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– Lymph node metastasis from moderate differentiated carcinoma. Upper jugular lymph node (HE stain, ob. 10×).
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Cervical esophageal cancer and hypopharyngeal cancer represent a major diagnostic issue in early stages, considering the fact that the implication of both cervical esophageal and hypopharyngeal cancers shows a poor prognostic from the very beginning. Positive diagnosis can only be made after histopathological analysis and immunohistochemical analys...
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Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging e...
Citations
... At present, ESCC mainly occurs in two-thirds of the stratified squamous epithelium of the esophagus. Histopathology can observe squamous differentiation of the esophageal epithelium; damage to basal and underlying structures; and matrix reactions, vascular lymphatic vessels, and peripheral nerves [15]. EC is common in men. ...
... The lower esophageal mucosa is in a low-pH environment for a long time, and the risk of ADC also increases [2]. ADSC is more invasive than epidermal cancer, with a spread of more than 75% in local lymph nodes, distant metastasis of more than 25%, and a 5-year survival rate of 15-25% [15]. In fact, regardless of histology, the prognosis level of esophageal cancer is unsatisfactory. ...
There are few studies on esophageal adenosquamous carcinoma (ADSC). Our study intended to investigate the clinical and survival features of ADSC. We included esophageal cancer (EC) data from the Surveillance, Epidemiology, and End Results program database to explore clinical and survival traits. Propensity score matching (PSM), the multivariate Cox regression model, and survival curves were used in this study. A total of 137 patients with ADSC were included in our analysis. The proportion of ADSC within the EC cohort declined from 2004 to 2018. Besides, results indicated no significant difference in survival between ADSC and SCC groups (PSM-adjusted HR = 1.249, P = 0.127). However, the survival rate of the ADSC group was significantly worse than that of the ADC group (PSM-adjusted HR = 1.497, P = 0.007). For the ADSC group, combined treatment with surgery had a higher survival rate than other treatment methods (all P < 0.001). Surgical resection, radiotherapy, and chemotherapy were independent protective prognostic factors (all P < 0.05). The proportion of ADSC has been declining from 2004 to 2018. The prognosis of ADSC is not significantly different from that of SCC but is worse than that of ADC. Surgery, radiotherapy, and chemotherapy could improve the prognosis of patients. Comprehensive treatment with surgery as the main treatment is more beneficial for some patients.
... The epidemiology of the hypopharyngeal and cervical esophageal cancer deals with the spread of the disease in the human population regarding sex, age, profession, time and space, as well as risk factors that contribute to these phenomena [5,6]. ...
Hypopharyngeal cancer is one of the most challenging pathologies regarding location, evolution, prognosis and functional implications. Since the hypopharynx is a crossroad in the digestive and respiratory pathways malignant pathology located at this site can cause dysphagia, odynophagia, respiratory distress and dysphonia. Complex anatomy and physiology of the hypopharynx make for pathology with a poor prognosis in late stages. Diagnosis and therapy are mandatory for ensuring high survival rates and as little functional impairment as possible. Therapy of hypopharyngeal cancer is a difficult test for both physician and patient. It requires a good collaboration between the ENT surgeon, pathologist, radiotherapist, chemotherapist, nutrition therapist and psychologist. Our approach to the subject is due to that data concerning this pathology is limited and the results of the overall oncology therapy are discouraging. Nonetheless, the technical steps of surgery make it difficult for ENT cancer surgeons to approach it, therefore the surgeons’ experience plays a very important role in decision making and establishing a good doctor-patient relationship, both during initial therapy and follow-up. We will also present an original technique developed in our clinic for restoring the continuity of the pharynx after total circular resection using the synthetic prosthesis.
... Adenocarcinoma of the cervical esophagus is uncommon, and squamous cell carcinoma is usually observed (2). Cervical esophageal squamous cell carcinoma (CESCC) has been reported to represent ~5% of esophageal cancer cases (3)(4)(5), and tobacco and alcohol consumption are risk factors for CESCC, the same as for thoracic esophageal cancer (6,7). ...
Cervical esophageal squamous cell carcinoma (CESCC) is less common compared with thoracic esophageal cancer, and few studies have investigated the clinicopathological features of CESCC. The present study analyzed 69 patients with CESCC who underwent various therapies at the University Hospital of Kyoto Prefectural University of Medicine between January 2000 and December 2016. The distance between the inferior border of the cricoid cartilage and upper edge of the tumor was evaluated using positron emission tomography and computed tomography. Positive and negative values indicated oral and anal directions, respectively. Using receiver operating characteristic curves, the cut-off value for laryngeal preservation was calculated as -5 mm. According to this value, the patients were divided into two groups: The short group (distance from the cricoid cartilage ≥-5 mm) and long group (distance from the cricoid cartilage <-5 mm). There were no significant differences in clinicopathological factors between the two groups except for body mass index. In univariate analysis, the 3-year overall survival rate was significantly lower in short group (45.4 vs. 79.6%; P=0.009). In multivariate analysis, short group was an independent prognostic risk factor (hazard ratio=2.65; P=0.039). This may be due to lymphatic flow around the cervical esophagus.
