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Esophageal cancer is a serious malignancy with high mortality. The two common distinctive pathologic subtypes of esophageal cancer are squamous cell carcinoma and adenocarcinoma. These differ with regards to etiology, ethnic distribution, pathogenesis, and location in the esophagus. The precursor lesions are also unique to each subtype. Squamous ce...
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... pathologic reporting is done on a standardized format jointly provided by the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC), and College of American Pathologists (CAP). Currently the AJCC/UICC TNM 7 th edition (43) is the staging system used for esophageal resection specimens to predict prognosis in ESCC and EAC ( Table 1). Several studies have shown that assessment of pathologic response to neoadjuvant therapy, in terms of tumor regression grade and nodal metastasis, are independent prognostic factors for both EAC and ESCC (44-46). ...
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Minimally invasive esophagectomy (MIE) has been reported to reduce postoperative complications especially pulmonary complications and have equivalent long‐term survival outcomes as compared to open esophagectomy. Robot‐assisted minimally invasive esophagectomy (RAMIE) using da Vinci surgical system (Intuitive Surgical, Sunnyvale, USA) is rapidly ga...
Citations
... The adventitia, muscularis propria, and submucosa are among the tissues that esophageal cancers can infiltrate before moving on to the pericardium and myocardium. Depending on the location and size of the tumor, the precise invasion route could change [6,20,21]. ...
Esophageal cancer is a significant health concern, with malignant tumors often invading nearby cardiac tissues. This comprehensive review explores the background information on esophageal tumors, including risk factors and diagnostic techniques. It delves into the significance of cardiac invasion, highlighting its impact on prognosis and treatment planning. Diagnostic methods, such as imaging modalities, endoscopic evaluation, and laboratory tests, are discussed in detail. The review also addresses the complications of cardiac invasion and management strategies, including surgical, radiation, and chemotherapy approaches. Furthermore, it explores emerging treatments, such as targeted therapies and immunotherapies, and their potential in improving patient outcomes. The article concludes by highlighting future research directions, including the development of imaging techniques, biomarkers, and personalized medicine approaches. By providing a comprehensive understanding of cardiac invasion in esophageal cancer, this review aims to contribute to the existing literature and offer insights for healthcare professionals in optimizing patient care.
... 3 Squamous cell carcinoma in-situ is the precancerous lesion of the squamous cell carcinoma. 4 Esophageal pagetoid squamous cell carcinoma in-situ, is one of the histological variant of squamous cell carcinoma in-situ, which is one of the rare tumors. 1 Paget's disease is defined as neoplastic mucin producing glandular cells infiltration in the squamous epithelium. 5 Pagetoid squamous cells shares histomorphological resemblance with the Paget's disease. ...
... Pagetoid squamous cell carcinoma in-situ is the precursor lesion of the esophageal SCC and which appears normal on endoscopy or may have subtle changes such as erythema, friability, erosion, plaque and nodularity. 4 This case signifies the importance of biopsies from the esophagus, even when there are mild changes in endoscopy such as thickened mucosa or erythema. ...
Squamous cell carcinoma (SCC) is the most common malignant tumor of the
esophagus, however, pagetoid SCCIS is an extremely rare condition in esophagus.1
Pagetoid Squamous Cell Carcinoma In-Situ (SCCIS) has been described in skin and
external genitalia frequently.2 Herein we report a case of pagetoid squamous cell
carcinoma in-situ in a 50-year-old male with clinical information, histopathological
and immunohistochemical findings.
The patient was a 50 years male with dyspepsia,refractory to proton pump
inhibitors (PPIs). In upper gastroduodenal endoscopy, there was no obvious lesion
in the esophagus and only mild erythema was noted. Biopsy showed a surprising
finding of full thickness high grade squamous dysplasia in the lining squamous
epithelium with scattered single large atypical cells. These cells were present away
from the foci of dysplasia. The cells were large and showed marked pleomorphism,
vesicular nuclei, prominent nucleoli and abundant pale to eosinophilic cytoplasm.
Immunohistochemistry (IHC) was positive for p63 and p53, which confirmed the
diagnosis of pagetoid SCCIS.
