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PubMed1991

Trends in cancer mortality, France 1950-1985.

Trends in mortality for main cancer sites in France between 1950 and 1985 are presented by sex. In the population aged 35-65, where long term trends can most reliably be assessed, an overall 1.1% mean annual increase is observed for males and a 0.6% mean annual decrease is observed for females. For males, this increase in total cancer mortality is mostly due to the sites associated with tobacco and alcohol. The important increase for lung cancer, and lesser increases for bladder, pancreas and kidney cancers are related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. For cancer sites associated with alcohol and tobacco, namely oesophagus, pharynx, larynx, tongue and mouth, mortality is increasing similarly for males and for females, although these cancers are much less frequent among females. For females, the overall moderate decrease is mostly due to the decrease in cervix and stomach cancer mortality, uncompensated by the observed increase in breast cancer; there is no marked increase in lung cancer mortality for women, contrary to what is observed in other Western countries.

Adult↗
PubMed2001

Primary digestive Richter's syndrome.

The clinical and morphologic transformation of 3 to 5% of chronic lymphocytic leukemia (CLL) to diffuse large-cell lymphoma (DLCL) is commonly referred to as Richter's syndrome. Richter's syndrome occurs mostly in lymph nodes and may represent a second neoplasm or a transformation from the same clonal population. Clinical features in six patients with digestive Richter's syndrome were recorded. Paired samples of CLL and DLCL were investigated by immunohistological analysis (n = 6) and by polymerase chain reaction (PCR) for immunoglobulin heavy-chain gene rearrangement (n = 4). Histological examination revealed the involvement of the gastrointestinal tract by DLCL of B-cell phenotype (n = 6). The same monoclonal rearrangement between CLL and DLCL was demonstrated by PCR and sequencing analyses in two patients. The monoclonal rearrangement was different between CLL and DLCL in only one case. Median survival was 22 months for five patients receiving chemotherapy, suggesting that digestive Richter's syndrome has a better prognosis than nodal Richter's syndrome. Indeed, appropriate surgical resection combined with chemotherapy led to partial or complete remission in four patients.

Aged↗
PubMed2004

Methylation pattern of CDH13 gene in digestive tract cancers.

Recently, the loss of CDH13 (T-cadherin, H-cadherin) gene expression accompanied by CDH13 promoter methylation was identified in colon cancers. We examined CDH13 methylation in oesophageal and gastric carcinomas. Five of 37 oesophageal cancers (14%) and 23 of 66 gastric cancers (35%) demonstrated abnormal methylation of the CDH13 promoter. Abnormal methylation was frequently found in gastric cancers of patients at all clinical stages just as in E-cadherin, another of the cadherin family, suggesting that these cancers could be methylated at an early stage. These results suggested that CDH13 might play a variety of roles depending on the tissue type.

Cadherins↗
PubMed1998

Circulating interleukin 6 concentrations and insulin resistance in patients with cancer.

BACKGROUND: The mechanism of insulin resistance in patients with cancer is not clear. This study was conducted to evaluate the possible role of circulating cytokines in inducing insulin resistance in patients with cancer. METHODS: Twenty-three patients with a variety of cancers were studied, including one patient with oesophageal cancer, 12 with gastric cancer, four with colon cancer and six with lung cancer. Six normal volunteers served as controls. Insulin resistance was evaluated by euglycaemic hyperinsulinaemic glucose clamp with a high physiological insulin concentration of 100 microunits/ml. Metabolized glucose, the M value, was compared between patients with cancer and controls. Serum concentrations of interleukin (IL) 6 and other cytokines (tumour necrosis factor (TNF) alpha, IL-8 and IL-10) were measured by enzyme-linked immunosorbent assay. RESULTS: The mean(s.d.) M value for patients with cancer (5.47(1.59) mg per kg per min) was significantly lower than that for controls (8.23(0.79) mg per kg per min) (P< 0.001). There was no relationship between the M value and degree of body-weight loss. Serum IL-6 concentration was measurable in eight of 23 patients: four with lung cancer, two with gastric cancer, and one each with oesophageal and colon cancer. None of the controls had a measurable serum IL-6 concentration. There was no significant relationship between serum IL-6 concentration and body-weight loss. TNF-alpha was undetectable in the serum of both patients with cancer and controls. Serum IL-8 and IL-10 were detected in seven and one of 23 patients respectively. These cytokines were not detected in the serum of controls. The M value was significantly smaller in those with measurable serum IL-6 (4.01(1.22) mg per kg per min) than in those with no measurable IL-6 (6.26(1.16) mg per kg per min) (P< 0.001). IL-6 and IL-8 levels were raised more frequently in the same patient but there was no significant relationship between IL-8 and M values. CONCLUSION: These results may suggest that IL-6 is related to insulin resistance in patients with cancer.

