0 and cT2N0 esophageal cancer based on EUS undergoing esophagectomy without neoadjuvant treatment were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. Surgical pathology was compared to EUS staging. Results: Between 2000 and 2015, 139 patients were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle 1/3 of the esophagus in 11 (8%) and lower 1/3 and gastroesophageal junction in 128 (92%) patients. Eighty-one percent of patients had adenocarcinoma, 9% had squamous cell carcinoma, 9% had Barrett’s dysplasia, and 1% had mixed histology. Clinical staging were as follows: 110 (79%) patients had cT1N0 and 29 (21%) patients had cT2N0 tumors. For the entire cohort, preoperative EUS matched the final surgical pathology in 76/139 patients for an accuracy rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. This included 12/109 (11%) of cT1N0 and 7/29 (24%) of cT2N0 patients. Conclusions: The accuracy of preoperative EUS staging in early esophageal cancer remains sub-optimal. Interestingly, a significant proportion (24%) of cT2N0 EC patients were found to have positive lymph nodes on surgical pathology, and perhaps these patients could have benefitted from neoadjuvant therapy. In light of these findings, the current management of cT2N0 esophageal cancer should be reconsidered.

PS01.239: MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN PATIENTS WITH AIDS: AN ENTITY ON THE RISE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 117-118
Author(s):  
Bruno Lorenzi ◽  
Neda Farhangmehr ◽  
Temisanren Akitikori ◽  
Kanatheepan Shanmuganathan ◽  
Oluwasunmisola Soile ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
General Population ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
World Health ◽  
Clinical Staging ◽  
Hiv Patients ◽  
Antiretroviral Medications

Abstract Background Recently it was reported by World Health Organization that over 36 million people are living with HIV globally; for the first time ever life expectancy in people with HIV exceeds the average. This is mainly due to the development of highly active antiretroviral medication that have turned AIDS from a life threatening disease to a chronic condition. HIV patients are as prone as the general population to developing esophageal cancer. We aim to describe our experience and factors for consideration whilst treating HIV patients with esophageal cancer. Methods In 2017, 77 cases were surgically treated for esophageal and gastroesophageal junction cancer in our tertiary referral centre. n = 2 (2.5%) were HIV positive. Their disease, demographic and surgical characteristics were analyzed and the outcomes are presented. Results A 62 and 65-year-old HIV male patients had 2-stage esophagectomy for gastro-esophageal junction adenocarcinoma. They both had similarities with locally advanced tumours and late presentation with dysphagia and > 10% total body weight loss. Clinical staging revealed T3N2M0 tumours in both cases. Viral load was low (< 40 copies/mL) and both had neoadjuvant chemotherapy as first line of treatment. Both had a 2-stage esophagectomy; one had laparoscopic-assisted and the other had totally minimally invasive. Histological staging was ypT3N1 and ypT3N3 respectively. Antiretroviral medications were in both started enterally on day 1; in the first case via a triple-lumen nasojejunal feeding tube and in the second via a single-lumen nasogastric tube. No feeding jejunostomies were placed. No immediate post-operative complications were noted. Length of stay was 14 and 8 days respectively. Conclusion AIDS patients with esophageal cancer can present late, with advanced tumors, as dysphagia is common due to fungal esophagitis and tends to be underestimated. Where indicated, this cohort of patients should receive full multimodality treatment, like the general population, as results are no different. Multidisciplinary approach with involvement of an HIV specialist doctor from the beginning of treatment planning is of paramount importance as optimization prior to surgery is commonly necessary. Antiretroviral medications are needed immediately post-operatively in all cases and a clear plan for enteral route administration should be in place. Disclosure All authors have declared no conflicts of interest.

Endoscopic submucosal dissection using a novel endoscopic articulating knife for clinical staging of early esophageal neoplasia.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 114-114
Author(s):  
Juan Genere ◽  
Harshith Priyan ◽  
Kenneth Wang
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Narrow Band Imaging ◽  
Clinical Stage ◽  
Clinical Staging ◽  
Blue Dye ◽  
Stricture Formation ◽  
Early Esophageal Cancer ◽  
Esophageal Neoplasia ◽  
Submucosal Dissection

114 Background: Clinical staging of early esophageal neoplasia traditionally involves histological confirmation and imaging with endoscopic ultrasound (EUS), CT, and PET which have low sensitivity and specificity for staging esophageal cancer (EC). Endoscopic submucosal dissection (ESD) therapy is traditionally used for treatment, but not diagnosis as it is felt to be technically challenging and have a high risk for complications. We applied a new articulating endoscopic knife that permits safe ESD (ESD-CC) to evaluate early neoplasia with potential curative resection. Methods: We performed a retrospective study of patients undergoing ESD to stage or treat suspected early EC (cT1-T2). Clinical stage was done by EUS, CT, and PET. Two expert GI pathologists reviewed all histology. Lesions were examined with high resolution white light endoscopy and narrow band imaging. ESD was done with 1:200,000 epinephrine and methylene blue dye injection for lifting and staining the submucosal space. A 5mm, scissors-like articulated knife was used to perform ESD and hemostasis. Complications during post-ESD observation or follow-up were recorded. Results: A total of 35 patients who underwent ESD-CC were included with median age 70 (IQR 12), 26 males (74%), and followed for a median 3.4 months (IQR 6.4). This group consisted of 32 potential adenocarcinomas and 3 squamous cell cancers. The clinical Pre-ESD diagnoses were cT1 EC (24, 69%) and suspected EC in Barrett’s esophagus (BE) (11, 31%). The cT1 EC cases had ESD staged at least T1b (5, 21%), T1a (11, 46%), EC in situ (1, 4%), and dysplastic BE (7, 29%). The suspected EC cases had ESD staged at least T1b (1, 9%), T1a (2, 18%), and DBE (8, 73%). ESD-CC up-staged 4 (11%), down-staged 10 (29%), and confirmed prior diagnosis in 21 (60%). No complications including bleeding, perforation, or stricture formation regardless of size of ESD, age of patient, or co-morbidities. Conclusions: Staging of early esophageal cancer can be improved using ESD with an articulating knife, without increase in complications. ESD may be used as a staging modality in early esophageal cancer.

