Adenocarcinomas of the esophagogastric junction

from Wikipedia, the free encyclopedia

The term adenocarcinoma of the esophagogastric junction describes a special subtype of cancer of the esophagus . Squamous cell carcinomas are another important genus .

Etiology and pathogenesis

Under normal circumstances, the esophagus is completely lined with squamous epithelium, which guarantees high mechanical strength. However, it is not very resistant to the influence of gastric acid. Under the influence of a long-standing reflux disease, i.e. the non- physiological reflux of gastric acid into the esophagus, which manifests itself in heartburn , the squamous epithelium is converted into gastric epithelium. This transformation is called Barrett's metaplasia . Circumscribed areas of adenoid epithelium develop that have a low probability of degenerating.

localization

The name of this disease entity is surgical in nature and therefore by definition localization-related. Since acid reflux from the stomach is of crucial importance, adenocarcinomas tend to occur in the distal part of the esophagus and also in the area of ​​the top of the stomach. Based on the position of the tumor bed in relation to the esophagus-stomach transition, the following classification is made:

  • AEG I: syn .: Barrett's carcinoma. Tumor center or main part of the tumor mass in the distal esophagus
  • AEG II: syn .: cardia carcinoma. Tumor center or tumor mass directly at the transition
  • AEG III: Tumor center within the stomach, here the distinction must be made from the subcardiac, actual gastric carcinoma.

Diagnosis

Symptoms are usually difficulty swallowing, but they only appear at a relatively late stage of the disease. Diagnostic procedures are endoscopy , endosonography , possibly computed tomography and, as an indispensable means of clear classification, the biopsy .

therapy

Tumors of the esophagus below the branching off of the trachea are usually radically resectable surgically . In order to reduce the tumor mass, chemoradiotherapy , i.e. chemotherapy with supportive radiation, is often carried out before the operation . Type I AEGs are given a subtotal oesophagectomy, which means that only the part of the esophagus that is infiltrated by the tumor is removed. Type II and III cancers require a transhiate extended gastrectomy, in which a large part of the stomach, including the lower esophagus, is removed. The food passage is made possible by connecting the esophageal stump with the remaining stomach or by inserting a section of the small intestine.

forecast

Surgical therapy has a perioperative mortality of less than 5% when carried out in an experienced center. If the tumor is completely removed, the 5-year survival rate is 40%. The individual prognosis depends heavily on the involvement of the lymph nodes. The 5-year survival rate for patients with stage I adenocarcinoma is 80%.

In recent years, endoscopic therapy has become established for early malignant changes in Barrett's esophagus (so-called high-grade intraepithelial neoplasia and adenocarcinoma restricted to the mucosa). First of all, endoscopic resection should be mentioned. With this method, the tumor is first sucked in during a normal endoscopic examination and then resected with a snare. Endoscopic therapy has meanwhile been well studied and the long-term results also prove its effectiveness and safety. The advantage over conventional surgery, which is associated with a mortality rate of 5–20% and a complication rate of 30–50%, is the low burden on the patient without serious complications. For malignant changes that grow deeper into the wall layers of the esophagus (the submucosa), however, surgical therapy should be carried out in an experienced surgical center (more than 20 esophagectomy per year), since in this case there is a risk of lymph node metastasis (about 30%) ) given is.

See also

swell

  • JR Siewert: Surgery . Heidelberg 2001, ISBN 3-540-67409-8 , pp. 569ff.
  • O. Pech, A. Behrens, A. May, L. Nachbar, L. Gossner, T. Rabenstein, H. Manner, E. Guenter, J. Huijsmans, M. Vieth, M. Stolte, C. Ell: Long- term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's esophagus. In: Good . (2008); 57 (9), pp. 1200-1206.
  • C. Ell, A. May, O. Pech, L. Gossner, E. Guenter, A. Behrens, L. Nachbar, J. Huijsmans, M. Vieth, M. Stolte: Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer ). In: Gastrointest Endosc . (2007); 65, pp. 3-10.
  • JD Birkmeyer, AE Siewers, EV Finlayson, TA Stukel, FL Lucas, I. Batista, HG Welch, DE Wennberg: Hospital volume and surgical mortality in the United States. In: N Engl J Med . (2002); 346 (15), pp. 1128-1137.
  • JD Birkmeyer, TA Stukel, AE Siewers, PP Goodney, DE Wennberg, FL Lucas: Surgeon volume and operative mortality in the United States. In: N Engl J Med. (2003); 349 (22), pp. 2117-2127.