Aged↗
PubMed2002

Different patterns of 11q allelic losses in digestive endocrine tumors.

Most foregut digestive endocrine neoplasms may be associated with the multiple endocrine type 1 (MEN-1) syndrome. In contrast, midgut/hindgut carcinoids never show such association. To investigate the pathogenetic involvement of the MEN-1 gene and of putative additional oncosuppressor gene(s) distal to it, a comparative analysis of loss of heterozygosity (LOH) at chromosome 11q13 to 11qter was performed in 27 foregut (pancreatic endocrine tumors [PETs]), 23 midgut (ileal and appendiceal), and 3 hindgut (rectal) endocrine tumors. LOH at the MEN-1 gene locus at 11q13 was observed in 52% of the 23 sporadic and in all 4 MEN-1-associated PETs and was found to consistently and continuously span to the most distal marker investigated at 11qter. In contrast, only occasional, discontinuous, and mostly interstitial LOH for 11q markers was observed in ileal (midgut) carcinoids, whereas no LOH was found in all appendiceal (midgut) and rectal (hindgut) carcinoids. The consistent extension of LOH from the MEN-1 region to 11qter in sporadic PETs suggests a mechanism of gene inactivation via chromosomal breakage and complete loss of chromosome 11q; furthermore, these results expand beyond the 11q13 region the search for additional oncosuppressor gene(s) potentially involved in the genesis of these neoplasms. The low frequency, limited extension, and discontinuous distribution of 11q deletions in midgut/hindgut carcinoids suggest that MEN-1 gene is not involved in the pathogenesis of these tumors.

Adult↗
PubMed2000

The use of laparoscopic ultrasonography in staging abdominal malignancy.

The merit of intraoperative ultrasonography in abdominal surgery has been recognized for several decades and has been well documented in the literature. With the proliferation of laparoscopic abdominal surgery, laparoscopic ultrasonographic technology rapidly developed and studies have confirmed its value in staging intra-abdominal malignancy. The combination of diagnostic laparoscopy and laparoscopic ultrasonography has been shown to be consistently superior to other preoperative imaging modalities in the staging of abdominal malignancy. Consequently there has been an improvement in the management of patients with abdominal malignancy, demonstrated by reductions in nontherapeutic laparotomies, improved resectability rates, and optimization of palliation.

Abdominal Neoplasms↗
PubMed2000

A novel method of virtual histopathology using laser-scanning confocal microscopy in-vitro with untreated fresh specimens from the gastrointestinal mucosa.

