Clinical outcome of surgical treatment for invasive early colorectal cancer in Japan

BACKGROUND/AIMS: Despite the high frequency of early colorectal cancer, little is known about the clinicopathologic features of invasive early colorectal cancer for which endoscopic polypectomy is not indicated. We wanted to determine the clinicopathologic features of these early colorectal cancers. MATERIALS AND METHODS: From 1973 to 1994, a total of 728 patients with colorectal cancer were reviewed retrospectively from hospital records. The clinicopathologic features of the 90 invasive early colorectal cancer patients who underwent major surgeries were compared with those of 626 patients with advanced colorectal cancer. RESULTS: The frequency of early colorectal cancer increased significantly from the periods 1973-1979 to 1990-1994: 0% in the former period and 18.3% in the later period. Minimally invasive surgery was chosen more frequently for the treatment of early colorectal cancers than for the treatment of advanced cancers (p < 0.005). Lymph node metastasis, lymph vessel invasion, and vascular invasion were more prevalent in advanced cancer cases than in early cancer cases (p < 0.005). Lymph node metastasis was found in 7 patients with early colorectal cancer (7.8%). There was no difference in histologic type between the early and advanced colorectal cancers. The 5-year survival rates of early colorectal cancer patients were higher than those of advanced cancer patients: 97.5% in early colon cancer patients; 93.5% in early rectal cancer patients; 59.8% in advanced colon cancer patients; 55.4% in advanced rectal cancer patients. Three early colorectal cancer patients died of recurrence. CONCLUSION: Minimally invasive surgery such as laparoscopic colectomy should be performed on patients with invasive early colorectal cancer when it is impossible for the cancer to be removed by endoscopic polypectomy.     

Squalene promotes the formation of non-bilayer structures in phospholipid model membranes

From the study on correlation between the depth of cancer invasion and the results of surgery, early cancer of the biliary tract may be defined as cancer cell invasion limited to the mucosal or muscularis propria in the case of carcinoma of the gallbladder, and to the mucosal or fibro-muscular layer in the case of carcinoma of the bile duct. With few exceptions, these tumors had no lymph node metastasis, venous invasion, perineural infiltration or involvement of the lymphatic vessels. Since the cumulative 5-year survival rate was 100% after resection of early cancer, the choice of surgical procedures was considered to be extended cholecystectomy for early cancer of the gallbladder, and the standard radical resective operation for early cancer of the bile duct. An accurate diagnosis was not made preoperatively in most cases of early cancer of the biliary tract. The diagnostic approach is discussed, including the recently developed imaging modalities, such as endoscopic ultrasonography and percutaneous transhepatic cholecystoscopy or cholangioscopy.     

Poor prognosis in early gastric cancer complicated by five or more positive nodes

BACKGROUND/AIMS: Despite the increased frequency of early gastric cancer, little is known about the clinicopathological features of early gastric cancers complicated by lymph node metastasis. This study was designed to determine whether the number of involved lymph nodes is associated with prognosis in patients with early gastric cancer. METHODOLOGY: Fifty one patients with node-positive early gastric cancer were reviewed retrospectively from hospital records. The patients were divided into two groups according to the number of positive nodes: a) 40 patients with 1-4 positive nodes, b) 11 patients with 5 or more positive nodes. RESULTS: The patients with 5 or more positive nodes showed poorer prognosis than patients with less than 5 positive nodes. CONCLUSIONS: Early gastric cancer patients with 5 or more positive nodes show a poorer prognosis than early gastric cancer patients with less than 5 positive nodes. Since surgery alone cannot completely cure patients with early gastric cancer complicated by 5 or more positive nodes, intensive postoperative chemo-immunotherapy should be administered to these patients.     

