Breast cancer metastasizing to the upper gastrointestinal tract(the esophagus and the stomach):A comprehensive review of the literature

Breast cancer can infrequently metastasize to the upper gastrointestinal(GI)tract but the exact incidence is not well established-there is considerable variation between incidence reported from clinical studies and incidence noted in autopsy series.Clinical presentation can be very non-specific and often mimics primary gastrointestinal conditions.Endoscopy alone may not be sufficient to make a diagnosis and misdiagnosis is also common.A high degree of awareness and clinical suspicion is required to establish metastases to the upper GI tract.We undertook a comprehensive review of the available literature on breast cancer metastases to the esophagus and stomach including the clinical symptoms and presentation,endoscopic features,additional diagnostic imaging modalities,treatment and outcomes.

Impact of sleep on gastrointestinal cancer

Sleep problems have become a significant public health concern,affecting a large portion of the global population and have been linked to increased morbidity and mortality.The incidence of gastrointestinal(GI)cancers continues to rise,posing a substantial burden on healthcare systems worldwide.This editorial aims to delve into the impact of sleep on GI cancers,including esophageal,gastric,colorectal,hepatobiliary,and pancreatic cancer.Recent literature investigating the potential connections between GI cancers and sleep was reviewed.We considered aspects such as sleep duration,sleep disorders,and circadian rhythmicity,in order to explore the underlying mechanisms that can contribute to the development of GI cancers and propose avenues for future research.

Time trends of incidence of digestive system cancers in changle of China during 1988-2002

AIM： To analyze the incidence of digestive system cancer in Changle of China over a 15-year period. METHODS： The datasets were presented as timeseries of China-standardized annual incidence during 1988-2002. Linear regression model was used to analyze the incidence of stomach, liver, esophagus and colorectal cancers. RESULTS： Linear regression models for the time-series of stomach and esophagus cancer incidences for both men and women were statistically significant （P 〈 0.05）; Regression models for liver cancer and for colorectal cancer were statistically significant for men （P 〈 0.05）. CONCLUSION： The incidence rates of stomach and esophagus cancers for both men and women had down tendencies. For men, liver cancer had a down trend of the incidence and colorectal cancer had an upward trend of the incidence rate.

Esophageal mucosal metastasis from adenocarcinoma of the distal stomach

Dissemination of gastric cancer may usually occur by direct spread through the perigastric tissues to adjacent organ, lymphatic spread, and hematogenous spread. We report a rare case of gastric cancer with mucosal metastastic lesion on the upper esophagus that was diagnosed by endoscopy and endosonography. A biopsy of the esophageal mass was performed and the pathologic findings with immunohistochemical stain for Mucin-5AC are proved to be identical to that of gastric adenocarcinoma, suggesting metastasis from main lesion of the gastric cancer. The lesion could not be explained by lymphatic or hematogenous spread,and its metastasis mechanism is considered to be different from previous studies. We suggest that the gastroesophageal reflux of cancer cells could be one of the possible metastatic pathways for metastasis of esophagus from an adenocarcinoma of the stomach.

Determination of esophageal squamous cell carcinoma and gastric adenocarcinoma on raw tissue using Raman spectroscopy