BACKGROUND AND STUDY AIMS: Histopathological examination for superficial gastrointestinal lesions has been mainly based upon the light microscopic examination of thin-slice specimens with hematoxylin and eosin (H&E) staining. However, it takes at least a couple of days to create a slide-glass for microscopic study. In order to obtain immediate microscopic images for untreated specimens, the authors used laser-scanning confocal microscopy (LCM) to study fresh samples of gastrointestinal mucosa. MATERIALS AND METHODS: Fresh untreated mucosal specimens from the esophagus, stomach, and colon, obtained by endoscopic pinch biopsy, polypectomy, or endoscopic mucosal resection (EMR), were fixed in normal saline and examined by LCM collecting the reflective light of a 488-nm wavelength argon laser beam. Findings from the LCM image were compared with those of conventional H&E staining in all specimens. For objective evaluation of the similarity of both pictures, the nucleus-to-cytoplasm ratio (N/C) of normal mucosa and that of cancer of the esophagus were calculated and statistically analyzed. The overall diagnostic accuracy for cancer was evaluated. RESULTS: The average scanning time to obtain the LCM image of a specimen was 1.6 seconds. The LCM images acquired corresponded well to the conventional H&E light microscopic images in the esophagus, stomach, and colon. Cell wall, nucleus, cytoplasm, and tissue structural elements were simultaneously visualized by LCM scanning. A difference in N/C ratios between normal mucosa and cancer in the esophagus was statistically apparent when Welch's test (P=0.05) was applied. The overall diagnostic accuracy of the LCM study for cancer was 89.7%. CONCLUSIONS: This novel method enables us to obtain an immediate serial virtual microscopic section through a fresh specimen, which has not actually been cut, although the resolution of the image obtained is still limited. These early results encourage us to develop imaging relevant to conventional histopathology alongside the development of LCM technology in the near future. We should aim at the in vivo application of LCM coupled to probes which can be introduced through the working channel of endoscopes.

Colon↗
PubMed2000

Minimally invasive surgery: hepatobiliary-pancreatic and foregut.

This review is confined to the liver, biliary tract, pancreas, and foregut (oesophagus and stomach). The issues relating to laparoscopic cholecystectomy mainly concern the bile duct injuries associated with this operation. This review provides some evidence that although the risk for this iatrogenic injury is declining, it continues to be a problem and is accompanied by significant morbidity, mortality, and a huge escalation in care costs. Laparoscopic clearance of ductal stones is undoubtedly safe and effective, and issues have now focused on comparisons between this form of management and orthodox endoscopic clearance. Laparoscopic cardiomyotomy may well replace other forms of treatment of achalasia, including balloon dilation and botulinum toxin injection. As the results of laparoscopic antireflux surgery have been so good in the medium term, the question of medical versus laparoscopic treatment is being addressed by two randomized clinical trials. Gastric resection is established only in respect of excision of mesenchymal tumours. Gastric surgery for advanced gastric cancer must still be regarded as developmental. Laparoscopic liver resections and in situ ablation are still confined to developing centres, but the early results are promising. However, simpler hepatic procedures, such as de-roofing of symptomatic simple hepatic cysts, are well established and in widespread practice. Only a few centres have published their results on laparoscopic pancreatic surgery. The early reported outcome for internal drainage of pancreatic pseudocysts, enucleation of benign insulinomas, and distal pancreatic resections has been good, but the experience is limited.

Bile Duct Neoplasms↗
PubMed2002

Technical modifications and strategies for stenting gastric outlet strictures using esophageal endoprostheses.

BACKGROUND AND STUDY AIMS: The outcome of stenting gastric outlet stricture is favorable compared with a bypass operation which has significant morbidity and mortality. In Japan, this procedure is particularly complicated by a lack of enteral stents. We report some technical stratagems for stent placement for gastric outlet strictures. PATIENTS AND METHODS: Between February 1993 and July 2001, 23 patients with gastric outlet strictures (14 men, nine women; mean age 72 years) underwent stent placement using an esophageal stent system. The Ultraflex or Z-stents were used in 18 or five patients, respectively. With the Ultraflex, we increased the length of the delivery system. Some patients underwent stent placement with the help of endoscopic assistance with a grasping forceps or a home-made sheath. RESULTS: The metal stent was successfully inserted in all patients. There were no complications during the procedure. Migration occurred in two out of five patients treated with the Z-stent, whereas there was no migration in patients treated with the Ultraflex stent. In two patients, curable pancreatitis was caused by pressure on the duodenal papilla. One of these patients also experienced bile stasis which required biliary decompression. There were three cases of obstruction, caused by tumor ingrowth (1), hyperplasia (1) and stent fracture (1); recanalization by an additional stent placement and/or cutting stent filaments was successful. All the patients died, with a median survival period of 52 days. There was no procedure-related mortality. CONCLUSIONS: With some technical modification, stent placement for gastric outlet stricture, even using an esophageal stent, is feasible. This procedure offers good palliation with no major complications.

