The incidence of esophageal tumors, and of adenocarcinoma in particular, has risen
markedly in recent years in the developed countries. The use of a variety of histopathological
and biological markers is now offering promising prospects for the future. Vertical
tumor invasion, intratumoral microvessel density, antimucin monoclonal antibodies,
flow cytometry, telomerase activity, and overexpression of cyclin D1 have been correlated
with the staging and prognosis of esophageal carcinomas. By combining these markers
with Lugol staining, a practical new method of staging esophageal tumors may become
available in the coming years.
As is well known, Barrett's mucosa is a preneoplastic condition. Discussions in the
literature concerning short forms of Barrett's esophagus and their relationship to
inflammation of the gastric cardia appear to describe two different scenarios - a
gastroesophageal reflux condition for short forms of Barrett's esophagus, and an inflammatory
phenomenon (perhaps unrelated to Helicobacter pylori infection) for inflammation of the gastric cardia. Cost-benefit studies of follow-up
procedures in Barrett's esophagus have yet to be conducted, and considerable efforts
- mainly using biological markers - are being made to identify those patients who
are at greatest risk.
Although the frequency of gastric tumors has declined in recent years, many as yet
unclear aspects of these tumors have been studied. Technological progress has not
led to substantial changes in the diagnostic procedures used, although autofluorescence
methods and three-dimensional reconstruction have been analyzed. Laparoscopy, preferably
combined with the use of ultrasound probes, may be a valuable tool for staging. The
suggestion that endoscopy should be avoided in young patients (the “treat but do not
scope” approach) has been seriously questioned, as it may lead to early cancer being
overlooked. There is thought to be an intermediate stage of gastric cancer (between
the early and advanced stages) in which the muscularis propria, but not the serosa,
is invaded. Endoscopic ultrasonography is becoming increasingly established as a basic
tool for the staging of gastric cancer. Gastric MALT lymphoma can be cured by H. pylori eradication therapy in many cases, but there is still uncertainty regarding the limitations
of this approach.
References
- 1
Daly J M, Fry W A, Little A G, et al.
Esophageal cancer: results of an American College of Surgeons patient care evaluation
study.
J Am Coll Surg.
2000;
19
562-572
- 2
Lagergren J, Bergstrom R, Nyren O.
Association between body mass and adenocarcinoma of the esophagus and gastric cardia.
Ann Intern Med.
1999;
13
883-890
- 3
Lagergren J, Nyren O.
No association between colon cancer and adenocarcinoma of the oesophagus in a population-based
cohort study in Sweden.
Gut.
1999;
44
819-821
- 4
Tajima Y, Nakanishi Y, Ochiai A, et al.
Histopathologic findings predicting lymph node metastasis and prognosis of patients
with superficial esophageal carcinoma: analysis of 240 surgically resected tumors.
Cancer.
2000;
88
1285-1293
- 5
Millikan K W, Mall J W, Myers J A, et al.
Do angiogenesis and growth factor expression predict prognosis of esophageal cancer?.
Am Surg.
2000;
66
401-405
- 6
Shih C H, Ozawa S, Ando N, et al.
Vascular endothelial growth factor expression predicts outcome and lymph node metastasis
in squamous cell carcinoma of the esophagus.
Clin Cancer Res.
2000;
6
1161-1168
- 7
Torres C, Wang H, Turner J, et al.
Prognostic significance and effect of chemoradiotherapy on microvessel density (angiogenesis)
in esophageal Barrett's esophagus-associated adenocarcinoma and squamous cell carcinoma.
Hum Pathol.
1999;
3
753-758
- 8
Sagara M, Yonezawa S, Nagata K, et al.
Expression of mucin 1 (MUC1) in esophageal squamous-cell carcinoma: its relationship
with prognosis.
Int J Cancer.
1999;
84
251-257
- 9
Watanabe M, Kuwano H, Tanaka S, et al.
Flow cytometric DNA analysis is useful in detecting multiple genetic alterations in
squamous cell carcinoma of the esophagus.
Cancer.
1999;
85
2322-2328
- 10
Koyanagi K, Ozawa S, Ando N, et al.
Telomerase activity as an indicator of malignant potential in iodine-nonreactive lesions
of the esophagus.
Cancer.
2000;
88
1524-1529
- 11
Kagawa Y, Yoshida K, Hirai T, et al.
Microsatellite instability in squamous cell carcinomas and dysplasias of the esophagus.
Anticancer Res.
2000;
2
213-217
- 12
Safatle-Ribeiro A V, Ribeiro U J r, Sakai P, et al.
Integrated p53 histopathologic/genetic analysis of premalignant lesions of the esophagus.
Cancer Detect Prev.
2000;
24
13-23
- 13
Tanaka M, Nonogaki S, Alberti V N, Forones N M.
p53 in epidermoid cancer of the esophagus.
