Recent Results in Cancer Research 182 Adenocarcinoma of the Esophagogastric Junction Bearbeitet von Paul M Schneider 1. Auflage 2010. Buch. xiv, 194 S. Hardcover ISBN 978 3 540 70578 9 Format (B x L): 15,5 x 23,5 cm Gewicht: 517 g Weitere Fachgebiete > Medizin > Klinische und Innere Medizin > Onkologie, Psychoonkologie Zu Leseprobe schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, ebooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte.
Contents 1 Epidemiology of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third... 1 Manuel Vial, Luis Grande, and Manuel Pera 1.1 Introduction.... 1 1.2 Demographics, Trends, and Geographic Variations of Adenocarcinoma of the Esophagus and EGJ... 2 1.3 Age, Gender, and Race... 4 1.4 Gastroesophageal Reflux Disease and ACE and EGJ... 4 1.5 Barrett s Esophagus and ACE and EGJ..................... 5 1.6 Obesity... 7 1.7 Additional Risk Factors for ACE and EGJ.... 9 1.7.1 Tobacco... 9 1.7.2 Alcohol... 9 1.7.3 Diet and Nutrition.... 9 1.7.4 Medications.... 10 1.7.5 Helicobacter pylori Infection... 11 1.8 Summary.... 11 References.... 12 2 Clinical Classification Systems of Adenocarcinoma of the Esophagogastric Junction... 19 Stefan Paul Mönig and Arnulf H. Hölscher 2.1 Esophagogastric Junction... 19 2.1.1 Introduction... 19 2.1.2 Definition... 19 2.1.3 Different Classification Systems.... 20 2.2 Classification of Adenocarcinoma of the EGJ Type I-III... 21 2.2.1 Definition and Topographical Classification... 21 2.2.2 Diagnosis... 21 2.2.3 Biological and Clinical Variations... 23 ix
x Contents 2.2.4 Surgical Consequences... 25 2.3 Conclusions.... 26 References.... 26 3 Histopathologic Classification of Adenocarcinoma of the Esophagogastric Junction... 29 Stephan E. Baldus 3.1 Introduction.... 29 3.2 Definition of the Esophagogastric Junction... 30 3.3 WHO Classification of Tumors of the Digestive System.... 31 3.3.1 General Principles... 31 3.4 Histopathologic Subtypes... 31 3.5 Precancerous Lesions and Histogenetic Aspects... 31 3.6 Prognostic Aspects of Histopathologic Classification... 33 3.7 UICC Classification and Grading... 34 3.8 Histopathologic Regression Grading After Neoadjuvant therapy................................... 34 References.... 36 4 The Pathogenesis of Barrett s Metaplasia and the Progression to Esophageal Adenocarcinoma... 39 Brechtje A. Grotenhuis, J. Jan B. van Lanschot, Winand N.M. Dinjens, and Bas P.L. Wijnhoven 4.1 Introduction.... 39 4.2 Normal Esophageal Epithelium... 40 4.3 Pathogenesis of Barrett s Metaplasia....................... 41 4.3.1 Development of Barrett s Esophagus: Congenital vs. Acquired... 41 4.3.2 Definition of Barrett s Metaplasia... 41 4.3.3 Gastroesophageal Reflux Disease.... 41 4.3.4 Cell of Origin of Barrett s Metaplasia... 47 4.3.5 Transformation into a Columnar Epithelium... 49 4.3.6 Clonal Expansion... 49 4.4 Progression to Esophageal Adenocarcinoma................. 50 4.4.1 Hallmarks of Cancer Progression... 51 4.4.2 Genetic Instability.... 53 4.5 Summary.... 54 References.... 54 5 Differences in the Molecular Biology of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third... 65 Kuno Lehmann and Paul M. Schneider 5.1 Introduction.... 65 5.2 Microsatelite Instability (MSI) and Loss of Heterozygosity (LOH)... 66
Contents xi 5.3 Difference in Phenotype on Histology and Immunohistochemistry... 66 5.4 Differences in the Hallmarks of Cancer... 67 5.5 Self-Sufficiency in Growth Signals... 67 5.6 Insensitivity to Antigrowth Signals... 67 5.7 Evasion of Apoptosis... 68 5.8 Limitless Replicative Potential.... 68 5.9 Sustained Angiogenesis... 68 5.10 Tissue Invasion... 68 5.11 Conclusion... 69 References.... 69 6 Clinical Staging of Adenocarcinoma of the Esophagogastric Junction... 73 Julia Cordin, Kuno Lehmann, and Paul M. Schneider 6.1 Introduction.... 73 6.2 Establishing the Diagnosis... 73 6.3 The Tumor Center Localization Determines the Classification... 74 6.4 Preoperative TNM Staging Defines Further Treatment Strategies... 75 6.5 Imaging Techniques for AEG.... 75 6.6 Endoscopic Ultrasound (EUS)... 75 6.7 Computed Tomography (CT)... 77 6.8 18 Fluorodeoxyglucose Positron Emission Tomography ( 18 FDG-PET)... 78 6.9 MRI.... 78 6.10 Staging Laparoscopy Excludes Peritoneal Disease... 78 6.11 Conclusion... 79 References.... 80 7 Endoscopic Mucosal Resection for Staging and Therapy of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third... 85 Henriette Heinrich and Peter Bauerfeind 7.1 Introduction.... 85 7.2 Staging and Marking Before ER.... 86 7.3 Endoscopic Resection Techniques... 86 7.4 Results of ER... 87 7.5 Results in Early Barrett s Adenocarcinoma or HGD... 87 7.6 Complications of ER in Barrett Esophagus... 88 7.7 ER for HGC or Early Cancer at the Esophagogastric Junction... 88 7.8 ER for Gastric Neoplasia... 89 7.9 Conclusion... 89 References.... 89
