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Khan IR, Sadida HQ, Hashem S, Singh M, Macha MA, Al-Shabeeb Akil AS, Khurshid I, Bhat AA. Therapeutic implications of signaling pathways and tumor microenvironment interactions in esophageal cancer. Biomed Pharmacother 2024; 176:116873. [PMID: 38843587 DOI: 10.1016/j.biopha.2024.116873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
Esophageal cancer (EC) is significantly influenced by the tumor microenvironment (TME) and altered signaling pathways. Downregulating these pathways in EC is essential for suppressing tumor development, preventing metastasis, and enhancing therapeutic outcomes. This approach can increase tumor sensitivity to treatments, enhance patient outcomes, and inhibit cancer cell proliferation and spread. The TME, comprising cellular and non-cellular elements surrounding the tumor, significantly influences EC's development, course, and treatment responsiveness. Understanding the complex relationships within the TME is crucial for developing successful EC treatments. Immunotherapy is a vital TME treatment for EC. However, the heterogeneity within the TME limits the application of anticancer drugs outside clinical settings. Therefore, identifying reliable microenvironmental biomarkers that can detect therapeutic responses before initiating therapy is crucial. Combining approaches focusing on EC signaling pathways with TME can enhance treatment outcomes. This integrated strategy aims to interfere with essential signaling pathways promoting cancer spread while disrupting factors encouraging tumor development. Unraveling aberrant signaling pathways and TME components can lead to more focused and efficient treatment approaches, identifying specific cellular targets for treatments. Targeting the TME and signaling pathways may reduce metastasis risk by interfering with mechanisms facilitating cancer cell invasion and dissemination. In conclusion, this integrative strategy has significant potential for improving patient outcomes and advancing EC research and therapy. This review discusses the altered signaling pathways and TME in EC, focusing on potential future therapeutics.
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Affiliation(s)
- Inamu Rashid Khan
- Department of Zoology, Central University of Kashmir, Ganderbal, Jammu and Kashmir 191201, India
| | - Hana Q Sadida
- Department of Human Genetics-Precision Medicine in Diabetes, Obesity and Cancer Program, Sidra Medicine, Doha 26999, Qatar
| | - Sheema Hashem
- Department of Human Genetics, Sidra Medicine Doha 26999, Qatar
| | - Mayank Singh
- Department of Medical Oncology (Lab), Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Muzafar A Macha
- Watson-Crick Centre for Molecular Medicine, Islamic University of Science and Technology, Awantipora, Jammu and Kashmir 192122, India
| | - Ammira S Al-Shabeeb Akil
- Department of Human Genetics-Precision Medicine in Diabetes, Obesity and Cancer Program, Sidra Medicine, Doha 26999, Qatar
| | - Ibraq Khurshid
- Department of Zoology, Central University of Kashmir, Ganderbal, Jammu and Kashmir 191201, India.
| | - Ajaz A Bhat
- Department of Human Genetics-Precision Medicine in Diabetes, Obesity and Cancer Program, Sidra Medicine, Doha 26999, Qatar.
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2
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Sabu J, Thida AM, Seong G, Mohiuddin A, Attia H, Agaronov M, Chiu E. Gastroesophageal Junction Adenocarcinoma With Skeletal Muscle Metastases: A Case Report and Literature Review. Cureus 2024; 16:e63855. [PMID: 39099909 PMCID: PMC11297803 DOI: 10.7759/cureus.63855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Esophageal and gastroesophageal junction (GEJ) malignancies are aggressive, and survival is poor once metastasis occurs. The most common sites of metastatic involvement include the liver, lymph nodes, lung, peritoneum, adrenal glands, bone, and brain, while skeletal muscle (SM) involvement is rare. We report a case of a 68-year-old female who presented with intractable emesis for one month and was found to have a primary GEJ adenocarcinoma measuring up to 6.7 cm. Endoscopic biopsy revealed poorly differentiated GEJ adenocarcinoma with positive AE1/AE3 immunostains. Positron emission tomography/computed tomography and magnetic resonance imaging revealed metastases to the omentum and left lower extremity SMs, including the proximal adductor longus, adductor magnus, and gluteus minimus. This study reviews the literature on SM metastasis in esophageal and GEJ cancer, GEJ cancer classification, incidence, treatment, and prognosis.
