Endoscopic laser treatment was initially applied for gastrointestinal bleeding, but has been actively extended, especially in Japan, to the curative treatment of early upper gastrointestinal cancers. We have treated 10 cases of early gastric cancer and 1 case of early esophageal cancer by Nd-YAG laser radiation, and 2 cases of early gastric cancer by photochemical therapy (PCT) with argon laser + hematoporphyrin derivative. Also, 62 cases of advanced cancer were treated, 10 of the esophagus and 52 of the stomach, for bleeding (18 cases) or stenosis (34 cases). The cases were nonresectable or they were patients who refused surgery. Satisfactory results were obtained by treatment with YAG laser, but have not yet been obtained with PCT. In order to find indications for the possible extension of endoscopic laser therapy to operable cases of early gastric cancer, we studied lymph node metastases in 200 cases of early gastric cancer surgically treated by us. It was found that early gastric cancers (both mucosal and submucosal) measuring less than 2 cm in diameter, of type I, IIa, and IIc (without ulcer scar), had no lymph node metastases and such cases can be treated by local therapy--such as endoscopic laser therapy. In palliative endoscopic laser therapy for complications of advanced gastrointestinal cancers, there are no major problems with active performance. We obtained a high (90%) hemostatic rate in bleeding cases of upper gastrointestinal cancer and a satisfactory (65%) rate of dilating effect in cases of cancerous stenosis at the esophagus and cardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound-mediated destruction of microbubbles has been proposed as an innovative non-invasive drug delivery system for cancer therapy. We developed a specific drug delivery system for squamous cell carcinoma that uses sonoporation with the anti-epidermal growth factor receptor (EGFR) antibody. Administration of a low dose of bleomycin (BLM) by sonoporation with the anti-EGFR antibody produced a marked growth inhibition of Ca9-22 cells in vitro. In addition, scanning electron microscopic analysis revealed apparent surface deformation of Ca9-22 cells treated with sonoporation in the presence of the antibody. Interestingly, the population of apoptotic cells was remarkably increased when a low dose of BLM was delivered using sonoporation with the Fab fragment of the anti-EGFR antibody. These findings indicate that sonoporation with the Fab fragment makes it possible to administer drugs into cells more efficiently and specifically, suggesting a novel application for chemotherapy and gene therapy treatments for oral squamous cell carcinoma.

A series of 536 patients who underwent gastric resections for advanced gastric cancer has been reviewed with regard to the diagnostic procedures for detecting gastric cancer. There were no characteristic symptoms of gastric cancer, but weight loss was a frequent complaint. Variation in the type and frequency of symptoms did not appear to depend on the presence or absence of metastases. Patients whose operations were delayed more than one year after the onset of symptoms accounted for 33% of the series, and 38% of these had visited their physicians within 6 months after the onset of symptoms but were misdiagnosed as having chronic gastritis or benign ulcer. The results of various laboratory examinations were not specific. Gastric acidity was found to be distinctly lower than in patients with benign gastric disease. Techniques of radiology, endoscopy, and endoscopic biopsy of the stomach have greatly improved, and the overall rates of correct diagnosis of gastric cancer were 96% by x-ray, 98% by endoscopy, and 90% by biopsy. These rates were slightly lowered when only Borrmann type IV lesions were considered. Celiac angiography was useful to determine the extent or depth of cancerous invasion and to detect liver metastases. The frequency of positive PPD or DNCB skin tests appeared to decrease as the stage of cancer advanced, indicating immunologic impairment in advanced gastric cancer.

No abstract