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PubMed2001

[Intra-operative radiation therapy in tumors of the digestive tract].

All the retrospective and prospective studies concerning IORT in tumors of the digestive tract tend to substantiate a significant improvement in local control without a significant increase in survival. Improvements in the results of IORT can be expected in the near future, and may occur on several fronts: - Technological improvements: advances in the development of IORT machines, with the construction of electron accelerators specifically designed for IORT; greater precision in the systems of collimation (asymmetric collimator, multiple leaves, computerization of the control of collimation); and increased adaptability of the localizers to each clinical situation and to each patients. - Increase in the biological effects of IORT: determination of the exact role of IORT in relation to other therapeutic methods, its integration into the global therapeutic strategy for cancer, and the optimization of IORT doses should all be studied in phase II and III trials. Interesting results are expected from the combination of different methods of preoperative, intraoperative, and postoperative radiotherapy with chemotherapy; the cumulative effect of radiosensitization and cytotoxicity can bring about both local control and treatment of the general disease. In addition, the combination of hypoxic cell radiosensitizers and IORT, a source of important cellular hypoxia as a result of single doses, appears promising. - Lastly, randomized studies in a larger number of patients with objectives and methodologies to be perfected will document the actual contribution of IORT to an increase in survival as part of an overall treatment strategy for digestive tumors. At present, the prognosis remains significantly related to systemic metastatic evolution; this can only be influenced by chemotherapy, whose efficacy remains to be demonstrated. As means for better control of systemic disease are discovered, the clear benefits of local control via IORT will assume increased importance.

Biliary Tract Neoplasms↗
PubMed1991

[Endoscopic ultrasonography of the digestive tract].

Endoscopic ultrasonography of the digestive tract provides for a precise ultrasonic study of the accessible gastrointestinal walls (oesophagus, stomach, duodenum, rectum) and, through these walls, of the adjacent organs (lymph node clusters, posterior mediastinum, pancreas, extrahepatic biliary ducts and perirectal environment). This method is better than computerized tomography to evaluate the local and regional extension of oesophageal and cardial carcinomas producing little or no stenosis and of gastric and rectum carcinomas and lymphomas. It is the examination of choice to detect a peri-anastomotic recurrence of these cancers and to evaluate submucosal tumors of the digestive tract. This method, without morbidity is better than computerized tomography or ultrasonography in the aetiological diagnosis of obstacles in the biliary tract and in the diagnosis and pretherapeutic assessment of pancreatic cancers or endocrine tumors.

Biliary Tract Diseases↗
PubMed1989

[Study of the morbidity structure by analyses of data from 6668 autopsied cases].

In a retrospective study, autopsy data of 6668 cases were collected from the first affiliated hospital, West China University of Medical Sciences, to assess the changes in autopsy rate between 1952 and 1987. The autopsy rate of dead patients was 14.3%, with two peaks obtained in the periods of 1954-1956 and 1964-1966 respectively. Anyhow, the autopsy rate declined sharply after 1967. The agreement of clinical diagnosis and pathological findings in this group was 68.9%. The most common diseases in this series were infectious and parasitic diseases' diseases of respiratory system, diseases of digestive system, neoplasms and diseases of cardio-vascular system. Accompanying the increase of age of the autopsied patients, neoplasia and cardio-vascular diseases were more frequently seen in this series.

Autopsy↗
PubMed1991

Endoscopic ultrasonography of the upper gastrointestinal tract.