A summary of cancer screening guidelines

Guidelines and programs for the early detection of cancer or cancer screening are based on the premise that outcomes are improved if the cancer is diagnosed and treated at the early stages of disease. However, there are also disadvantages to the early detection of cancer that must be considered when evaluating and establishing guidelines and programs. The Cancer Bureau of the Laboratory Centre for Disease Control at Health Canada has compiled a summary of existing guidelines for the early detection of various cancers. Recommendations have been provided by governmental organizations, non-governmental organizations, health agencies and professional associations. Many organizations base their guidelines on current evidence and periodically update them as new evidence becomes available. Therefore, it is our intention to revise this compilation in the future to reflect any updates. Guidelines for the early detection of cancer are listed in the tables that follow for 12 different cancer sites: breast, cervical, prostate, colorectal, ovarian, skin, testicular, gastric, lung, pancreatic, bladder and oral cancers.     

Prospective study of "early" gastric cancer

In order to elucidate the natural history of early gastric cancer, we followed up non-concurrently certain patients who had been diagnosed endoscopically as having "early' gastric cancer and who had histological evidence of cancer by biopsy, but on whom surgical resection had been delayed or had not been conducted. At the Center for Adult Diseases, Osaka, 56 cases were eligible for this study. Out of these, 27 cases progressed to advanced cancer and 16 remained at the early stage during the follow-up period (6-88 months, mean: 29 months). The remaining 13 cases had had neither surgical resection nor examinations. The survivorship function for the duration of "early" gastric cancer was estimated by the life-table method of Kaplan and Meier. The median of the duration was estimated as 37 months. The 5-year survival rate of the 34 cases on whom surgical resection had not been conducted was estimated as 64.5%. These results suggest that early diagnosis and early treatment may lead to a reduction of mortality from stomach cancer.     

Early gastric cancer mimicking advanced gastric cancer

The clinicopathological features of 37 early gastric cancers mimicking advanced gastric cancer were reviewed retrospectively, and were compared with 596 other early gastric cancers and 126 mp gastric cancers, defined as gastric cancer invading the muscularis propria of the stomach. A greater tumour size (P < 0.005), submucosal invasion (P < 0.005), lymph node and lymph vessel invasion (P < 0.005) and vascular invasion (P < 0.025) were found more frequently in early gastric cancers mimicking advanced gastric cancers than in other early gastric cancers. There were no significant differences in the clinicopathological findings between early gastric cancers mimicking advanced gastric cancers and mp gastric cancers. Patients with early gastric cancers mimicking advanced gastric cancers showed a lower survival rate than patients with other early gastric cancers, but a higher survival than those with mp gastric cancers. The macroscopic appearance of an advanced gastric cancer was an indicator of massive submucosal invasion and lymph node metastasis in early gastric cancer. As early gastric cancers mimicking advanced gastric cancers showed similar clinicopathological findings to mp gastric cancers, these cancers should be treated as mp gastric cancers.     

Brachytherapy and breast cancer

The study compares, in true adenocarcinoma of the cardia and in adenocarcinoma in Barrett's esophagus, the prevalence of early cancers and their outcome in those patients suitable for resection surgery. From 1980 to 1993, 26 of 350 (7.4%) resected adenocarcinomas of the esophago-gastric junction were pathologically staged as early cancer or pT1. The prevalence of early cancer was 3.7% (11/294) for true cancer of the cardia and 27% (15/56) for cancer in Barrett's esophagus (P < 0.001). Ten of the 15 latter cancers were diagnosed during endoscopic surveillance for benign Barrett's esophagus. Among early cancers, there were four mucosal and 22 submucosal tumours; of the latter, eight had lymph node metastasis and seven neoplastic permeation of lympho-hematic vessels. The most frequently used surgical procedure was esophago-gastric resection and gastric pull-up. Postoperative morbidity was 15.4%, and hospital mortality 3.8%. Excluding postoperative deaths, the overall 5-year survival rate was 79% for early cancer of the cardia and 83% for early cancer in Barrett's esophagus (log rank test = 0.0214, P = 0.88). Overall, the survival rate was 100% in the absence of lymph node metastasis and 43% in the presence of node metastasis (log rank test = 15.811, P = 0.0001). Only one of five patients with both node metastasis and vessel infiltration survived longer than 5 years. In conclusion, the prevalence of early cancer was significantly greater for cancer in Barrett's esophagus than for true cancer of the cardia. Prognosis of the two types of tumour after resection surgery was the same and depended on lymph node status and neoplastic permeation of lympho-hematic vessels.     