Hepatogastroenterology.
1999;
46
1765-1768
- 14
Toyoda H, Nakamura T, Shinoda M, et al.
Cyclin D1 expression is useful as a prognostic indicator for advanced esophageal carcinomas,
but not for superficial tumors.
Dig Dis Sci.
2000;
45
864-869
- 15
Shiozaki H, Doki Y, Kawanishi K, et al.
Clinical application of malignancy potential grading as a prognostic factor of human
esophageal cancers.
Surgery.
2000;
127
552-561
- 16
Arber N, Gammon M D, Hibshoosh H, et al.
Overexpression of cyclin D1 occurs in both squamous carcinomas and adenocarcinomas
of the esophagus and in adenocarcinomas of the stomach.
Hum Pathol.
1999;
3
1087-1092
- 17
D'Errico A, Barozzi C, Fiorentino M, et al.
Role and new perspectives of transforming growth factor-alpha (TGF-alpha) in adenocarcinoma
of the gastro-oesophageal junction.
Br J Cancer.
2000;
82
865-870
- 18
Menzel J, Hoepffner N, Nottberg H, et al.
Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional
endoscopic ultrasound in a prospective histopathologically verified study.
Endoscopy.
1999;
31
291-297
- 19
Mallery S, Van Dam J.
Increased rate of complete EUS staging of patients with esophageal cancer using the
nonoptical, wire-guided echoendoscope.
Gastrointest Endosc.
1999;
5
53-57
- 20
Shinkai Y, Niwa Y, Arisawa T, et al.
Evaluation of prognosis of squamous cell carcinoma of the esophagus by endoscopic
ultrasonography.
Gut.
2000;
47
120-125
- 21
Yamamuro E M, Cecconello I, Iriya K, et al.
Lugol dye endoscopy for analysis of esophageal mucosa in achalasia.
Hepatogastroenterology.
1999;
46
1687-1691
- 22
Fagundes R B, de Barros S G, Putten A, et al.
Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk
for squamous cell carcinoma of the esophagus.
Endoscopy.
1999;
31
281-285
- 23
O'Connor J B, Falk G W, Richter J E.
The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the
Cleveland Clinic Barrett's Esophagus Registry.
Am J Gastroenterol.
1999;
94
2037-2042
- 24
Thurberg B L, Duray P H, Odze R D.
Polypoid dysplasia in Barrett's esophagus: a clinicopathologic, immunohistochemical,
and molecular study of five cases.
Hum Pathol.
1999;
3
745-752
- 25
Polkowski W, van Lanschot J J, ten Kate F J, et al.
Intestinal and pancreatic metaplasia at the esophagogastric junction in patients without
Barrett's esophagus.
Am J Gastroenterol.
2000;
95
617-625
- 26
Sharma P, Weston A P, Morales T, et al.
Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus
and in the gastric cardia.
Gut.
2000;
46
9-13
- 27
Rudolph R E, Vaughan T L, Storer B E, et al.
Effect of segment length on risk for neoplastic progression in patients with Barrett
esophagus.
Ann Intern Med.
2000;
132
612-620
- 28
Weston A P, Badr A S, Hassanein R S.
Prospective multivariate analysis of clinical, endoscopic, and histological factors
predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma.
Am J Gastroenterol.
1999;
94
3413-3419
- 29
Nilsson J, Skobe V, Johansson J, et al.
Screening for oesophageal adenocarcinoma: an evaluation of a surveillance program
for columnar metaplasia of the oesophagus.
Scand J Gastroenterol.
2000;
35
10-16
- 30
Provenzale D, Schmitt C, Wong J B.
Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer
risk.
Am J Gastroenterol.
1999;
94
2043-2053
- 31
Gimenez A, Minguela A, de Haro L M, et al.
DNA ploidy status and proliferative activity as markers of malignant potential in
Barrett's esophagus: flow cytometric study using routinely paraffin-embedded tissue.
World J Surg.
2000;
24
72-77
- 32
Younes M, Lechago J, Chakraborty S, et al.
A Relationship between dysplasia, p53 protein accumulation, DNA ploidy, and Glut1
overexpression in Barrett metaplasia.
Scand J Gastroenterol.
2000;
35
131-137
- 33
Sarbia M, Bektas N, Muller W, et al.
Expression of cyclin E in dysplasia, carcinoma, and nonmalignant lesions of Barrett
esophagus.
Cancer.
1999;
86
2597-2601
- 34
Chinyama C N, Marshall R E, Owen W J, et al.
Expression of MUC1 and MUC2 mucin gene products in Barrett's metaplasia, dysplasia
and adenocarcinoma: an immunopathological study with clinical correlation.
Histopathology.
1999;
35
517-524
- 35
Van Laethem J L, Peny M O, et al. et al .
Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's
oesophagus.
Gut.
2000;
46
574-577
- 36
Garewal H, Ramsey L, Sharma P, et al.