EUS unites two established imaging techniques and extends the range of observation into and beyond the wall of the GI tract. The close proximity of the sonographic probe to the region of interest combined with high ultrasonic frequencies of between 7.5 and 12 MHz yields images of high resolution. EUS is used in the staging of benign and malignant neoplastic disorders of the oesophagus, stomach, pancreas and extrahepatic bile ducts. It helps to establish operability, to plan surgical approach, to follow response to therapy and to search for recurrence. The predictive value in defining the T and N stages of oesophageal carcinoma lies between 80 and 90% and 65 and 85%, respectively. It is clearly superior to CT in tumour stages T1 and T2. In gastric cancer, resectability based on the TNM staging system can be correctly assessed by EUS in 85% of cases and EUS detection and staging of early gastric cancer reaches an accuracy of 90%. The EUS accuracy rate for resectability of pancreatic carcinoma is 83% and tumour infiltration into the portal and splenic vein can be correctly determined by EUS in 94% and 67%, respectively. A reliable EUS differentiation between chronic pancreatitis and pancreatic carcinoma based on the echo pattern and outer margins is not possible. The development of EUS-guided needle biopsy should improve the specificity of EUS in this regard. Experience to data suggests as well that EUS will assume an important place in the staging of bile duct tumours. EUS has expanded our endoscopic and sonographic capabilities and it is to be hoped that further technical improvement, e.g. the construction of forward-viewing endoscopes combined with radial scanning devices, will contribute to a widespread use of this technique by gastroenterologists.

Contraindications↗
PubMed2005

Update on the paris classification of superficial neoplastic lesions in the digestive tract.

BACKGROUND AND STUDY AIMS: Neoplastic lesions in the digestive-tract mucosa are termed "superficial" when the depth of invasion is limited to the mucosa and submucosa. The endoscopic appearance has a predictive value for invasion into the submucosa, which is critical for the risk of nodal metastases. MATERIALS AND METHODS: The endoscopic morphology of superficial lesions can be assessed with a standard video endoscope after spraying of a dye--an iodine-potassium iodide solution for the stratified squamous epithelium, or an indigo carmine solution for the columnar epithelium. In 2002, a workshop was held in Paris to explore the relevance of the Japanese classification. The conclusions were revised in 2003 in Osaka in relation to the definition of the subtypes used in endoscopy and the evaluation of the depth of invasion into the submucosa. In Japan, the description of advanced cancer in the digestive-tract mucosa using types 1 - 4 is supplemented by a type 0 when the endoscopic appearance is that of a superficial lesion. Type 0 is divided into three categories: protruding (0 - I), nonprotruding and nonexcavated (0 - II), and excavated (0 - III). Type 0 - II lesions are then subdivided into slightly elevated (IIa), flat (IIb), or depressed (IIc). Nonprotruding depressed lesions are associated with a higher risk of submucosal invasion. After endoscopic resection, invasion into the submucosa is an important criterion for the necessity of additional surgical resection. Micrometer analysis of the depth of invasion in the specimen is more precise, and distinct cut-off limits have been established in the esophagus, stomach, and large bowel. CONCLUSIONS: The morphology of superficial and nonprotruding neoplastic lesions is relevant to the prognosis. Following endoscopic detection, the lesions are analyzed using chromoendoscopy and assigned a subtype of the type 0 classification. The choice between endoscopic or surgical treatment is based on this description.

Digestive System Neoplasms↗
PubMed1994

Endoscopic techniques in gastrointestinal oncology.

Gastrointestinal endoscopy continues to play a significant role in gastroenterologic oncology. As a diagnostic tool, it has largely replaced radiology in diseases of the gastrointestinal tract because of its capability to provide a tissue diagnosis by endoscopic biopsy. The still-expanding therapeutic potential of gastrointestinal endoscopy represents the prototype of minimal invasive therapy. This review deals with relevant papers on diagnostic and therapeutic gastrointestinal endoscopy during the past 2 years. The abundance of studies renders a detailed discussion of all or even most of them impossible; therefore, only trends are shown. The reader is referred to the annotations in the reference list for more detailed information.

Adult↗
PubMedDate not supplied

Endoscopic ultrasound-guided fine-needle aspiration.

