Diagnosis and therapy for advanced esophageal cancer

High incidence of esophageal cancer in central-western Brazil: a migrant effect?

To determine the incidence and mortality rates of esophageal cancer in central-western Brazil: Goiânia, Brasília, Cuiabá, and Campo Grande, incidence data for Cuiabá (2000-2005) and Brasília (1999-2002) were obtained from the National Cancer Institute, and data from Goiânia (1995-2008) from the Population-Based Cancer Registry of Goiânia. Mortality data for the cities of central-western Brazil were obtained for the period 1980-2008 from the Ministry of Health. Age-standardized incidence and mortality rates were calculated using the world population of Segi. Mortality trends were assessed with the Joinpoint Regression Program and a P value less than 0.05 was defined as significant. The highest incidence of esophageal cancer among men was in Cuiabá (16.0/100 000); the lowest was in Goiânia (6.5/100 000). Among women, the incidence rates were similar in Brasília and Cuiabá, but in Goiânia, the incidence declined. There was a significant increase in mortality among men in Cuiabá (2.4%, P=0.03) and Campo Grande (1.2%, P=0.05), and in women (1.6%, P=0.04) in Goiânia. Mortality by age group increased significantly in Campo Grande by 1.9% for men aged at least 50 years and in Goiânia by 2.7% among women aged at least 50 years; the mortality decreased in Goiânia by 2.2% for women aged less than 50 years. The incidence of esophageal cancer in Brasília and Cuiabá was similar to that of southern Brazil in some periods. There was an increase in mortality trends for men in Cuiabá and Campo Grande, and for women in Goiânia.

The influence of symptom type and duration on the fate of the metaplastic columnar-lined Barrett's oesophagus

BACKGROUND

Prolonged gastro-oesophageal reflux resulting in columnar metaplasia of the oesophagus is the main risk factor for oesophageal adenocarcinoma.

AIM

To examine the duration of symptoms and associations of different symptoms with the development of columnar-lined oesophagus, dysplasia and adenocarcinoma.

METHODS

UK multicentre cohort study of patients with columnar-lined oesophagus whose date of symptom onset (1082 patients) and/or types of symptoms reported (1681 patients) were documented. Follow-up was examined by analysis of histological reports from the registering centers.

RESULTS

Symptoms of dysphagia/odynophagia and nausea/vomiting were associated with development of dysplasia. High-grade dysplasia and adenocarcinoma were associated with dysphagia/odynophagia and weight loss. Median duration from symptom onset to detection of columnar-lined oesophagus without intestinal metaplasia: 2.6 years, columnar-lined oesophagus with intestinal metaplasia: 5.0 years, indefinite changes for dysplasia: 19.3 years and low-grade dysplasia: 30.0 years. One tenth of patients had developed high-grade dysplasia at 9.6 years and one tenth had developed adenocarcinoma at 13.8 years from symptom onset.

CONCLUSIONS

In patients with columnar-lined oesophagus, symptoms of dysphagia/odynophagia and nausea/vomiting were associated with a higher risk of development of dysplasia and adenocarcinoma. There is a trend for longer duration of symptoms to the detection of dysplasia.

Barrett's columnar-lined oesophagus: demographic and lifestyle associations and adenocarcinoma risk

OBJECTIVES

Lifestyle and demographic risk factors for the development of oesophageal adenocarcinoma developing from columnar-lined oesophagus are not well defined.

METHODS

Demographic and lifestyle factors, endoscopy and histology reports were extracted from 1,761 subjects from seven UK centres. The associations of columnar-lined oesophagus with demographic and lifestyle factors and the development of adenocarcinoma were examined.

RESULTS

5.5% of patients had prevalent adenocarcinoma (more common in males, older patients, patients diagnosed earlier in the cohort and current or recent smokers). Adenocarcinoma incidence was 23 patients in 3,912 years or 0.59% per annum. Only increased age at diagnosis correlated with an increased risk of incident adenocarcinoma. There was no association with obesity or alcohol history.

CONCLUSIONS

Oesophageal adenocarcinoma occurs more commonly in older patients and is more frequent in males than females. Once columnar-lined oesophagus had been diagnosed, there were no other demographic or lifestyle factors which were predictive of the development of incident adenocarcinoma in this cohort.

Neoplasia avançada de esôfago: diagnóstico ainda muito tardio

RACIONAL: A neoplasia de esôfago está entre as 10 mais incidentes no Brasil. O diagnóstico é geralmente tardio e a sobrevida média é de 4 a 6 meses, independente da terapêutica. O alívio da disfagia e a melhora da qualidade de vida são os objetivos principais da terapêutica paliativa. OBJETIVO: Avaliar a qualidade de vida e a paliação da disfagia obtida com diferentes tipos de tratamento oferecidos aos pacientes com neoplasia avançada de esôfago. PACIENTES E MÉTODO: Avaliação prospectiva de 38 pacientes com neoplasia avançada de esôfago, com disfagia, sem possibilidade de tratamento curativo, entre setembro de 2001 a junho de 2005. Os pacientes foram alocados aleatoriamente, de acordo com a disponibilidade da terapia ou preferência do paciente ou do médico responsável, sendo 14 tratados com colocação de prótese (9 metálicas auto-expansíveis, 4 plásticas e 1 plástica auto-expansível), 4 com cirurgia paliativa, 8 com gastrostomia (7 cirúrgicas e 1 endoscópica) e 12 com sonda nasoenteral. RESULTADOS: Houve melhora do índice médio de disfagia em 30 dias em todos os grupos, exceto no da gastrostomia. A colocação da prótese de esôfago melhorou a disfagia de forma estatisticamente significante em relação às outras terapias paliativas. A qualidade de vida avaliada pela mediana do índice de Karnofsky não apresentou melhora em nenhum grupo de pacientes. O número de internações necessárias não foi diferente entre os grupos. A duração média das internações foi maior no grupo de tratamento cirúrgico (42 dias), embora sem diferença significativa. Não houve diferença na sobrevida média dos pacientes, independente do tipo de tratamento. CONCLUSÃO: A paliação ideal para todos os casos não existe. O método deve ser individualizado para cada paciente. O tratamento cirúrgico paliativo é o mais oneroso, devido ao prolongado tempo médio de internação desses pacientes. Infelizmente, o diagnóstico de tumor de esôfago em nosso meio ainda é muito tardio, limitando o benefício que poderia advir dos métodos de ponta de paliação endoscópica.