Early gastric cancer with psammomatous calcification

We describe a 51 year-old man with calcified early gastric cancer. The calcification was not displayed by abdominal X-ray, CT, or conventional ultrasound. Only endoscopic ultrasonography displayed the distribution of calcification in vivo. Endoscopic ultrasonography revealed a slightly hypoechoic lesion with a high echoic line, without involvement of the fourth layer. Histopathologically, it was a IIc type early gastric cancer. The depth of cancer invasion was limited to the mucosa and a mucin pool was not observed. Psammomatous calcification was observed in the lumen of the carcinomatous glands. This seems to be the first case reported in which psammoma bodies were observed in early gastric cancer.     

Early cancer detection programmes for women at high risk for breast and ovarian cancer: a proposal of practical guidelines

Women from families with multiple breast and/or ovarian cancers may be at increased risk to develop breast/ovarian cancer themselves. Due to personal experience with family members having these diseases they are anxious and ask for specific prophylactic measurements or treatment. The detection of two susceptibility genes, BRCA1 and BRCA2, has given insight into the genetic background of part of the familial breast/ovarian cancer syndromes. This has led to an increased demand in genetic counselling, testing, and early cancer detection programmes. Prospective data from early cancer detection programmes in this high risk population are yet not available. Based on data from epidemiological risk studies, breast and ovarian screening programmes and follow up data from breast cancer trials recommendations for an early cancer detection programme have been summarized. At the present these recommendations are tested in a prospective trial.     

Early gastric cancer in the remnant stomach

BACKGROUND/AIMS: Early gastric cancer in the remnant stomach is rare. Periodical endoscopic examinations are mandatory for patients with partial gastrectomy for a good prognosis. Our goal is to improve the surgical management of gastric cancer in the remnant stomach. We have retrospectively investigated a total of 15 rare cases of early gastric cancer after partial gastrectomy. METHODOLOGY: From 1976 to 1994, a total of 2,102 cases of gastric cancer were resected in our Department. Among these resected cases, 845 cases were histologically diagnosed as having early gastric cancer of the stomach. Of these, 15 patients had previously undergone a partial gastric resection. The time interval between the initial partial gastrectomy and the second resection of the remnant stomach, was more than 10 years for 8 patients (Group 1) and less than 10 years for 7 patients (Group 2). Here we investigate these rare cases of remnant early gastric cancer. RESULTS: The incidence of early gastric cancer in the remnant stomach was 1.8% (15/845). The cancer location in the remnant stomach was around the stoma and suture line in 75% of Group 1 and in 28.6% of Group 2. The incidence rate of mucosal cancer (m-cancer) was 87.5% for Group 1, and 14.3% for Group 2. Total gastrectomy was selected for 37.5% of Group 1, and for 100% of Group 2. No lymph node metastasis was discovered in both groups. The postoperative mortality was zero in both groups. One patient from Group 2, later died of liver metastasis 2 years after the second total gastrectomy, while the other 9 patients continued to live for more than 5 years with no gastric cancer recurrence to date. CONCLUSIONS: The outcome for patients with gastric cancer in the remnant stomach is generally considered poor. However, the outcome of early gastric cancer in the remnant stomach was good without major postoperative complications. Therefore, to improve surgical management of remnant-stump gastric cancer, early diagnosis is most important, using periodic endoscopic follow-up examinations, especially around the stoma. When mucosal cancer around the stoma is diagnosed, subtotal gastrectomy can be selected even in gastrectomized patient for a good prognosis.     

The need for health promotion in oral cancer prevention and early detection

OBJECTIVES: This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. METHODS: A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. RESULTS: Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. CONCLUSIONS: To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.     