Thirty-eight consecutive patients underwent endoscopic ultrasound-guided fine-needle aspiration. Of 46 lesions, 34 were extraluminal (12 pancreatic masses, 8 periesophageal nodes, 6 celiac nodes, 2 pericolonic masses, 1 mediastinal mass, 1 perigastric mass, 1 liver, 1 periduodenal node, 1 perirectal mass, 1 perirectal node) and 12 were submucosal (8 gastric, 3 duodenal, 1 esophageal). One hundred sixty-three passes were made, with an average of 3.5 passes per lesion and 4.3 passes per patient (range, 1 to 8). Adequate specimens were obtained from 91% of targeted lesions. The overall diagnostic accuracy was 87%. In patients with malignant lesions, sensitivity was 91% and specificity 100%. Celiac nodes were successfully sampled and diagnostic in 5 of 6 (83%) patients. No complications occurred. Using this technique, an initial tissue diagnosis of malignancy was made in 66% of cancer patients without a previous diagnosis and the preoperative stage was changed in 44% of cancer patients. The additional information gained by this modality directly influenced the decision not to perform surgery in 26% of patients with a primary malignancy. Endoscopic ultrasound-guided fine-needle aspiration is feasible and can be safely used to evaluate submucosal and extraluminal lesions in both the upper and lower gastrointestinal tract with a high degree of diagnostic accuracy.

Adult↗
PubMed2004

[The clinical value of miniature ultrasonic probes on diagnosis and treatment of digestive tract diseases].

OBJECTIVE: To investigate the clinical value of miniature ultrasonic probes (MUP) in the diagnosis and treatment of digestive tract diseases. METHODS: 537 patients who were indicated for endoscopic ultrasorography (EUS) underwent EUS with 7.5 - 20 MHz MUP and double-cavity electronic endoscope. According to the diagnoses of MUP, those patients who presented the indication of treatment were treated by endoscopic resection or surgical excision respectively, the postoperative histological results were compared with the preoperative diagnoses of MUP. A follow-up with MUP was periodically made for a few patients without endoscopic resection or surgical excision. RESULTS: Among the 537 patients the diagnosis of gastrointestinal submucosal lesions was made in the 256 cases, polyp in 56 cases, inflammatory prominence in 37 cases, extrinsic compression 53 cases, digestive tract cancer 50 cases, peptic ulcer 17 cases, cholecystolithiasis 11 cases, chronic pancreatitis in 8 cases, and achalasia 2 cases and 47 cases were diagnosed as normal, After examination of MUP, 220 patients were treated by endoscopic resection or surgical excision respectively, the postoperative histological results of 211 patients were completely consistent with the preoperative diagnosis of MUP, and diagnostic accuracy of MUP was 95.9%. The result of follow-up with MUP indicated that gastrointestinal leiomyoma, lipoma, phlebangioma and cyst were unchanged within 1 - 2 years. The patients who were treated by endoscopic resection or centesis showed no complication. CONCLUSION: EUS with MUP is a valuable method in diagnosis of gastrointestinal submucosal lesions, staging of digestive tract cancer and diagnosis of biliary-pancreatic diseases. It plays a very important role for making scientific, effective, safe and economic therapeutic plan.

Adolescent↗
PubMed2001

Endoscopic mucosal resection.

We are now finding more malignancies in their early stages than previously. Attempts to ablate these lesions are difficult and do not provide the histological information required to decide on further treatment. Surgery is difficult to justify, as only a minority of lesions are associated with lymph node metastases and lesions may not become clinically relevant within the lifetime of an elderly patient. Endoscopic mucosal resection allows cancers to be resected at minimal cost, morbidity and mortality. It is also the most reliable investigation when assessing lesions which are suspicious for containing early cancer. After endoscopic removal, histological assessment of depth of penetration and a search for invasion into lymphatics or venules allows the risk of microscopic lymph node metastases to be predicted. The risk of developing metastatic disease can then be balanced against the risks of surgery in view of the patient's age and health.

Biopsy↗
PubMed1991

[Endoscopic laser therapy. Indications, effectiveness and cost analysis in a medical department].

Between June 1985 and December 1988, 297 endoscopic laser procedures were performed in 130 patients. The indications comprised hemostasis, coagulation of potentially bleeding lesions, palliative tumor therapy in the upper and lower gastrointestinal tract and in the tracheobronchial tree, eradication of adenomas after incomplete snare resection, and recanalization of benign esophageal/cardiac strictures and postoperative colonic stenoses. In addition, an endoscopically introduced biliary endoprosthesis was shortened. Treatment was highly effective, and the complication rate less than 1%. The average operating cost of the laser equipment was DM 80 per application, increasing to 430 DM when account was taken of the high purchasing price of the laser.

