Treatment of Oesophago-Gastric Tumours

Abstract

The incidence of oesophageal adenocarcinoma continues to rise rapidly in the West whereas cancer of the stomach is becoming less common. Most patients present with advanced disease that is not amenable to curative treatment. This review focuses on recent evidence on the endoscopic therapy of oesophago-gastric cancer. Although there are many treatment modalities available, there is a paucity of good quality randomised trial evidence on which to base palliative treatment decisions. Furthermore, although palliation of dysphagia may be improved by expandable metal stents or ablative therapy, there is no evidence that this improves survival and each of these therapies has a high frequency of complications particularly in longterm survivors. Exciting developments have however been reported in the therapy of early stage oesophago-gastric cancer. Endoscopic mucosal resection is particularly promising with high rates of complete removal of early cancer or high grade dysplasia. Long-term follow up of these patients is required because of high rates of metachronous tumour formation and at present there are no randomised trial data comparing endoscopic mucosal resection with conventional surgery.

Role of optical techniques in combined use of selected methods of medical imaging

“…The esophageal stents are designed for traversing malignant or benign esophageal strictures if standard operation is contraindicated [27][28][29]. The purpose of the esophagus stenting is often to bridge the obstruction in the esophagus interior.…”

“…In a case of cancer process, patients can be qualified to successful radical treatment (only in initial stages) and choosing an optimal method for palliative treatment (in hard progressive stages) [27,28]. The use of EUS can also assist controlling of the stents insertion and monitoring effects of treatment [19].…”

“…Patients can suffer from pancreatic carcinoma compressing the bile duct and extra-hepatic bile duct obstruction due to cholangiocarcinoma or benign biliary strictures [27,28]. The tumour can spread and neoplastic destruction leads to the retention of bile around the margin of the tumour.…”

Tratamento endoscópico do câncer epidermóide do esôfago

“…Entretanto, o aumento da fístula ou formação de outra podem acontecer. Os pacientes com estenose traqueobronquial devem ter sua estenose respiratória tratada em primeiro lugar (8,9) . A colocação de próteses através da junção esôfago-gástrica constitui-se problema particular.…”

“…A colocação de próteses através da junção esôfago-gástrica constitui-se problema particular. Em comparação com as próteses colocadas para lesões mais proximais, o efeito paliativo é menor e pode ter taxa de complicações maior (8) . (15) cônico concebido para aplicar força radial variável ao longo do comprimento do stent, para atender às diferenças anatômicas no esôfago distal e na cárdia.…”