Pagetoid squamous cell carcinoma in-situ is one of the rare entities with subtle
clinical presentation and endoscopic findings. Evaluation of this case signifies the
importance of taking biopsies in the lesions which shows minimal mucosal change
in the endoscopy.
... Esophageal squamous cell carcinoma (ESCC) is the primary pathological type of esophageal malignant neoplasms, accounting for approximately 84% of esophageal cancer cases; however, the 5-year overall survival rate is only~20% [1,2]. ESCC arises from the epithelial cells that line the esophagus and is primarily found in the upper two-thirds of the esophagus [3]. ESCC represents one of the most aggressive digestive neoplasms globally, characterized by a high mortality rate and geographical variations in incidence: East Asia has the worst epidemic incidence of ESCC and fatality, which burdens healthcare systems tremendously [2,4]. ...
The occurrence and development of esophageal cancer involve multiple genetic abnormalities that contribute to the malignant transformation of esophageal epithelial cells, followed by invasion and metastasis, leading to a poor outcome. Esophageal squamous cell carcinoma (ESCC) is the predominant histological subtype of esophageal malignancy in East Asia, with approximately half of newly diagnosed ESCC cases occurring in China. The TP53 tumor suppressor gene mutation is one of the most common mutations in ESCC. TP53 mutations are observed even in the early phases of esophageal carcinogenesis. Normal functions of the p53 network are lost in cells of ESCC patients who harbor the mutant TP53 gene, inducing tumor development, radiation resistance, chemotherapy resistance, and immune suppression, promoting progression and metastasis, thereby resulting in an overall poor prognosis. Although clinical trials of several pharmacological compounds targeting mutational TP53 have been explored, novel approaches are still urgently required to improve the observed dismal survival. A better understanding of the role of the mutant TP53 gene in human ESCC might lead to the discovery of innovative targeted therapies to treat this malignancy.
... Primary esophageal cancer is histologically divided into two types: esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), with each type having different types of metastases occurring at different stages. Stages 1a and 1b, with an invasion depth of sm1, are generally considered to be free of lymph node metastasis, while the chances of lymph node metastasis increase continuously thereafter (3). ...
Esophageal cancer is a prevalent tumor of the digestive tract worldwide. The detection rate of early-stage esophageal cancer is very low, and most patients are diagnosed with metastasis. Metastasis of esophageal cancer mainly includes direct diffusion metastasis, hematogenous metastasis, and lymphatic metastasis. This article reviews the metabolic process of esophageal cancer metastasis and the mechanisms by which M2 macrophages, CAF, regulatory T cells, and their released cytokines, including chemokines, interleukins, and growth factors, form an immune barrier to the anti-tumor immune response mediated by CD8+ T cells, impeding their ability to kill tumor cells during tumor immune escape. The effect of Ferroptosis on the metastasis of esophageal cancer is briefly mentioned. Moreover, the paper also summarizes common drugs and research directions in chemotherapy, immunotherapy, and targeted therapy for advanced metastatic esophageal cancer. This review aims to serve as a foundation for further investigations into the mechanism and management of esophageal cancer metastasis.
... ESCC predominates in the upper and mid-thirds of the esophagus. It is thought to develop through the progression of premalignant precursor lesions of the squamous lining of the esophagus (squamous dysplasia), which result from the presence of chronic inflammation [14,15] that causes architectural changes such as disordered cellular stratification, loss of cellular polarity, and premature keratinization. Several risk factors have been associated with the development of ESCC, namely smoking, tobacco chewing, alcohol consumption, intake of hot beverages, and diets with reduced consumption of fresh fruits and vegetables [16][17][18]. ...
Simple Summary
Esophageal cancer has very high mortality and morbidity rates. In this study, we reviewed the current literature on the impact of microbiota on esophageal cancer and its precursor lesions. Globally, a decrease in microbiota richness and evenness in esophageal cancer is identified, which is accompanied by an increase in the abundance of Gram-negative bacteria.