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Affiliation(s)
- Jacob Sabu
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Aye M Thida
- Department of Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Gyuhee Seong
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Amena Mohiuddin
- Department of Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Hagar Attia
- Department of Pathology and Laboratory Medicine, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Maksim Agaronov
- Department of Pathology and Laboratory Medicine, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Edwin Chiu
- Department of Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University/Kings County Hospital, New York, USA
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3
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Garcia A, Morris N, Francis P, Baik D. Rare Metastasis of Esophageal Adenocarcinoma to the Female Reproductive Tract. ACG Case Rep J 2024; 11:e01233. [PMID: 38179264 PMCID: PMC10766279 DOI: 10.14309/crj.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Esophageal cancer is common and typically metastasizes to the liver, lung, and lymph nodes. Reproductive tract metastases are extremely rare. In fact, to the best of our knowledge, only 2 cases of esophageal carcinoma metastasizing to the ovaries have been reported. Thus, increased recognition of unusual metastatic sites is necessary to decrease the morbidity and mortality from distant esophageal metastases. We present a case of ovarian and fallopian tube metastases from esophageal adenocarcinoma in a 59-year-old woman.
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Affiliation(s)
- Alexander Garcia
- Department of Internal Medicine, Cooper University Hospital, Camden, NJ
| | | | - Pilin Francis
- Department of Gastroenterology, Cooper University Hospital, Camden, NJ
| | - Daniel Baik
- Department of Gastroenterology, Cooper University Hospital, Camden, NJ
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4
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Wang Y, Yang W, Wang Q, Zhou Y. Mechanisms of esophageal cancer metastasis and treatment progress. Front Immunol 2023; 14:1206504. [PMID: 37359527 PMCID: PMC10285156 DOI: 10.3389/fimmu.2023.1206504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Esophageal cancer is a prevalent tumor of the digestive tract worldwide. The detection rate of early-stage esophageal cancer is very low, and most patients are diagnosed with metastasis. Metastasis of esophageal cancer mainly includes direct diffusion metastasis, hematogenous metastasis, and lymphatic metastasis. This article reviews the metabolic process of esophageal cancer metastasis and the mechanisms by which M2 macrophages, CAF, regulatory T cells, and their released cytokines, including chemokines, interleukins, and growth factors, form an immune barrier to the anti-tumor immune response mediated by CD8+ T cells, impeding their ability to kill tumor cells during tumor immune escape. The effect of Ferroptosis on the metastasis of esophageal cancer is briefly mentioned. Moreover, the paper also summarizes common drugs and research directions in chemotherapy, immunotherapy, and targeted therapy for advanced metastatic esophageal cancer. This review aims to serve as a foundation for further investigations into the mechanism and management of esophageal cancer metastasis.
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Affiliation(s)
- Yusheng Wang
- Department of Thoracic Surgery, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Wei Yang
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu, China
| | - Qianyun Wang
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu, China
| | - Yong Zhou
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu, China
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5
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El Abiad JM, Hales RK, Levin AS, Morris CD. Soft-Tissue Metastases From Esophageal Cancer. J Gastrointest Surg 2019; 23:1721-1728. [PMID: 30809784 DOI: 10.1007/s11605-019-04160-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metastatic carcinoma to skeletal muscle and/or subcutaneous fat is a rare event. Only 27 cases of esophageal cancer to soft tissue have been described in the English-language literature. PURPOSE Our goal was to describe the prevalence and clinical characteristics of soft-tissue metastasis among patients with primary esophageal cancer at a single institution. METHODS We performed a retrospective review of all patients with primary esophageal cancer. Data points analyzed included histologic subtype, anatomic location, metastasis pattern, treatment, and survival. Kaplan-Meier curves were used to estimate survival time, and log-rank tests were used for comparisons. For all analyses, P < 0.05 was considered significant. RESULTS Of 1341 patients with primary esophageal cancer, 25 (1.9%) had metastases to soft tissue. Soft-tissue metastases were diagnosed at a median age of 64 years, a median 9.6 months after esophageal cancer diagnosis. Adenocarcinoma was the predominant histopathological type, and soft-tissue metastasis was most common in the lower extremity. Local intervention was used for 10 symptomatic patients with favorable prognoses. Chemotherapy was the only treatment modality in 18 patients. Median survival time after diagnosis of soft-tissue metastasis was 8.9 months and was longer in patients with metastasis in soft tissue only (24.6 months, P = 0.007) and in those who received local intervention (11.1 months vs those who did not, P = 0.020). CONCLUSION We estimate the prevalence of soft-tissue metastasis to be 1.9% among patients with esophageal cancer. Local intervention may be beneficial for patients in otherwise good health with symptomatic soft-tissue lesions.