Dendritic cells of the human epidermis: immuno-electron microscopic studies of la antigen reactivity

1978 ◽  
Vol 36 (2) ◽  
pp. 644-645
Author(s):  
G. Rowden ◽  
M. G. Lewis ◽  
T. M. Phillips
Keyword(s):  
Dendritic Cells ◽  
Langerhans Cells ◽  
Cell Types ◽  
Cell Type ◽  
Electron Microscopic ◽  
La Antigen ◽  
Microscopic Studies ◽  
A Cell ◽  
C3 Receptors ◽  
Antigen Reactivity

Langerhans cells of mammalian stratified squamous epithelial have proven to be an enigma since their discovery in 1868. These dendritic suprabasal cells have been considered as related to melanocytes either as effete cells, or as post divisional products. Although grafting experiments seemed to demonstrate the independence of the cell types, much confusion still exists. The presence in the epidermis of a cell type with morphological features seemingly shared by melanocytes and Langerhans cells has been especially troublesome. This so called "indeterminate", or " -dendritic cell" lacks both Langerhans cells granules and melanosomes, yet it is clearly not a keratinocyte. Suggestions have been made that it is related to either Langerhans cells or melanocyte. Recent studies have unequivocally demonstrated that Langerhans cells are independent cells with immune function. They display Fc and C3 receptors on their surface as well as la (immune region associated) antigens.

scholarly journals Fibroblasts Influence the Efficacy, Resistance, and Future Use of Vaccines and Immunotherapy in Cancer Treatment

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 634
Author(s):  
Bailee H. Sliker ◽  
Paul M. Campbell
Keyword(s):  
Transforming Growth Factor ◽  
Transforming Growth Factor Β ◽  
Cell Types ◽  
Fibroblast Activation Protein ◽  
Cancer Associated Fibroblasts ◽  
Cell Type ◽  
Adaptive Immune ◽  
Adaptive Immune Cells ◽  
New Research ◽  
Tumor Types

Tumors are composed of not only epithelial cells but also many other cell types that contribute to the tumor microenvironment (TME). Within this space, cancer-associated fibroblasts (CAFs) are a prominent cell type, and these cells are connected to an increase in tumor progression as well as alteration of the immune landscape present in and around the tumor. This is accomplished in part by their ability to alter the presence of both innate and adaptive immune cells as well as the release of various chemokines and cytokines, together leading to a more immunosuppressive TME. Furthermore, new research implicates CAFs as players in immunotherapy response in many different tumor types, typically by blunting their efficacy. Fibroblast activation protein (FAP) and transforming growth factor β (TGF-β), two major CAF proteins, are associated with the outcome of different immunotherapies and, additionally, have become new targets themselves for immune-based strategies directed at CAFs. This review will focus on CAFs and how they alter the immune landscape within tumors, how this affects response to current immunotherapy treatments, and how immune-based treatments are currently being harnessed to target the CAF population itself.

scholarly journals Epigenetic reprogramming of cell identity: lessons from development for regenerative medicine

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Amitava Basu ◽  
Vijay K. Tiwari
Keyword(s):  
Regenerative Medicine ◽  
Cell Types ◽  
Direct Conversion ◽  
Cellular Reprogramming ◽  
Specific Cell ◽  
Cell Type ◽  
Pathological Conditions ◽  
Gene Regulatory ◽  
Induced Pluripotent ◽  
And Function

AbstractEpigenetic mechanisms are known to define cell-type identity and function. Hence, reprogramming of one cell type into another essentially requires a rewiring of the underlying epigenome. Cellular reprogramming can convert somatic cells to induced pluripotent stem cells (iPSCs) that can be directed to differentiate to specific cell types. Trans-differentiation or direct reprogramming, on the other hand, involves the direct conversion of one cell type into another. In this review, we highlight how gene regulatory mechanisms identified to be critical for developmental processes were successfully used for cellular reprogramming of various cell types. We also discuss how the therapeutic use of the reprogrammed cells is beginning to revolutionize the field of regenerative medicine particularly in the repair and regeneration of damaged tissue and organs arising from pathological conditions or accidents. Lastly, we highlight some key challenges hindering the application of cellular reprogramming for therapeutic purposes.

Sign in / Sign up

Export Citation Format

Share Document