Stomach cancer. A 10-year material with emphasis on early cancer

Between 1982 and 1991, 112 patients were treated for gastric cancer at Harstad Hospital in Northern Norway. Early gastric cancer accounted for 20% of all the adenocarcinomas (110), which is high compared with figures from other western studies. The role of endoscopy for detecting early gastric cancer is discussed. The five year survival rate after radical surgery was found to be significantly higher for patients with early gastric cancer than for patients who underwent curative surgery for either infiltrative or regional cancer. For patients with a tumour that had invaded the regional lymph nodes the five year survival rate was only 10%. This result can be improved by more extended lymph node dissection. The perioperative mortality rate (8%) was usually a result of severe cancer cachexia or underlying cardial disease, and not anastomotic leakage. The results as regards the cure of early gastric cancer are comparable with those described in other studies.     

Cloning and characterization of a cDNA encoding a novel heterogeneous nuclear ribonucleoprotein-like protein and its expression in myeloid leukemia cells

Breast cancer is the second leading cause of cancer-related deaths among women in the United States. Approximately 180,000 new cases of breast cancer are diagnosed each year and a quarter of these are fatal. Early detection is a key to survival of these patients. Unfortunately, no definitive markers are available to diagnose breast cancer at early stages. Identification of such early markers, therefore, is an important priority in breast cancer research. In order to identify early markers, we have focussed on understanding the molecular mechanisms that can lead to conversion of the normal mammary epithelial cells into precancerous immortal cells. Over last several years, we have developed in vitro models of human mammary epithelial cell immortalization which have allowed us to invoke the critical roles of the known tumor suppressor pathways in the maintenance of the untransformed state of mammary epithelial cells. These models are now being used to identify novel genes whose expression is important for normal mammary epithelial cell growth and whose altered expression contributes to breast cell transformation. Characterization of the molecular machinery whose alterations result in early preneoplastic transformation should help identify candidate genes for evaluation as potential early diagnostic markers.     

Synchronous and metachronous primary malignancies in organs other than the stomach in patients with early gastric cancer

BACKGROUND/AIMS: We investigated the outcomes of patients with early gastric cancer, with special reference to the prognosis of patients with synchronous or metachronous primary malignancies in organs other than the stomach. PATIENTS AND METHODS: Among 890 patients with early gastric cancer, 97 (10.9%) had synchronous or metachronous primary malignancies in organs other than the stomach. Ten-year survival rates were compared between patients who had additional malignancies and patients who had early gastric cancer but no other malignant disease (control group). RESULTS: Synchronous primary malignancies were detected in 32 patients and metachronous primary malignancies were detected in 65 patients (17 had developed before gastrectomy and 48 developed after gastrectomy). Hepatic cell carcinoma, lung cancer and colorectal cancer were frequently detected between 2 and 24 years after gastrectomy. The 10-year survival rate was 80.8% for 769 patients in the control group but it was only 49.7% for the 92 patients with additional malignancies. Moreover, metachronous malignant disease was found more over 10 years after gastrectomy in 30 of the 48 cases (62.5%). CONCLUSIONS: These results suggest the importance of long-term follow-up for detection of metachronous carcinomas at sites other than the stomach for patients with early gastric cancer.     

Sensitivity of immunochemical occult blood testing in detecting early colorectal cancer

Sensitivity of immunochemical occult blood testing (IFOBT) for early colorectal cancer (CRC) calculated in known cases is reported to be around 50-60%. Sensitivities of IFOBT for cancer in the preclinical stage were reported based on findings of colonoscopy performed on all screenees. Of 5715 asymptomatic persons who underwent flexible sigmoidoscopy (FS), 13 cases of early cancer were found, within the reach of FS. Sensitivities were 53.8%, 76.9 and 84.6% for one-day test, two-day test and three-day test of IFOBT by immunochemical hemagglutination, respectively. While corresponding figure was only 15.4% for three-day Hemoccult test. Other reports indicated that sensitivity of IFOBT is around 30% for small lesions of early CRC less than 1 cm in diameter. IFOBT is much more sensitive in detecting early CRC than Hemoccult test but is poorly sensitive for tiny early CRC.     