BACKGROUND Cancer detection is a global research focus,and novel,rapid,and label-free techniques are being developed for routine clinical practice.This has led to the development of new tools and techniques from the bench side to routine clinical practice.In this study,we present a method that uses Raman spectroscopy(RS)to detect cancer in unstained formalin-fixed,resected specimens of the esophagus and stomach.Our method can record a clear Raman-scattered light spectrum in these specimens,confirming that the Raman-scattered light spectrum changes because of the histological differences in the mucosal tissue.AIM To evaluate the use of Raman-scattered light spectrum for detecting endoscopically resected specimens of esophageal squamous cell carcinoma(SCC)and gastric adenocarcinoma(AC).METHODS We created a Raman device that is suitable for observing living tissues,and attempted to acquire Raman-scattered light spectra in endoscopically resected specimens of six esophageal tissues and 12 gastric tissues.We evaluated formalin-fixed tissues using this technique and captured shifts at multiple locations based on feasibility,ranging from six to 19 locations 200 microns apart in the vertical and horizontal directions.Furthermore,a correlation between the obtained Raman scattered light spectra and histopathological diagnosis was performed.RESULTS We successfully obtained Raman scattered light spectra from all six esophageal and 12 gastric specimens.After data capture,the tissue specimens were sent for histopathological analysis for further processing because RS is a label-free methodology that does not cause tissue destruction or alterations.Based on data analysis of molecular-level substrates,we established cut-off values for the diagnosis of esophageal SCC and gastric AC.By analyzing specific Raman shifts,we developed an algorithm to identify the range of esophageal SCC and gastric AC with an accuracy close to that of histopathological diagnoses.CONCLUSION Our technique provides qualitative information for real-time morphological diagnosis.However,further in vivo evaluations require an excitation light source with low human toxicity and large amounts of data for validation.

Endoscopic resection of superficial gastrointestinal tumors

Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

Carcinoma of the gastroesophageal junction in Chinese patients

Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to BE.As such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients.The emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of EA.In conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA.Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.

Burden of six major types of digestive system cancers globally and in China

Background:Digestive system cancers constitute a significant number of cancer cases,but their burden is not uniform.As Global Cancer Observatory(GLOBOCAN)2022 has recently updated its estimates of cancer burden,we aimed to investigate the burden of six major digestive system cancers both worldwide and in China,along with geographical and temporal variations in cancer-specific incidence and mortality.Methods:We extracted data on primary cancers of the esophagus,stomach,colorectum,liver,pancreas,and gallbladder from the GLOBOCAN database for 2022.Age-standardized incidence and mortality rates were calculated and stratified by sex,country,region,and human development index(HDI).We used the 2022 revision of the World Population Prospects(United Nations)to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change(AAPC)to analyze cancer incidence trends in China.Results:In 2022,the estimated global incidence of digestive system cancers reached 4,905,882,with an estimated 3,324,774 cancer-related deaths.Colorectal cancer was most prevalent in terms of incidence and mortality.There was a significant correlation between the burden of gastrointestinal cancers and country HDI.From 1988 to 2012,the incidence of esophageal,gastric,and liver cancers declined in China,whereas colorectal and pancreatic cancer incidences continued to increase.By 2050,colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality,respectively.Conclusions:Digestive system cancers remain a significant public health challenge globally and in China.Although progress has been made in the prevention and control of some cancers,the burden of digestive system cancers persists.The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers,mitigating their impact on public health.

Bile acids as endogenous etiologic agents in gastrointestinal cancer

Bile acids are implicated as etiologic agents in cancer of the gastrointestinal (GI) tract, including cancer of the esophagus, stomach, small intestine, liver, biliary tract, pancreas and colon/rectum. Deleterious effects of bile acid exposure, likely related to carcinogenesis, include: induction of reactive oxygen and reactive nitrogen species; induction of DNA damage; stimulation of mutation; induction of apoptosis in the short term, and selection for apoptosis resistance in the long term. These deleterious effects have, so far, been reported most consistently in relation to esophageal and colorectal cancer, but also to some extent in relation to cancer of other organs. In addition, evidence is reviewed for an association of increased bile acid exposure with cancer risk in human populations, in specific human genetic conditions, and in animal experiments. A model for the role of bile acids in GI carcinogenesis is presented from a Darwinian perspective that offers an explanation for how the observed effects of bile acids on cells contribute to cancer development.

Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

AIM： To investigate the clinicopathologic features which predict surgical overall survival in patients with proxima gastric carcinoma involving the esophagus （PGCE）. METHODS： Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pa- thology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were se- lected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, accord- ing to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospec- tive analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori （H. pylon} infection, surgical modality, Siewert type, tumor Bormann＇s type, size, dif- ferentiation, histology type, surgical margin, lympho- vascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognos- tic factors for overall survival were assessed with uni- and multi-variate analyses. RESULTS： Patients＇ mean age was 65 years （range： 47-90 years）. The male： female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann＇s type, size, histology type, surgical modality, positive surgical margin, lym- phovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion （P = 0.003）, poor differentiation （P = 0.0003）, 〉 15 to- tal lymph nodes retrieved （P = 0.008）, positive lymph nodes （P = 0.001）, and distant metastasis （P = 0.005） predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival （P = 0.007）. By multivariate analysis, ≥ 16 positive nodes （P = 0.018）, lymph node ratio 〉 0.2 （P = 0.003）, and overall pathologic stage （P= 0.002） were independent predictors for poor overa survival after resection. CONCLUSION： Patients with PGCE showed worse over- all survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.

食管癌、胃癌常用筛查诊断方法比较

在食管癌、胃癌高发区农村,对35岁以上男女476人,采用同步盲法依次应用肿瘤耳部信息诊断仪、隐血珠、拉网细胞学、胃镜、刷片、组织学活检6种方法进行了筛查诊断,并应用判定矩阵统计学方法对其敏感性、特异性、符合率、正确指数、阳性预报值、阴性预报值等14项指标进行了综合评价.结果表明食管拉网细胞学检查是普查发现食管癌、贲门癌的较好方法.应用纤维胃镜直视、刷片或活检对于明确诊断有重要作用,但也有一定局限性.对每项检查的费用和效益进行了综合分析,并对普查和临床应用提出了建议.

人发5种元素与食管癌胃癌发病关系的前瞻性研究

在食管癌胃癌高发区对１２３０人进行的５年前瞻性研究表明，吸烟是发病的危险因素之一（ＯＲ＝３．４１），而豆品消费则是一种保护性因素（ＯＲ＝０．２３）。用原子吸收技术对发病前的头发元素分析显示，病例组发Ｃａ、Ｍｇ、Ｆｅ和Ｚｎ水平较未患癌的正常对照者低；吸烟组的发Ｃａ、Ｍｇ和Ｃｕ水平较不吸烟者低；而豆品多消费组的发Ｃａ、Ｍｇ、Ｆｅ和Ｃｕ水平则较少消费者高，均有统计学差异。

猴头菇药效研究

1974年起作者对猴头菇的药效进行了系统的研究.研究探明,猴头蔬具有提高税体耐缺氧能力,提高心血输出量,加速血液循环,抑制肿泪细胞生长等作用.治疗胃,肠溃疡、各种胃炎的有效率达87. 7％,治疗胃、食道癌的有效率达69. 3 ％,治疗冠心病心绞痛的有效率达76. 9％。

叶丽红教授治疗噎膈经验

[目的]总结叶丽红教授治疗噎膈的临床经验。[方法]通过临床跟诊,收集整理相关资料,从噎膈的病因病机、治则治法等方面探讨其治疗本病的经验,归纳用药规律,并予病案佐证。[结果]叶师认为,阴津亏耗是噎膈发生、发展的关键,气滞、痰凝、血瘀相互搏结,阻滞食管,胃失通降而致本病。叶师在治疗中主张以扶正祛邪为治则,采用理气降逆、祛痰化瘀的方法辨证施治,尤其重视滋润通降、运用经方及虫类药。所举病案以胃阴不足为主要病机,夹有痰瘀之邪,治疗以益胃养阴、祛痰化瘀、和降胃气为主,兼以抗癌解毒散结,获得良效。[结论]叶丽红教授认为噎膈本虚而标实,阴虚为本,气滞、痰阻、血瘀为标,强调噎膈的治疗以扶正为本、祛邪为辅,临床疗效显著,对指导中医药的临床工作意义重大。

