Imaging and Staging of Esophageal Malignancy

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

Esophageal Cancer and Treatment Modalities

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients. Key words: Esophageal Cancer, Treatment, Surgery, Radiation, Chemotherapy, Chemoradiation

Gerybinių stemplės anastomozės striktūrų gydymas

Eugenijus Stratilovas, Egidijus SangailaVilniaus universiteto Onkologijos instituto Bendrosios ir abdominalinės chirurgijosir onkologijos skyrius, Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas Viena iš dažniausiai pasitaikančių vėlyvųjų komplikacijų po stemplės rezekcinio pobūdžio operacijų yra gerybinė anastomozės striktūra. Dėl striktūros išsivysčiusi disfagija ilgam pablogina ligonio gyvenimo kokybę. Pagrindiniai šios komplikacijos gydymo metodai išlieka dažnos endoskopijos, dilatacijos bužais sukėlus nejautrą. Autoriai siūlo taikyti gana paprastą šių striktūrų gydymo metodą – dilataciją Folley kateteriu. Rezultatai Šiuo būdu gydyti keturi pacientai. Visi procedūrą pakėlė gerai, gydymo komplikacijų nebuvo. Po dviejų procedūrų rijimas tapo normalus, toliau procedūros tęstos ambulatoriškai, praėjus 3 mėn. rijimas išliko normalus. Išvada Anastomozės striktūros dilatacija Folley kateteriu yra saugus, veiksmingas ir pigus metodas. Reikšminiai žodžiai: stemplės vėžys, anastomozės striktūra, dilatacija The treatment of the benign esophagus anastomosis strictures Eugenijus Stratilovas, Egidijus SangailaVilnius University, Institute of Oncology, Department of Generaland Abdominal Surgery and Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background One of the most frequent late complications after the resectable type of esophageal surgery is benign anastomosis stricture. The subsequent dysphagia worsens the patients’ quality of life for a long time. The main treatment modalities for this complication remain frequent endoscopy, dilatation using weighted bougies under anesthesia. Authors recommend use a simple mode of treatment – dilatation with the Folley catheter. Results Four patients underwent the treatment. All patients felt well, there were no treatment complications. Swallowing after two procedures became normal, the treatment was continued in outpatient clinic; after three months the swallowing was good. Conclusions Dilatation of a stricture with the Folley catheter is a safe and cost-effective method. Key words: esophageal cancer, anastomosis benign stenosis, dilatation