Cost-Benefit Analysis↗
PubMed2003

EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary.

EUROCARE-3 analysed the survival of 1815584 adult cancer patients diagnosed from 1990 to 1994 in 22 European countries. The results are reported in tables, one per cancer site, coded according to the International Classification of Diseases (ICD)-9 classification. The main findings of the tables are summarised and commented on in this article. For most solid cancers, wide differences in survival between different European populations were found, as also reported by EUROCARE-1 and EUROCARE-2, despite a remarkable (10%) overall increase in cancer survival from 1985 to 1994. Survival was highest in northern Europe (Sweden, Norway, Finland and Iceland), and fairly good in central-southern Europe (France, Switzerland, Austria and Spain). Survival was particularly low in eastern Europe, low in Denmark and the UK, and fairly low in Portugal and Malta. The mix of tumour stage at diagnosis explains much of the survival differences for cancers of the digestive tract, female reproductive system, breast, thyroid, and also skin melanoma. For tumours of the urinary tract and prostate, the differences were explained mainly by differences in diagnostic criteria and procedures. The case mix by anatomic subsite largely explains differences in survival for head and neck cancers. For oesophagus, pancreas, liver and brain cancer, with poor prognoses, survival differences were limited. Tumours, for which highly effective treatments are available, such as testicular cancer, Hodgkin's lymphoma and some haematological malignancies, had fairly uniform survival across Europe. Survival for all tumours combined (an indicator of the overall cancer care performance of a nation's health system) was better in young than old patients, and better in women than men. The affluence of countries influenced overall cancer survival through the availability of adequate diagnostic and treatment procedures, and screening programmes.

Brain Neoplasms↗
PubMed1993

[Digestive system cancers and pregnancy].

Digestive tract cancers are infrequent during pregnancy. Prognosis is usually dismal both because diagnosis is delayed as a result of symptoms being ascribed to the pregnancy and because saving both the mother and fetus is difficult. A review of the relevant literature, focused on colorectal and gastric cancers which are the most common forms, emphasizes the need for early diagnosis and for adjusting treatment to gestational age at diagnosis.

Colonic Neoplasms↗
PubMed1991

[Totally implantable venous access sites. Results of a series of 101 cases].

The authors report their results of the use of 101 totally implanted venous access systems for chemotherapy in 92 patients. They stress the high incidence (19.8%) of complications: thrombosis 6.8% and 6.9% linked to the material. The correct complication rate must be decreased by strict attention paid to the surgical procedure, use and greater education of the nursing staff. The value of this material is to give greater comfort to patients and to assess its widespread use for intensive long-term chemotherapy.

Adult↗
PubMedDate not supplied

[Incidence of digestive tumors in the health district of Leon, Spain in 1993-1997: high incidence of colorectal carcinoma].

AIM: To determine the incidence of various digestive tumors in the health district of Leon. PATIENTS AND METHODS: All digestive tumors registered in the Hospital Tumor Registry in Leon from 1993-1997 were included. Unadjusted and adjusted incidence rates of each kind of tumor, using the ICD-9 classification, were calculated. RESULTS: A total of 9,913 cancer cases were included. Diagnosis was confirmed by the Department of Pathology in 93.4%. Of these, 25.38% originated primarily in the digestive system, which represents an unadjusted incidence of 151.73 new cases per 100,000 inhabitants/year. A total of 58.07% were male and 41.93% female. Colon cancer was the most frequent (31.5%), followed by gastric cancer (25.7%) and rectal cancer (20.3%). The highest incidence, both unadjusted and adjusted, was in colon cancer (52.8 and 25.9) followed by gastric cancer (47.4 and 24.3) and rectal cancer (36.1 and 18.3, all they 10(5)/year. CONCLUSIONS: Incidence of digestive cancer in Leon is very high and that of colorectal cancer is higher than in any other region in Spain. This is only partly due to the marked aging of our population.

Aged↗