颈胸腹3切口治疗中晚期高位食管癌124例临床研究

为扩大中晚期高位食管癌手术适应证，提高远期效果，采用右进胸全食管切除、胸骨后全胃代食管、颈部食管（咽）胃吻合重建（简称本组或三野手术）。与同期左胸左颈手术组对照（简称对照组或二野手术），并经统计学处理。结果：右进胸７３例，肿瘤切除完成三野手术７０例，切除率９５．９％（７０／７３），术后并发症４例（５．７％），死亡１例（１．４％），近期治愈率９８．６％（６９／７０）。远期随访１、３、５、１０ａ存活率分别为８９．８％（６２／６９）、５８．９（４１／６９）、５５％（３８／６９）、２０％（１４／６９）。对照组６２例，肿瘤切除完成二野手术５４例，切除率８７．１％（５４／６２），术后并发症８例（１４．８％），死亡２例（３．７％）。远期随访１、３、５、１０ａ存活率分别为７７．７％（４０／５２）、５０．０％（２６／５２）、３４．６％（１８／５２）、１１．０％（６／５２）。两组差异显著（Ｐ＜０．０１）。表明：右进胸三野手术肿瘤切除率高，开胸时间短，对心肺功能干扰小，术后并发症少，淋巴结清扫彻底且安全，远期效果较二野手术好。

关于加强肿瘤医院食管、胃、肺、乳腺癌治疗规范化建设的研究

目的为提高恶性肿瘤治疗的规范化水平。方法对照卫生部肿瘤防治办公室组织编写的《中国恶性肿瘤诊治规范》和国际抗癌联盟编写的《临床肿瘤手册》第５版，分析本院１９８１～１９９７年对食管、胃、肺、乳腺癌四种主要恶性肿瘤计２８５３４例患者的手术、放疗、化疗及其它抗癌治疗的情况。结果发现了一些在今后肿瘤医疗工作中切待改进和加强的方面。

改良MTT法检测胃癌及食管癌细胞的体外药物敏感率

目的 研究胃癌、食管癌细胞对常用化疗药物的敏感率 ,为临床选择有效的化疗药物提供参考。方法 应用化疗药敏改良MTT法测定 4 2例胃癌、16例食管癌的癌细胞对氮芥等化疗药物的敏感率。结果 1种化疗药物对同一种肿瘤不同个体的抑制率不同 ,化疗药物对不同肿瘤抑制率不同。结论 不同肿瘤及同一种肿瘤的不同个体对化疗药物的敏感率有明显差异 ,建议临床参照肿瘤药敏实验结果 。

胸内或食管床食管胃吻合术对动脉血气的影响

食管中段、下段癌根治术常采用胃食管弓上吻合.由于较大的胸胃,占据左侧胸腔,而造成患者术后一系列的不适.作者通过44例行食管胃主动脉弓上吻合者,采用随机分组对照的方法,分别进行了胃与食管的左胸和食管床途径行食管胃弓上吻合.通过术前和术后的动脉血气分析以了解二种术式对动脉血气的影响.结果表明:PO_2两组术前和术后相比,均有下降(P<0.01);但术后二组相比,食管床组优于左胸内组(P<0.05);而 PCO_2两组术前、术后的下降值,均无显著差异.

管状胃重建消化道在食管癌手术中的应用进展

食管癌作为威胁全球人类的健康问题而备受关注。相比传统的全胃代食管手术,管状胃重建消化道在食管癌手术中可以明显促进胃排空、使吻合口狭窄发生率下降、进而使反流性食管炎和胃食管反流等术后并发症得以减少,同时还减轻对心肺的压迫、减少术后胸胃综合征。因此,在不延长患者手术以及术后的住院时间、手术也相对较安全的基础上,管状胃较传统全胃代食管更能显著地改善食管癌患者术后的生活质量,提高食管癌患者的生存率,防止复发和转移。本文就管状胃重建消化道在食管癌手术中运用的相关内容做一综述。