Adult↗
PubMed2003

Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy.

BACKGROUND AND STUDY AIMS: The mortality rate for surgical revision of gastroesophageal anastomotic leakage after resection for cancer approximates 60 %. The efficacy of endoscopically placed covered metallic stents for treatment of gastroesophageal leakage was evaluated. PATIENTS AND METHODS: Between June 1996 and June 2002 we treated 21 patients with proven gastroesophageal leakage; 18 had anastomotic leakage and three patients had perforation for different reasons. The extent of the leaks ranged from one-quarter of the intestinal circumference to its complete dehiscence. The average time from surgery to detection of leakage was 6.1 days (range 3 - 15 days). Mortality, healing rate, length of hospital stay, and complications were assessed. RESULTS: The insertion of stents was performed endoscopically under radiological guidance without any complication in all patients. In 9.5 % (2/21) of patients complete sealing of the leak was not achieved. The mortality associated with anastomotic leakage was 23.8 % (5/21). In 80.1 % (17/21) patients complete healing of the leakage was achieved. The average hospital stay was 67 days (range 14 - 158 days). Of 23 stents, 13 (56.5 %) were removed, and three patients developed stenosis after removal. CONCLUSION: The treatment of gastroesophageal leakage with covered stents appears to reduce mortality and the complication rate associated with major leakage. Therefore this technique seems to be a reasonable alternative in the treatment of clinically relevant anastomotic leakage.

Adult↗
PubMed2003

Endoscopic tumor diagnosis and treatment.

The abstracts from this year's Digestive Disease Week (DDW) show that endoscopic is consistently playing a prominent role in current gastroenterology. The topic of tumor diagnosis and treatment overlaps considerably with other review areas - e. g., endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. This review therefore focuses on the following topics: enhanced imaging, endoscopic mucosal resection (EMR), and palliative stent therapy. Endoscopy with tissue sampling is increasingly becoming an integral part of transitional research, in collaboration with molecular biologists and geneticists, among others. This role is unlikely to be challenged by any of the rapidly improving pure imaging modalities, and may well become a core role for endoscopy in the years to come. Abstracts from this category are not included in this overview.

Clinical Trials as Topic↗
PubMed2004

Eyes wide shut.

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Digestive System Neoplasms↗
PubMed1984

[CA 12-5 in cancer of the digestive tract. A comparison with CA 19-9 and CEA in cancer of the pancreas and colon].

In 42 control subjects and 134 patients with benign or malignant disease of the pancreas or large intestine, the recently produced tumour-associated antigen CA 12-5 was determined together with CEA and CA 19-9. Only 4% of controls and patients with benign disease (except those with acute pancreatitis) had CA 12-5 values above 35 U/ml, compared with 60% of patients with pancreas carcinoma and 21% with colon carcinoma. For the former (pancreas carcinoma) there was also a good correlation to stage of tumour (0 of 6 tumours stage TxN0M0, 7 of 11 TxN1M0, 16 of 20 TxN1M1 greater than 35 U/ml) and progression of the malignancy. Simultaneous determination of all three antigens increased the rate of tumour-marker positive patients from 87% (CA 19-9) to 92% for pancreas carcinoma and from 25% (CEA) to 51% for colon carcinoma.

Acute Disease↗
PubMed2001

Prospective evaluation of balloon-sheathed catheter US system.