... The development of HNSCC is a multistep progressive process from precancerous lesions to malignant tumors, and despite the chemotherapy advances, the survival rate of HNSCC patients has not considerably changed over the last decades (R. P. TAKES & al. [2] and N. ZHANG & al. [3], BERTESTEANU & al. [4], POPESCU & AL. [5]). Treatment options are available, including chemotherapeutic agents such as cisplatin (CisPt) which is considered to be a standard treatment for patients with advanced HNSCC (R. BELCHER & al. [6]). ...
... This can be used as a temporary or definitive method of therapy or in the case of extreme morbidities with the impossibility of doing surgery under general anesthesia (11)(12)(13). The versatility of this method makes it one of the preferred means of surgical therapy (14)(15)(16). Usually, the Montgomery T tube stays in place for up to 6 months. However, there are cases in which this period of time may be increased according to the particularities of the patient and the overall aspect of the case (17)(18)(19). ...
Laryngo-tracheal stenosis is a complex pathology which requires multiple surgical interventions and diligence from the surgeon and patience from the patient so that normal physiology may be restored. The aim of this paper is to evaluate the factors that can influence the evolution of this pathology.
It is presented a retrospective study in which 20 cases of larynx stenosis from 2008 until 2018 were evaluated. The study revealed a predominance of the pathology in men, especially from rural environment. The etiology of larynx stenosis was both iatrogenic and traumatic. Multiple surgical interventions classical and endoscopic were necessary, along with tracheostomy. In 7 cases there was the need for larynx stent to be mounted.
There was no significant correlation between age, etiology and the site of stenosis and the removal of the tracheostomy. Larynx stenosis benefit in present by modern surgical techniques. Current therapeutic options include conservative therapy, endoscopic approach and external approach depending on the site, severity, morbidities of the stenosis. Even if technology is of great help in LS management of many patients, unfortunately there are still cases where therapy is very complex and with poor functional results.
... Squamous dysplasia is a well described histological precursor lesion of esophageal SCC [11][12][13][14]. Dysplasia is thought to be caused by molecular alterations [15]. Early detection of molecular alterations, endoscopic and histological features of squamous dysplasia is necessary to identify SCC at an early stage [16][17][18][19] In the next paragraphs we will describe the currently available organ sparing treatment options for locally advanced CEC, which combine RT with chemotherapy. ...
Background:
The aim of this systematic review is to provide an overview of the diagnosis, treatment options and treatment related complications of cervical esophageal carcinoma (CEC) and subsequently provide recommendations to improve quality of care.
Design:
Studies were identified in PubMed, EMBASE and Web of Science. A total of 107 publications fulfilled the inclusion criteria and were included.
Results:
CEC is uncommon, accounting for 2-10% of all esophageal carcinomas. These tumors are often locally advanced at presentation and have a poor prognosis, with a 5-year overall survival (OS) of 30%. Tobacco and alcohol consumption seem to be the major risk factors for developing CEC. Surgery is usually not possible due to the very close relationship to other organs such as the larynx, trachea and thyroid gland. Therefore, the current standard of care is definitive chemoradiation (dCRT) with curative intent. Treatment regimens used to treat CEC are adapted by established regimens in lower esophageal squamous cell carcinoma (SCC) and head and neck squamous cell carcinoma (HNSCC). However, dCRT may be accompanied by severe side effects and complications. Several diagnostic and predictive markers have been studied, but currently there is no other biomarker than clinical stage to determine patient management.Suggestions to improve patient outcomes are to determine the exact radiation dose needed for adequate locoregional control and to combine radiotherapy (RT) with optimal systemic therapy backbone.
Conclusion:
CEC remains unchartered territory for many practising physicians and patient with CEC have a poor prognosis. In order to improve the outcome for CEC patients, future studies should focus on identification of new diagnostic biomarkers or targets for radiosensitizers, amelioration of radiation schedules, optimal combination of chemotherapeutic agents and/or new therapeutic targets.
... Smoking is the major risk factor incriminated, statistics considering that smoking more than 20 years doubles the risk of developing squamous cell cancer. Prolonged exposure to dust and chemicals, such as polycyclic aromatic hydrocarbons, are also considered as major risk factors for pharyngeal squamous cancer [11][12][13][14]. ...
Pharyngeal squamous cell carcinoma is a rare neoplasm, whose incidence increases with age. Computed tomography (CT) imaging is an easy way to explore the pharyngeal region, having the advantage of being able to highlight and characterize the existence of a tumor in this region, and to determine its local extension and lymphatic metastasis. In this group were included a total of 27 patients, who, following the histopathological findings were diagnosed with pharyngeal squamous cell carcinoma and who have previously received a CT scan. CT examination protocol included a native scan and post-intravenous administration of contrast medium, in both the arterial phase and in parenchymal and venous phase. The scan was made with 2 mm thin sections, subsequently were performed coronal and sagittal reconstructions. The examination plan included the thoracic region down to the aperture. The paper tries to establish correlations between the morphological appearance and semiological computed tomography characters of the lesions.
