crossing96/oncoscreening huggingface dataset:
Management and outcome of intrathoracic bleeding due to vascular injury during transhiatal esophagectomy.	STUDY OBJECTIVE: The objective of this study was to ascertain the incidence and outcome of intrathoracic vascular injury during transhiatal resection of the esophagus. BACKGROUND: Resection of the esophagus is indicated for a variety of benign and malignant diseases and can be performed via the transhiatal or transthoracic route. As the esophagus is in close vicinity to the aorta, pulmonary vessels and the azygous vein, these blood vessels can be injured during its resection. METHODS: We extracted data on the incidence, management, and outcome of intrathoracic vascular injuries that occurred during transhiatal esophagectomy between 1983 and 2010 from a prospectively maintained esophageal diseases database. RESULTS: During this period, 710 transhiatal esophagectomies were done for malignant (n = 617) and benign causes (n = 93). Intrathoracic vascular injury occurred in ten patients (1.4%). The indication for esophagectomy was malignancy (nine patients) and corrosive stricture (one patient). All nine patients with malignancy had squamous cell carcinoma, and the tumor was located in the midthoracic esophagus in seven and lower thoracic esophagus in two patients. Eight of nine patients with cancer had received preoperative radiotherapy. The site of injury was the aorta/its esophageal branch (six patients), azygous vein (three patients), and inferior pulmonary vein (one patient). The estimated median intraoperative blood loss was 4,450 ml (range, 2,000-6,000 ml), and the median duration of the surgery was 5 h (range, 4-7 h). On a multivariable analysis, location of tumor (in the midthoracic esophagus) was a significant risk factor for the occurrence of vascular injury. Seven patients required a thoracotomy to control the bleeding while in two patients, it could be identified and controlled transhiatally. Two patients died intraoperatively due to massive bleeding and another two died in the postoperative period. Of the patients who survived (n = 6), three patients had an uneventful recovery, one patient developed a cervical anastomotic leak, and two patients developed chest infection. CONCLUSION: Vascular injury during transhiatal esophagectomy is a rare but life-threatening complication. There may be a higher risk in tumors located in the mid esophagus. Management involves prompt identification and control via a dilated hiatus or a thoracotomy.	esophagus
Patients with nondysplastic Barrett's esophagus have low risks for developing dysplasia or esophageal adenocarcinoma.	BACKGROUND & AIMS: The risks of dysplasia and esophageal adenocarcinoma (EAC) are not clear for patients with nondysplastic Barrett's esophagus (NDBE); the rate of progression has been overestimated in previous studies. We studied the incidences of dysplasia and EAC and investigated factors associated with progression of BE. METHODS: The BE study is a multicenter outcomes project of a large cohort of patients with BE. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Patients followed up for at least 1 year after the index endoscopy examination were included, whereas those diagnosed with dysplasia and EAC within 1 year of diagnosis with BE (prevalent cases) were excluded. Of 3334 patients with BE, 1204 met the inclusion criteria (93.7% Caucasian; 88% male; mean age, 59.3 y) and were followed up for a mean of 5.52 years (6644.5 patient-years). RESULTS: Eighteen patients developed EAC (incidence, 0.27%/y; 95% confidence interval [CI], 0.17-0.43) and 32 developed HGD (incidence, 0.48%/y; 95% CI, 0.34-0.68). The incidence of HGD and EAC was 0.63%/y (95% CI, 0.47-0.86). There were 217 cases of low-grade dysplasia (incidence, 3.6%/y; 95% CI, 3.2-4.1). Five and 10 years after diagnosis, 98.6% (n = 540) and 97.1% (n = 155) of patients with NDBE were cancer free, respectively. The length of the BE was associated significantly with progression (EAC <6 cm, 0.09%/y vs EAC ≥ 6 cm, 0.65%/y; P = 0.001). CONCLUSIONS: There is a lower incidence of dysplasia and EAC among patients with NDBE than previously reported. Because most patients are cancer free after a long-term follow-up period, surveillance intervals might be lengthened, especially for patients with shorter segments of BE.	esophagus