xii Contents 8 Surgical Strategies for Adenocarcinoma of the Esophagogastric Junction... 93 Marc Schiesser and Paul M. Schneider 8.1 Introduction.... 93 8.2 Surgical Strategies for AEG Siewert Type I.... 95 8.2.1 Reconstruction... 99 8.2.2 Limited Resection.... 99 8.2.3 Minimal Invasive Operation Techniques... 100 8.3 Surgical Strategies for AEG Siewert Type II and III... 101 8.3.1 Limited Resection.... 103 8.3.2 Minimal Invasive Techniques.... 103 8.3.3 Sentinel Node Technique... 103 8.4 Summary.... 104 References.... 104 9 Current Status of Sentinel Lymph Node Biopsy in Adenocarcinoma of the Distal Esophagus, Gastric Cardia, and Proximal Stomach... 107 Stephan Gretschel and Peter M. Schlag 9.1 Introduction.... 107 9.2 Pattern of Lymph Node Metastases... 107 9.3 Extension of Resection... 108 9.4 The Techniques of Sentinel Node Biopsy... 108 9.5 Upstaging... 110 9.6 Using the SLN as Frozen Section During Surgery.... 110 9.7 Current Status of Sentinel Lymph Node Biopsy in Gastric Cancer... 110 9.8 Sentinel Lymph Node Concept in AEG..................... 111 References.... 112 10 Current Diagnosis and Future Impact of Micrometastases for Therapeutic Strategies in Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third... 115 Asad Kutup, Emre F. Yekebas, and Jakob R. Izbicki 10.1 Introduction.... 115 10.2 Incidence of Nodal Micrometastases... 116 10.3 Mode of Spread.... 117 10.4 Effect of Nodal Microinvolvement on Survival... 119 10.5 Current and Future Perspectives.... 121 References.... 122
Contents xiii 11 Quality Indicators of Surgery for Adenocarcinoma of the Esophagus and Gastroesophageal Junction... 127 Toni Lerut, Georges Decker, Willy Coosemans, Paul De Leyn, Herbert Decaluwé, Philippe Nafteux, and Dirk Van Raemdonck 11.1 Introduction.... 127 11.2 Quality Issues in the Definition of Cancer of the Gastroesophageal Junction (GEJ).... 128 11.3 Quality Control and Quality Issues in the Staging of Esophageal Cancer... 130 11.4 Quality Issues in the Use and Indications for Induction Chemo- and Chemoradiotherapy... 132 11.4.1 Chemotherapy.... 132 11.4.2 Chemoradiotherapy.... 133 11.5 Type of Surgical Approach, Extent of Esophageal/Gastric Resection, and Extent of Lymph Node Dissection... 135 11.6 Use (and Misuse?) of Minimally Invasive Esophagectomy Techniques... 137 11.7 Quality of Perioperative Management... 138 11.8 Conclusion... 139 References.... 139 12 Peri-Operative and Complication Management for Adenocarcinoma of the Oesophagus and Oesophagigastric Junction... 143 K. Tobias E. Beckurts 12.1 Patient Selection and Evaluation... 143 12.2 Pre-Operative Preparation... 144 12.3 Anaesthesia.... 144 12.4 Operative Prophylaxis of Complications... 145 12.5 Immediate Post-Operative Care... 146 12.6 Surgical Complications.... 147 12.7 Management of Pulmonary Complications... 148 12.8 Postoperative Nutrition.... 149 12.9 Summary.... 149 References.... 150 13 Multimodality Therapy for Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third... 155 John V. Reynolds, Thomas J. Murphy, and Narayamasamy Ravi 13.1 Introduction.... 155 13.2 Multimodal Therapy... 156 13.3 The Evidence-Base for Neoadjuvant and Adjuvant Approaches... 156
xiv Contents 13.3.1 Neoadjuvant Chemotherapy.... 156 13.3.2 Neoadjuvant Chemoradiotherapy... 158 13.3.3 Postoperative Combination Therapy... 160 13.4 New Combinations and Novel Agents... 160 13.5 Conclusions.... 161 References.... 164 14 Metabolic Response Evaluation by PET During Neoadjuvant Treatment for Adenocarcinoma of the Esophagus and Esophagogastric Junction... 167 A. Sendler 14.1 Response Evaluation.... 169 14.2 Response Evaluation by CT Scan Studies and EUS... 170 14.3 Response Evaluation by PET After Neoadjuvant Treatment... 171 14.4 PET During Treatment... 173 14.5 Conclusion... 174 References.... 175 15 Molecular Response Prediction in Multimodality Treatment for Adenocarcinoma of the Esophagus and Esophagogastric Junction... 179 Georg Lurje and Heinz-Josef Lenz 15.1 Introduction.... 179 15.2 Molecular Markers; Defining their Role.... 180 15.2.1 Epidermal Growth Factor Receptors (EGFR, HER2/neu)... 182 15.2.2 Tumor Suppressor Gene p53... 182 15.2.3 Survivin.... 183 15.2.4 Cyclooxygenase-2 (COX-2)... 183 15.2.5 Excision Repair Cross-Complementing 1 (ERCC1)... 184 15.2.6 Gene Expression Microarray Profiling... 184 15.2.7 CpG Island Methylator Phenotype (CIMP)... 185 15.3 Conclusion... 186 References.... 186