Abstract
Esophageal cancer is a major health problem, being the seventh most incidence cancer worldwide. Due to the often-late diagnosis and lack of efficient treatments, the overall 5-year survival is as low as 10%. Therefore, understanding the etiology and the mechanisms that drive the development of this type of cancer could improve the management of patients, increasing the chance of achieving a better clinical outcome. Recently, the microbiome has been studied as a putative etiological factor for esophageal cancer. Nevertheless, the number of studies tackling this issue is low, and the heterogeneity in the study design and data analysis has hindered consistent findings. In this work, we reviewed the current literature on the evaluation of the role of microbiota in the development of esophageal cancer. We analyzed the composition of the normal microbiota and the alterations found in precursor lesions, namely Barrett’s esophagus and dysplasia, as well as in esophageal cancer. Additionally, we explored how other environmental factors can modify microbiota and contribute to the development of this neoplasia. Finally, we identify critical aspects to be improved in future studies, with the aim of refining the interpretation of the relationship between the microbiome and esophageal cancer.
... EAC is a gland-forming tumor most commonly with tubular, tubulopapillary, or papillary growth patterns. Well-differentiated tumors show >95% gland formation, moderately differentiated tumors show 50-95% gland formation, and poorly differentiated tumors show <50% gland formation [28]. The diagnosis of EAC is typically confirmed via an endoscopic biopsy. ...
Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence and is associated with a poor prognosis. Barrett’s esophagus (BE) is a known precursor of esophageal adenocarcinoma. This review aims to explore Barrett’s esophagus, esophageal adenocarcinoma, and the progression from the former to the latter. An overview of the definition, diagnosis, epidemiology, and risk factors for both entities are presented, with special attention being given to the areas of debate in the literature. The progression from Barrett’s esophagus to esophageal adenocarcinoma is reviewed and the relevant molecular pathways are discussed. The definition of Barrett’s esophagus remains debated and without international consensus. This, alongside other factors, has made establishing the true prevalence of Barrett’s esophagus challenging. The degree of dysplasia can be a histological challenge, but is necessary to guide clinical management. The progression of BE to EAC is likely driven by inflammatory pathways, pepsin exposure, upregulation of growth factor pathways, and mitochondrial changes. Surveillance is maintained through serial endoscopic evaluation, with shorter intervals recommended for high-risk features.
... Barrett's esophagus is also a complication with GERD following on from NERD and dysphagia, with some studies suggesting erosive esophagitis as a major risk factor for Barrett's esophagus, with up to a fivefold increased risk [9,34,35]. The risk of Barrett's esophagus increases with the length of time of untreated GERD [36] and is typically a precursor to esophageal adenocarcinoma [3,35,37]. Eusebi et al. recently estimated the pooled prevalence of patients with confirmed Barrett's esophagus in those with GERD at 7.0%, higher among those who drank alcohol [17]. ...
The growing prevalence of gastroesophageal reflux disease (GERD) needs to be carefully managed to relieve
the symptoms and prevent complications. Complications of GERD can include erosive esophagitis, Barrett’s
esophagus and gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are typically first-line
treatment for GERD alongside lifestyle changes in view of their effectiveness and cost-effectiveness.
However, there are concerns with adherence to dosing regimens and recommended lifestyle changes
reducing their effectiveness. There are also concerns about potential complications from chronic high-dose
PPIs. These include an increased risk of chronic kidney disease, cardiovascular events and infections.
Recommendations to physicians include prescribing or dispensing the lowest dose of PPI for the shortest
time, with ongoing patient monitoring. Activities among community pharmacists and others have resulted
in increased dispensing of PPIs without a prescription, which can be a challenge. PPIs are among the most
prescribed and dispensed medicines in view of their effectiveness in managing GERD. However, there are
concerns with the doses prescribed and dispensed as well as adherence to lifestyle advice. These issues and
challenges need to be addressed by health authorities to maximize the role and value of PPIs
... 5 This disease has two major histological subtypes: squamous cell carcinoma and adenocarcinoma, with a global predominance of squamous cell carcinoma. 6,7 The risk of this cancer is significantly associated with consuming tobacco, alcohol, hot tea, and processed meat. 4,8 Most patients are currently diagnosed at a late stage with local or distant metastasis. ...