Radical esophagectomy for esophageal cancer: results in Thai patients.	BACKGROUND: Radical esophagectomy was reported to have prolonged survival in patients with esophageal cancer However, it is associated with high morbidity and mortality. Controversy still exists regarding value of radical esophagectomy MATERIAL AND METHOD: The authors analyzed the results, including complications and survival in 68 consecutive patients with esophageal cancer who were treated with transthoracic radical esophagectomy at the Department of Surgery, Siriraj hospital, Mahidol University between June 2002 and June 2008. RESULTS: There were 57 males and eight females with a mean age of 59.28 +/- 11.25 years. Regarding T staging, 81.5% of the patients were in T3 stage while 1.5% of the patients had Ti stage, 15.4% had T2 stage, and 1.5% had T4 stage. Lymph node metastasis (NI) was found in 63.1% of the patients and NO was in 36.9%. Most of the patients were in advanced stages with 53.8% in stage III, 44.6% in stage II, and 1.5% in stage I. The 5-year survival rate of the patients with node positive was significantly lower than the patients with node negative (p = 0.018). The survival was significantly better in stage Ilcompared to stage III (p = 0.012). Overall 5-year survival rate was 28. 5%. Most common complications were from pulmonary causes (22.1%), anastomotic leakage (8.8%), and wound infection (8.8%). Mortality rate was 4.41%. CONCLUSION: Radical esophagectomy was associated with relatively low mortality and acceptable survival. It should be considered in surgical treatment of patients with esophageal cancer	esophagus
Staging of early adenocarcinoma in Barrett's esophagus.	The main goal in the staging of patients with early neoplasia arising in the context of Barrett's esophagus (BE) is to identify individuals who are eligible for endoscopic therapy and differentiate them from those who require surgical management. To make the proper patient selection a combined staging strategy consisting of endoscopy evaluation, endoscopic ultrasonography, and endoscopic mucosal resection is necessary. In this article, the authors summarize the evidence behind each different staging modality in the setting of early BE adenocarcinoma and propose a staging approach that helps to select patients who are suitable for endoscopic therapy.	esophagus
Biology of Barrett's esophagus and esophageal adenocarcinoma.	The past few years have brought new advances in our understanding of the molecular mechanisms underlying the development of Barrett's esophagus and esophageal adenocarcinoma. Although knowledge of the genetic basis for these conditions has not yet translated into clinically useful biomarkers, the current pace of biomedical discovery holds endless possibilities for molecular medicine to improve the diagnosis and management of patients with these conditions. This article provides a useful conceptual basis for understanding the molecular events involved in the making of Barrett metaplasia and in its neoplastic progression, and provides a rationale for evaluating studies on the application of molecular medicine to the diagnosis and management of patients with Barrett's esophagus and esophageal adenocarcinoma.	esophagus
Living with incurable oesophageal cancer. A phenomenological hermeneutical interpretation of patient stories.	PURPOSE: The study explores how patients diagnosed with incurable oesophageal cancer experience living with the illness, and provides insight into and an understanding of the patients' situation, reality and phenomena in their life world. METHOD: The method takes a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur's narrative theory on mimesis as the structure and process of the method, and Ricoeur's theory of interpretation for the analysis of patient stories. The stories materialise from narrative interviews, and the phenomena of the patients' life world results in an analysis of these stories. RESULTS: Through the analysis of the narrative interviews, phenomena of the patients' life world appear which are described in themes such as debut of the illness, denial, the person's own suspicion, existential turning point, despair, hope, the body, affirmation of irrevocable illness, acknowledgement of dying, life phenomena, relations and feeling of independence. The understanding of the patients' experiences is augmented and improved through a discussion of the themes in a philosophical perspective, drawing upon theoretical and philosophical viewpoints of Kierkegaard, Løgstrup, Merleau-Ponty, Ricoeur, Benner & Wrubel, and on empirical research. CONCLUSIONS: Based on the phenomena in the ill person's life world brought about by analysis, it seems that incurably ill oesophageal cancer patients find themselves in a complex life situation, in which they need more than an objective estimate and fulfilment of need from hospital service. Our study illustrates some perspectives on the life situation of the incurably ill, which will contribute to the improved development of supportive care in nursing.	esophagus