直径小于2厘米胃癌预制因素分析

Objective:The aim of our study was to identify clinicopathological characteristics as predictive factors for gastric cancer tumours of less than 2 cm in diameter. Methods: The clinicopathological features of 129 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1980 and 2000. The results of retrospective analysis of clinicopathological data of 58 patients with advanced cancer were compared with those of 71 patients with early cancer. Univariate and multivariate analyses of patients with gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features. Results: Lymph-node metastasis was found more frequently in the advanced cancer group than in the early cancer group. In univariate analysis, unfavorable prognostic factors included deep cancer invasion. Using Cox's proportional hazard regression model, only depth of invasion emerged as an independent statistically significant prognostic parameter associated with long-term survival. Conclusion: Depth of invasion is an independent prognostic factor for gastric cancer tumours of less than 2 cm in diameter. Laparoscopic surgery should not be performed on tumours that are diagnosis in advanced stage and lymph-node involvement. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future.     

Expression of trefoil group antigen pS2 in human gastric cancer

Expression of trefoil group antigen pS2 was examined immunohistochemically in resected stomachs from 121 patients with gastric cancer. Gastric cancer was classified as either undifferentiated or differentiated by histology, and was also divided into gastric type or non-gastric type by mucin-histochemistry. Immunoreactive pS2 was present in 20% of early cancers and 30% of advanced cancers (NS), and in 25% of undifferentiated and 15% of differentiated early cancers (NS), whereas the antigen was present in 38% of undifferentiated and 15% of differentiated advanced cancers (p = 0.04). Positivity for pS2 was found more often in gastric type early cancer (p = 0.04) as well as advanced cancer (p = 0.0002), and was also more frequent in cancers showing scirrhous (p = 0.04) and infiltrative growth (p = 0.03). Cancer positive for pS2 was characterized by mucin-histochemistry and microscopy as gastric type with scirrhous growth and diffuse infiltration, and thus the expression of pS2 in gastric cancer appears to be related to the growth of cancer with these characteristics.     

Surgery for gynecologic cancer

Surgery is an integral part of staging procedures for ovarian, endometrial, and vulvar cancers, with a move toward surgicopathologic rather than clinical staging in cervical cancer. Morbidity can be reduced without compromising patient cure by individualizing surgery for patients with early vulvar cancer, and reproductive potential can be maintained in some women with early ovarian cancer. The place of prophylactic oophorectomy and primary and secondary surgery in ovarian cancer remain controversial and await prospective study. Recent developments in laparoscopic techniques have been applied to a number of problems in gynecologic cancer surgery, and the feasibility of laparoscopic lymphadenectomy and radical pelvic surgery has been demonstrated. Care must be taken, however, to ensure that the tenets of surgical oncology are not sacrificed in order to offer minimal-access surgery to women with gynecologic cancer.     

Use of a life events calendar approach to elicit occupational history from farmers

BACKGROUND: The usefulness of and problems associated with an ultrasound catheter probe in the pretreatment staging of endoscopically early gastric cancer remain unexplored. METHODS: Endoscopic ultrasonography using a 15 MHz catheter probe of 2.6 mm diameter was performed in a prospective study to determine the pretherapy staging of endoscopically early gastric cancer in 78 patients. The results of the ultrasound images were compared with the histologic findings of the specimens obtained by endoscopic mucosal resection or surgical resection. RESULTS: The accuracy of the catheter probe for depth of invasion of endoscopically early gastric cancers was 67% (52 of 78 patients). The accuracy in determining depth of invasion in relation to endoscopic type was significantly higher for the elevated type (91%) than for the depressed type of early cancer (56%) (p < 0.01). The staging accuracy classified by histologic type was significantly higher for differentiated (86%) than for undifferentiated (18%) cancer (p < 0.01). Staging accuracy decreased as tumor size increased. The accuracy, sensitivity, and specificity for nodal staging were 80%, 17%, and 90%, respectively. CONCLUSIONS: A 15 MHz ultrasound catheter probe is most useful for determining depth of invasion when the tumor is histologically differentiated and endoscopically of the small elevated type early gastric cancer, but it is unreliable in the diagnosis of metastatic lymph nodes.