... Smoking is the major risk factor incriminated, statistics considering that smoking more than 20 years doubles the risk of developing squamous cell cancer. Prolonged exposure to dust and chemicals, such as polycyclic aromatic hydrocarbons, are also considered as major risk factors for pharyngeal squamous cancer [11][12][13][14]. ...
Pharyngeal squamous cell carcinoma is a rare neoplasm, whose incidence increases with age. Computed tomography (CT) imaging is an easy way to explore the pharyngeal region, having the advantage of being able to highlight and characterize the existence of a tumor in this region, and to determine its local extension and lymphatic metastasis. In this group were included a total of 27 patients, who, following the histopathological findings were diagnosed with pharyngeal squamous cell carcinoma and who have previously received a CT scan. CT examination protocol included a native scan and post-intravenous administration of contrast medium, in both the arterial phase and in parenchymal and venous phase. The scan was made with 2 mm thin sections, subsequently were performed coronal and sagittal reconstructions. The examination plan included the thoracic region down to the aperture. The paper tries to establish correlations between the morphological appearance and semiological computed tomography characters of the lesions.
... Similar types of macroscopic growth patterns have been defined in the classification of the Japanese Society for Esophageal Diseases. 3,4 The majority of primary adenocarcinomas arise in the lower third of the esophagus within a segment of Barrett mucosa. Adjacent to the tumor, the typical salmon-pink mucosa of Barrett esophagus may be evident. ...
Background: The diseases of the gastrointestinal tract (GIT) are the most common and leading cause of morbidity and mortality than the disorders of any other systems of the body. Gastrointestinal (GI) tract tumors are one of the most common cancers accounting for 11% of all cancers. Among these tumors, upper gastrointestinal tract malignancies are quite aggressive with a dismal prognosis. Malignant tumors are most common than benign. The most common carcinoma of the esophagus is Squamous cell carcinoma (SCC). Incidence of SCC is less than 5 per 100,000 populations in males and 1 per 100,000 populations in females. Gastric cancer was the second most common cancer in the World and 60% of them occurred in developing countries. The most common carcinoma of the Stomach is Adenocarcinoma. Aim & Objectives: To study the spectrum of neoplastic lesions of the upper gastrointestinal tract by the examination of endoscopic biopsies and surgically resected specimens. To determine the degree of severity of the malignancies by assessing the depth of invasion, Lymph nodal & Omental spread. Methods: The present study is both retrospective & prospective study for a period of 5 years from January 2007 to December 2011. The sample size includes all the endoscopic biopsies & surgically resected specimens of gastrointestinal tract received at Department of Pathology, S.V. Medical College, Tirupati. The study also obtained clearance from the ethical committee of the institution. The biopsy specimens thus obtained were fixed in 10% buffered neutral formalin. The sections were stained routinely with H & E. Special stains and IHC done wherever necessary. Results: we have received 120 specimens regarding the upper gastrointestinal system. Among these 120 specimens, 71 specimens were endoscopic biopsies & 49 specimens were surgically resected specimens. Out of 71 Endoscopic biopsies 28 biopsies were malignant among which 2 was esophagus and 26 were stomach. Out of 49 surgically resected specimens 1 was benign and 32 were malignant tumors. Out of 59 neoplasms of stomach there were single cases each of Sub mucosal Lipoma, Malignant lymphoma, GIST & 56 cases of Adenocarcinoma & its variants were noted. Conclusion: Most of the neoplasms are of stomach (97%). All the neoplasms are malignant except one benign lesion sub mucous lipoma of stomach. Most of the neoplasms of stomach were Adenocarcinoma (96.5%). Both tumors of esophagus were squamous cell carcinoma occurred after 50 years of age.
Background:
Few studies have examined optimal treatment specifically for cervical esophageal carcinoma. This study evaluated the outcome of three common treatment strategies with a focus on the debated role of surgery.
Methods:
All patients with cervical esophageal cancer treated at a single center were identified and their outcomes analyzed in terms of morbidity, mortality, and recurrence according to the treatment they received, i.e. surgery alone, definitive platinum-based chemoradiation (CRT), or CRT followed by surgery.
Results:
The study population included 148 patients with cervical esophageal cancer from a prospective database of 3445 patients. Primary surgery was the treatment of choice for 56 (37.83%) patients, definitive CRT was the treatment of choice for 52 (35.13%) patients, and CRT followed by surgery was the treatment of choice for 40 (27.02%) patients. CRT-treated patients obtained 36.96% complete clinical response, with overall morbidity and mortality rates of 36.95 and 2.17%, respectively. Surgical complete resection was achieved in 71.88% of surgically treated cases, with morbidity and mortality rates of 52.17 and 6.25%, respectively. No significant survival difference existed among the three treatments, but patients who underwent surgery alone had a significantly lower stage of disease (p = 0.031). Compared with patients with complete response after CRT, surgery did not confer any significant survival benefit, and overall 5-year survival was lower than definitive CRT alone. In contrast, surgery improved survival significantly in patients with non-complete response after definitive CRT (p = 0.023).
Conclusions:
Definitive platinum-based CRT should be the treatment of choice for cervical esophageal cancer. Surgery has a role for patients with non-complete response as it adds significant survival benefit, with acceptable morbidity and mortality.