Biomarker studies in reversed Barrett's esophagus.
Am J Gastroenterol.
1999;
94
2829-2833
- 37
Gotoda T, Saito D, Kondo H, et al.
Endoscopic and histological reversibility of gastric adenoma after eradication of
Helicobacter pylori.
J Gastroenterol.
1999;
34
91-96
- 38
Zullo A, Romiti A, Rinaldi V, et al.
Gastric pathology in patients with common variable immunodeficiency.
Gut.
1999;
45
77-81
- 39
Kikuchi S, Hiki Y, Sakakibara Y, Kakita A, Kuwao S.
Measuring the tumor volume of gastric carcinoma by computer image analysis: clinical
significance.
World J Surg.
2000;
24
603-607
- 40
Ohashi S, Segawa K, Okamura S, et al.
The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal
resection of early gastric cancer.
Gut.
1999;
45
599-604
- 41
Smith A, John T G, Garden O J, Brown S P.
Role of laparoscopic ultrasonography in the management of patients with oesophagogastric
cancer.
Br J Surg.
1999;
86
1083-1087
- 42
Feussner H, Omote K, Fink U, et al.
Pretherapeutic laparoscopic staging in advanced gastric carcinoma.
Endoscopy.
1999;
31
342-347
- 43
Abe S, Izuishi K, Tajiri H, et al.
Correlation of in vitro autofluorescence endoscopy images with histopathologic findings
in stomach cancer.
Endoscopy.
2000;
32
281-286
- 44
Kitahara F, Kobayashi K, Sato T, et al.
Accuracy of screening for gastric cancer using serum pepsinogen concentrations.
Gut.
1999;
44
693-697
- 45
Mayinger B, Reh H, Hochberger J, Hahn E G.
Endoscopic photodynamic diagnosis: oral aminolevulinic acid is a marker of GI cancer
and dysplastic lesions.
Gastrointest Endosc.
1999;
5
242-246
- 46
Bramble M G, Suvakovic Z, Hungin A P.
Detection of upper gastrointestinal cancer in patients taking antisecretory therapy
prior to gastroscopy.
Gut.
2000 ;
46
464-467
- 47
Wayman J, Hayes N, Raimes S A, Griffin S M.
Prescription of proton pump inhibitors before endoscopy: a potential cause of missed
diagnosis of early gastric cancers.
Arch Fam Med.
2000;
9
385-388
- 48
Breslin N P, Thomson A B, Bailey R J, et al.
Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia.
Gut.
2000;
46
93-97
- 49
Bini E J, Rajapaksa R C, Valdes M T, Weinshel E H.
Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive
fecal occult blood test?.
Am J Med.
1999;
106
613-618
- 50
Nakamura K, Kamei T, Ohtomo N, et al.
Gastric carcinoma confined to the muscularis propria: how can we detect, evaluate,
and cure intermediate-stage carcinoma of the stomach?.
Am J Gastroenterol.
1999;
94
2251-2255
- 51
Yoshimura T, Shimoyama T, Fukuda S, et al.
Most gastric cancer occurs on the distal side of the endoscopic atrophic border.
Scand J Gastroenterol.
1999;
34
1077-1081
- 52
Cammarota G, Cianci R, Pirozzi G, Gasbarrini G.
Minimal endoscopic aspects of gastric low-grade malt-lymphoma.
Hepatogastroenterology.
1999;
46
2818-2822
- 53
Morgner A, Lehn N, Andersen L P, et al.
Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma: complete remission after curing
the infection.
Gastroenterology.
2000;
118
821-828
- 54
Steinbach G, Ford R, Glober G, Sample D, et al.
Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue: an
uncontrolled trial.
Ann Intern Med.
1999;
131
88-95
- 55
Weston A P, Banerjee S K, Horvat R.
Prospective long-term endoscopic and histologic follow-up of gastric lymphoproliferative
disease of early stage IE low-grade B-cell mucosa-associated lymphoid tissue type
following Helicobacter pylori eradication treatment.
Int J Oncol.
1999;
15
899-907
- 56
Chang D K, Chin Y J, Kim J S, et al.
Lymph node involvement rate in low-grade gastric mucosa-associated lymphoid tissue
lymphoma: too high to be neglected.
Hepatogastroenterology.
1999;
46
2694-2700
- 57
Kojima T, Takahashi H, Parra-Blanco A, et al.
Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection.
Gastrointest Endosc.
1999;
5
516-522
- 58
DeMatteo R P, Lewis J J, Leung D, et al.
Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors
for survival.
Ann Surg.
2000;
231
51-58
M. Moretó,M.D.
Gastroenterology Unit
Hospital de Cruces
Plaza de Cruces
48903 Baracaldo
Spain
Fax: Fax:+ 34-94-60063558
Email: E-mail:mmoretoc@meditex.es