BACKGROUND: Catheter US probes must rely on luminal water to create images because they do not incorporate a water-filled balloon such as that used with a designated echoendoscope. The purpose of this study is to determine the effectiveness and safety of a balloon sheath for the US catheter system. METHODS: Catheter EUS was performed on 50 patients by using a 2.3 mm 12 MHz or 20 MHz catheter probe. Catheter EUS was used in 47 cases, and a newly developed water-filled balloon sheath was used in 41 cases. Both devices were used in 39 cases. Procedure time, depth of ultrasound penetration, and a subjective assessment of image quality and ease of use were recorded, along with TMN stage as applicable. Catheter EUS findings were confirmed with a standard radial scanning echoendoscopy (S-EUS) in 18 cases. RESULTS: Catheter probe EUS (C-EUS) and catheter probe plus balloon (CB-EUS) imaging was obtained of 25 esophageal, 8 gastric, 4 rectal, 1 biliary, and 1 duodenal lesion. Time required for the ultrasound portion of the examination was identical with C-EUS and CB-EUS. Depth of penetration increased with CB-EUS with both the 12 MHz and 20 MHz probes (p < 0.05). Subjective assessment of image clarity improved when CB-EUS was used in the esophagus. C-EUS failed to identify 2 esophageal cancers and 2 sets of paraesophageal lymph nodes, and understaged 1 esophageal cancer. The remaining 14 cancers were staged identically by both modalities. The catheter probes with and without the balloon sheath were easy to use, even in markedly narrow esophageal strictures. CB-EUS did not significantly improve resolution in the stomach or rectum. S-EUS confirmed findings of CB-EUS in all 18 cases in which both instruments were used. There were no procedure-related complications. CONCLUSIONS: For esophageal lesions, CB-EUS improves images compared with C-EUS, and enhances depth of penetration without prolonging or encumbering the examination. CB-EUS offers no advantage over C-EUS in organs other than the esophagus. S-EUS, when possible, remains the preferred imaging modality for esophageal cancers because of the ability to image the celiac axis and other deep structures.

Catheterization↗
PubMed2001

EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice.

BACKGROUND: This study assesses the cost savings associated with using endoscopic ultrasound (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) for evaluating patients with suspected obstructive jaundice. METHODS: One hundred forty-seven patients with obstructive jaundice of unknown or possibly neoplastic origin had EUS as their first endoscopic procedure. With knowledge of the final diagnosis and actual management for each patient, their probable evaluation and outcomes and their additional costs were reassessed assuming that ERCP would have been performed as the first endoscopic procedure. Also calculated were the additional costs incurred if EUS were unavailable for use after ERCP and had to be replaced by computed tomography or other procedures. RESULTS: The final diagnoses in these patients included malignancies (65%), choledocholithiasis or cholecystitis (18%), "medical jaundice" (11%), and miscellaneous benign conditions (6%). Fifty-four percent had EUS-guided fine-needle aspiration but only 53% required ERCP after EUS. An EUS-first approach saved an estimated $1007 to $1313/patient, but the cost was $2200 more if EUS was unavailable for use after ERCP. Significant savings persisted through sensitivity analysis. CONCLUSIONS: Performing EUS with EUS-guided fine-needle aspiration as the first endoscopic procedure in patients suspected to have obstructive jaundice can obviate the need for about 50% of ERCPs, helps direct subsequent therapeutic ERCP, and can substantially reduce costs in these patients.

Adult↗
PubMed1997

Adenocarcinoma cells are targeted by the new GnRH-PE66 chimeric toxin through specific gonadotropin-releasing hormone binding sites.

Luteinizing hormone-releasing hormone, also termed gonadotropin-releasing hormone (GnRH), accounts for the hypothalamic-pituitary gonadal control of human reproduction. The involvement of GnRH has been demonstrated in several carcinomas of hormone-responsive tissues. Exploiting this common feature, we constructed a Pseudomonas exotoxin (PE)-based chimeric toxin (GnRH-PE66) aimed at targeting those cancer cells bearing GnRH binding sites. We report here the strong growth inhibition and killing of a surprisingly wide variety of cancers, confined to the adenocarcinoma type. These cancer cells arising from hormone-responsive tissues, as well as non-responsive ones, express specific GnRH binding sites as indicated by the marked killing of ovarian, breast, endometrial, cervical, colon, lung, hepatic, and renal adenocarcinoma. This cytotoxicity is specific as it could be blocked upon addition of excess GnRH. The specificity of GnRH-PE66 chimeric toxin was also confirmed by GnRH binding assays, and its ability to prevent the formation of colon cancer xenografts in nude mice is presented. Although the functional role of specific GnRH binding sites in human carcinomas remains obscure, GnRH-PE66 displays considerable targeting potential and its use as a therapeutic agent for cancer should be considered.

ADP Ribose Transferases↗