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Affiliation(s)
- Jad M El Abiad
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Russell K Hales
- Department of Oncology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Carol D Morris
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD, 21287, USA. .,Department of Oncology, Johns Hopkins Medicine, Baltimore, MD, USA.
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6
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Saito A, Murakami M, Otsuka K, Komoto M, Kato R, Motegi K, Yamashita T, Date H, Ariyoshi T, Goto S, Koizumi T, Yamazaki K, Watanabe M, Aoki T. A long-term survival case after surgical resection of skeletal muscle metastasis following esophagectomy for squamous cell carcinoma of the esophagus. J Surg Case Rep 2017; 2017:rjx141. [PMID: 28852458 PMCID: PMC5570075 DOI: 10.1093/jscr/rjx141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 12/29/2022] Open
Abstract
Cases of skeletal muscle metastasis of esophageal carcinoma are very rare, with few reports of long-term survival. We report a case of long-term survival after surgical resection of skeletal muscle metastasis. A 56-year-old man with advanced esophageal cancer and early gastric cancer underwent thoracoscopic esophagectomy, 2-field lymph node dissection, partial gastrectomy and gastric tube reconstruction. Six months later, cervical lymph node metastasis and mediastinal lymph node recurrence were found. Therefore, the patient underwent cervical lymph node dissection and adjuvant chemoradiotherapy. Two years and 3 months after the esophagectomy, a muscle metastasis was found in the left shoulder, and he underwent tumor dissection, followed by adjuvant chemotherapy for a year. There has been no sign of recurrence since, even 13 years after the esophagectomy. We believe our aggressive surgical treatment might have led to long-term survival.
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Affiliation(s)
- Akira Saito
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Masahiko Murakami
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Koji Otsuka
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Masahiro Komoto
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Rei Kato
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Kentaro Motegi
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Takeshi Yamashita
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Hiromi Date
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Tomotake Ariyoshi
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Satoru Goto
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Tomotake Koizumi
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Kimiyasu Yamazaki
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Makoto Watanabe
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
| | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, Showa University, Shinagawa, Tokyo 142-8555, Japan
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Sperandeo M, Trovato FM, Melillo N, Dimitri L, Musumeci G, Guglielmi G. The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases. Eur J Radiol 2017; 90:234-244. [PMID: 28583640 DOI: 10.1016/j.ejrad.2017.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022]
Abstract
Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.
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Affiliation(s)
- Marco Sperandeo
- Unit of Intervenional Ultrasound of Internal Medicine, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Italy
| | - Nadia Melillo
- Rheumatology Unit, Department of Medical Science, University of Foggia, Italy
| | - Lucia Dimitri
- Histology and Pathology Unit, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy; Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy.
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8
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Ludmir EB, Robey B, Shelby E, Patel-Nguyen SV, Rittershaus A, Contarino MR. Skeletal muscle metastasis from signet ring cell esophageal adenocarcinoma. Transl Gastroenterol Hepatol 2017; 1:37. [PMID: 28138604 DOI: 10.21037/tgh.2016.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 12/14/2022] Open
Abstract
Symptomatic skeletal muscle metastasis from esophageal adenocarcinoma is rare. Here we report the case of a 49-year-old man who presented with right thigh pain, and was found to have symptomatic psoas muscle metastasis as the presentation of esophageal adenocarcinoma. The primary tumor was notable for signet ring cells (SRC), a poor prognostic indicator as well as a predictor of biologic aggressiveness. The patient passed away within 1 month of diagnosis due to disease progression, supporting the aggressiveness of such SRC esophageal lesions. Lastly, a literature review reveals a differential pattern of metastatic spread between esophageal adenocarcinomas and squamous cell carcinomas as regards muscle metastases. Skeletal muscle metastases are more likely to be due to esophageal adenocarcinoma, whereas myocardial metastases are almost exclusively due to esophageal squamous cell carcinoma (ESCC). These differences may represent an example of the 'seed and soil' hypothesis of metastasis.
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Affiliation(s)
- Ethan B Ludmir
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin Robey
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Evan Shelby
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonya V Patel-Nguyen
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
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