Adenocarcinoma of the Esophagogastric Junction (eBook)

Preface 6
Contents 8
Epidemiology of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third 14
1.1 Introduction 14
1.2 Demographics, Trends, and Geographic Variations of Adenocarcinoma of the Esophagus and EGJ 15
1.3 Age, Gender, and Race 17
1.4 Gastroesophageal Reflux Disease and ACE and EGJ 17
1.5 Barrett’s Esophagus and ACE and EGJ 18
1.6 Obesity 20
1.7 Additional Risk Factors for ACE and EGJ 22
1.8 Summary 24
References 25
Clinical Classification Systems of Adenocarcinoma of the Esophagogastric Junction 31
2.1 Esophagogastric Junction 31
2.2 Classification of Adenocarcinoma of the EGJ Type I- III 33
2.3 Conclusions 38
References 38
Histopathologic Classification of Adenocarcinoma of the Esophagogastric Junction 41
3.1 Introduction 41
3.2 Definition of the Esophagogastric Junction 42
3.3 WHO Classification of Tumors of the Digestive System 43
3.4 Histopathologic Subtypes 43
3.5 Precancerous Lesions and Histogenetic Aspects 43
3.6 Prognostic Aspects of Histopathologic Classification 45
3.7 UICC Classification and Grading 46
3.8 Histopathologic Regression Grading after Neoadjuvant Therapy 46
References 48
The Pathogenesis of Barrett’s Metaplasia and the Progression to Esophageal Adenocarcinoma 51
4.1 Introduction 51
4.2 Normal Esophageal Epithelium 52
4.3 Pathogenesis of Barrett’s Metaplasia 53
4.4 Progression to Esophageal Adenocarcinoma 62
4.5 Summary 66
References 66
Differences in the Molecular Biology of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third 76
5.1 Introduction 76
5.2 Microsatelite Instability (MSI) and Loss of Heterozygosity ( LOH) 77
5.3 Difference in Phenotype on Histology and Immunohistochemistry 77
5.4 Differences in the Hallmarks of Cancer 78
5.5 Self-Sufficiency in Growth Signals 78
5.6 Insensitivity to Antigrowth Signals 78
5.7 Evasion of Apoptosis 79
5.8 Limitless Replicative Potential 79
5.9 Sustained Angiogenesis 79
5.10 Tissue Invasion 79
5.11 Conclusion 80
References 80
Clinical Staging of Adenocarcinoma of the Esophagogastric Junction 84
6.1 Introduction 84
6.2 Establishing the Diagnosis 84
6.3 The Tumor Center Localization Determines the Classification 85
6.4 Preoperative TNM Staging Defines Further Treatment Strategies 86
6.5 Imaging Techniques for AEG 86
6.6 Endoscopic Ultrasound (EUS) 86
6.7 Computed Tomography (CT) 88
6.8 18Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET) 89
6.9 MRI 89
6.10 Staging Laparoscopy Excludes Peritoneal Disease 89
6.11 Conclusion 90
References 91
Endoscopic Mucosal Resection for Staging and Therapy of Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third 95
7.1 Introduction 95
7.2 Staging and Marking Before ER 96
7.3 Endoscopic Resection Techniques 96
7.4 Results of ER 97
7.5 Results in Early Barrett’s Adenocarcinoma or HGD 97
7.6 Complications of ER in Barrett Esophagus 98
7.7 ER for HGC or Early Cancer at the Esophagogastric Junction 98
7.8 ER for Gastric Neoplasia 99
7.9 Conclusion 99
References 99
Surgical Strategies for Adenocarcinoma of the Esophagogastric Junction 102
8.1 Introduction 102
8.2 Surgical Strategies for AEG Siewert Type I 104
8.3 Surgical Strategies for AEG Siewert Type II and III 110
8.4 Summary 113
References 113
Current Status of Sentinel Lymph Node Biopsy in Adenocarcinoma of the Distal Esophagus, Gastric Cardia, and Proximal Stomach 116
9.1 Introduction 116
9.2 Pattern of Lymph Node Metastases 116
9.3 Extension of Resection 117
9.4 The Techniques of Sentinel Node Biopsy 117
9.5 Upstaging 119
9.6 Using the SLN as Frozen Section During Surgery 119
9.7 Current Status of Sentinel Lymph Node Biopsy in Gastric Cancer 119
9.8 Sentinel Lymph Node Concept in AEG 120
References 121
Current Diagnosis and Future Impact of Micrometastases for Therapeutic Strategies in Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third 124
10.1 Introduction 124
10.2 Incidence of Nodal Micrometastases 125
10.3 Mode of Spread 126
10.4 Effect of Nodal Microinvolvement on Survival 128
10.5 Current and Future Perspectives 130
References 131
Quality Indicators of Surgery for Adenocarcinoma of the Esophagus and Gastroesophageal Junction 135
11.1 Introduction 135
11.2 Quality Issues in the Definition of Cancer of the Gastroesophageal Junction ( GEJ) 136
11.3 Quality Control and Quality Issues in the Staging of Esophageal Cancer 138
11.4 Quality Issues in the Use and Indications for Induction Chemo- and Chemoradiotherapy 140
11.5 Type of Surgical Approach, Extent of Esophageal/ Gastric Resection, and Extent of Lymph Node Dissection 143
11.6 Use (and Misuse?) of Minimally Invasive Esophagectomy Techniques 145
11.7 Quality of Perioperative Management 146
11.8 Conclusion 147
References 147
Peri- Operative and Complication Management for Adenocarcinoma of the Oesophagus and Oesophagigastric Junction 151
12.1 Patient Selection and Evaluation 151
12.2 Pre- Operative Preparation 152
12.3 Anaesthesia 152
12.4 Operative Prophylaxis of Complications 153
12.5 Immediate Post- Operative Care 154
12.6 Surgical Complications 155
12.7 Management of Pulmonary Complications 156
12.8 Postoperative Nutrition 157
12.9 Summary 157
References 158
Multimodality Therapy for Adenocarcinoma of the Esophagus, Gastric Cardia, and Upper Gastric Third 162
13.1 Introduction 162
13.2 Multimodal Therapy 163
13.3 The Evidence-Base for Neoadjuvant and Adjuvant Approaches 163
13.4 New Combinations and Novel Agents 167
13.5 Conclusions 168
References 171
Metabolic Response Evaluation by PET During Neoadjuvant Treatment for Adenocarcinoma of the Esophagus and Esophagogastric Junction 174
14.1 Response Evaluation 176
14.2 Response Evaluation by CT Scan Studies and EUS 177
14.3 Response Evaluation by PET After Neoadjuvant Treatment 178
14.4 PET During Treatment 180
14.5 Conclusion 181
References 182
Molecular Response Prediction in Multimodality Treatment for Adenocarcinoma of the Esophagus and Esophagogastric Junction 185
15.1 Introduction 185
15.2 Molecular Markers Defining their Role
15.3 Conclusion 192
References 192