Introduction:
The overall 5-year survival rate for esophageal cancer patients in low- and middle-income countries was reported to be low, despite the availability of advanced treatments. Thus, this study aimed to assess determinants of survival outcomes among esophageal cancer patients in Kenya.
Methods:
A retrospective cohort study was employed among 299 adult esophageal cancer patients. The data were collected using a data abstraction tool consisting of patients' clinical characteristics and survival outcome measuring parameters. Statistical Package for the Social Sciences (SPSS) statistical software (version 20.0, IBM. USA) was used to analyze the data. The Kaplan-Meier and Cox regression analyses were used to determine the survival outcome and determinants of mortality, respectively.
Results:
The mortality rate was 43.1%, and 11.1% of patients demonstrated distant metastases in the follow-up period. Despite treatment, 20.1% had progressed disease, and 13.0% did not respond to treatment. Radiotherapy (AHR: 3.3, 95% CI: 1.4-7.8, p = 0.007), chemotherapy (AHR: 3.9, 95% CI: 1.2-6.1, p = 0.020), and chemoradiation (AHR: 5.6, 95%CI: 1.6-10.2, p = 0.006) were the significant determinants of survival in advanced stage (III and and IV) patients.
Conclusions:
There was a high mortality rate, disease progression, and nonresponse of esophageal cancer patients. Hence, it is essential to improve the survival of patients through early detection and timely initiation of the available treatment options.
... This poor prognosis has been attributed to late diagnosis, with reportedly 40% of esophageal cancers in the USA diagnosed with distant metastases and another 32% diagnosed with local organ and lymph node involvement [4]. A number of hereditary and environmental risk factors have been identified for both ESCC and EAC, which support different underlying pathobiologies between the two subtypes [5]. ...
Advances in technology and improved understanding of the pathobiology of esophageal cancer have allowed endoscopy to serve a growing role in the management of this disease. Precursor lesions can be detected using enhanced diagnostic modalities and eradicated with ablation therapy. Furthermore, evolution in endoscopic resection has provided larger specimens for improved diagnostic accuracy and offer potential for cure of early esophageal cancer. In patients with advanced esophageal cancer, endoluminal therapy can improve symptom burden and provide therapeutic options for complications such as leaks, perforations, and fistulas. The purpose of this review article is to highlight the role of endoscopy in the diagnosis, treatment, and palliation of esophageal cancer.
... Barrett's oesophagus (BO) is considered a precursor to oesophageal adenocarcinoma (OAC) and is defined as columnar metaplasia of the stratified squamous epithelium of the distal oesophagus which arises in the setting of gastro-oesophageal-reflux disease (GORD) [1]. Given the well-characterized link between BO and OAC, endoscopic screening for BO in high-risk individuals followed by regular surveillance of BO patients is recommended by many international medical societies [2]. ...
Oesophageal adenocarcinoma (OAC) incidence has increased dramatically in the developed world, yet outcomes remain poor. Extensive endoscopic surveillance programs among patients with Barrett’s oesophagus (BO), the precursor lesion to OAC, have aimed to both prevent the development of OAC via radiofrequency ablation (RFA) and allow earlier detection of disease. However, given the low annual progression rate and the costs of endoscopy/RFA, improvement is needed. Prognostic biomarkers to stratify BO patients based on their likelihood to progress would enable a more targeted approach to surveillance and RFA of high-risk precursor lesions, improving the cost–risk–benefit ratio. Similarly, diagnostic biomarkers for OAC could enable earlier diagnosis of disease by allowing broader population screening. Current standard treatment for locally advanced OAC includes neoadjuvant chemotherapy (+/− radiotherapy) despite only a minority of patients benefiting from neoadjuvant treatment. Accordingly, biomarkers predictive of response to neoadjuvant therapy could improve patient outcomes by reducing time to surgery and unnecessary toxicity for the patients who would have received no benefit from the therapy. In this mini-review, we will discuss the emerging biomarkers which promise to dramatically improve patient outcomes along the BO-OAC disease sequence.
