Early Diagnosis of Cancer of the Oesophagus and Stomach

Abstract

We know the main facts abouit cancer. We know it is the chief cause of death in men and women in the years after 40-the time when they have established a place in life, a home, a reputation, when they are most useful to their profession and their country and most necessary to their families. We know that at first it is not a tumour but an insensible transformation of the cells in some part of the body to a structure that is a caricature of the normal rather than something new or different; that this new tissue has no nerve supply, and that it produces no inflammatory reaction in the normal parts surrounding it-in other words, that it is entirely painless, and in most cases entirely symptomless. We know that, for purposes of recording, cancers can be sorted into three stages, based on their gross naked-eye pathology: Stage I, in which there is a local growth only; Stage II, in which as well as the local growth there are early metastases in the nearest lymphatic glands or in tissues immediately adjacent; and Stage III, in which the primary growth or the metastases are fixed, or more distant organs are involved. We know also that in those parts of the body which can be effectively irradiated, or where a radical operation that satisfies pathological criteria can be performed-the breast, the colon, the rectum, and most parts of the skin-the five-year cures in Stage I are 80 to 90%, in Stage II about 50%, and in Stage III not more than 10%.Radiation will improve, but it is doubtful whether that improvement will be dramatic. Radical surgery can hardly get more radical, for the limitations now set are not the result of timidity or lack of enterprise but are rather due to Charles-Mayo's stipulation that among the results of successful surgery should be a live patient. If, therefore, we are to get more cures it can only be by finding more patients in Stage I, the stage of silence.Two of the most malignant of all growths are those of the oesophagus and the stomach. Cure of oesophageal cancer is almost unknown. Cure of gastric cancer is sometimes seen, but in not more than 5% of those cases that come to a surgical clinic; yet it is the commonest of all malignant growths, and the chief cause of cancer deaths in all civilized countries in which records are kept. There are no signs or symptoms by which we can diagnose these diseases in their early stages, but are there any which should raise our suspicions and allow us to start those investigations that will give the answer in time? It is those early signs that are the hardest to discover, and many of you may have observed some warning sign that the rest of us have not noticed. If you have I hope that you will share it Those who were in the first World War will remember the " stand to " in the front trenches an hour before dawn, the hour when mists and half-shadows conceal familiar objects, the hour when the enemy may creep unseen, when a suspicious alertness is the only way to safety. We should all " stand to " over our patients who have passed the forty mark, suspicious of t...

A Diagnostic Consideration for All Ages: Pseudoachalasia in a 22-Year-Old Male

“…This diagnosis demands committed clinical, radiographic, manometric, and endoscopic assessment to achieve distinction from primary achalasia. Pseudoachalasia, originally described by Ogilvie in 1947, is the result of a primary tumor at the esophagogastric junction in 70% of patients 2–4 . Adenocarinoma of the distal esophagus in the setting of Barrett’s esophagus is the predominate presentation; however, many intrinsic and extrinsic conditions resulting in lower esophageal sphincter impairment have been described 3 .…”

Pseudoachalasia of the Cardia Secondary to Nongastrointestinal Neoplasia

“…[4][5][6]11]. In 1947, Ogilvie described the lower esophageal and cardia neoplastic syndrome that mimics idiopathic achalasia [12,13]. Pseudoachalasia comprises about 2%-4 % of all the cases that meet the typical achalasia manometric criteria.…”

Pseudoachalasia as First Manifestation of a Malignancy

“…However, in about 70% of affected patients, pseudoachalasia is caused by a primary or secondary malignancy [43,44] with primary malignancy accounting for 54-70% [44][45][46] and secondary malignancy for 6% of cases [47]. Pseudoachalasia as a manifestation of a malignancy was first described by Howarth in 1919 [48] and later by Ogilvie [49]. Carcinoma of the esophagus or cardia with typical strictures of the esophagogastric junction is the tumor most likely to cause pseudoachalasia [50].…”