Esophageal adenocarcinoma after Nissen's fundoplication for Barrett's esophagus: report of a case.	It remains unclear whether surgical treatment of gastro-esophageal reflux disease (GERD) and Barrett's esophagus (BE) decreases the long-term risk of lower esophagus malignancy; yet, proposed reductions in Barrett's epithelial transformation have been used as a rationale for antireflux surgery. We report the case of a 63-year-old woman with a 40-year history of GERD, whose symptoms returned after a Nissen fundoplication. A gastroscopy done 3 years later revealed BE. Despite close surveillance, adenocarcinoma of the lower esophagus was diagnosed 8 years after the original surgery. Thus far, there is insufficient evidence to convince practitioners that surgery should be the first line of treatment to prevent malignant change in BE. Further well-standardized, prospective trials are required. Our case demonstrates that antireflux surgery in a patient with GERD and BE cannot be relied upon to prevent adenocarcinoma.	esophagus
Comparison of prevalence, viral load, physical status and expression of human papillomavirus-16, -18 and -58 in esophageal and cervical cancer: a case-control study.	BACKGROUND: Human papillomavirus (HPV) infection is a major risk factor for the development of nearly all cases of cervical cancer worldwide. The presence of HPV DNA in cases of esophageal squamous-cell carcinoma (ESCC) has been reported repeatedly from Shantou, China, and other regions with a high incidence of esophageal carcinoma (EC). However, unlike in cervical squamous-cell carcinoma (CSCC), in ESCC, the characteristics of HPV are unclear. Thus, the role of high-risk HPV types in the carcinogenesis of ESCC remains uncertain. METHODS: Seventy cases of ESCC with 60 controls and 39 cases of CSCC with 54 controls collected from patients in Shantou region in China were compared for the distributions of HPV-16, -18 and -58; viral load; and viral integration using real-time PCR assay and HPV-16 expression using immunostaining. RESULTS: The detection rates and viral loads of HR-HPV infection were significantly lower in ESCC than in CSCC (50.0% vs. 79.48%, P = 0.005; 2.55 ± 3.19 vs. 361.29 ± 441.75, P = 0.002, respectively). The combined integration level of HPV-16, -18 and -58 was slightly lower in ESCC than in CSCC (P = 0.022). HPV-16 expression was detected in 59.26% of ESCC tissue and significantly associated with tumour grade (P = 0.027). CONCLUSIONS: High levels of HR-HPV expression and integration may be an indicator of the risk of ESCC, at least for patients in the Shantou region of China. However, a relatively low HPV copy number and infection rate in ESCC is unlikely to play an essential a role in the carcinogenesis of ESCC as in cervical cancer. Factors other than HR-HPV infection may contribute to the carcinogenesis of ESCC.	esophagus
Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation.	Intrathoracic anastomotic leakage in patients with esophagectomy is associated with high morbidity and mortality. Until recently surgical reexploration was the preferred way of dealing with this life-threatening complication. But mortality remained significant. After the first successful reports we adopted endoscopic stent implantation as a primary treatment option. The aim of this study was to investigate the feasibility and the results of endoscopic stent implantation. Between January 2004 and December 2009, 167 patients underwent an esophageal resection. Surgery was mainly the result of esophageal cancer. An intrathoracic esophageal anastomotic leak was endoscopically verified in 17 patients. Twelve patients received an implantation of a self-expanding stent as a primary treatment. An endoscopic stent placement was accomplished in all 12 patients. In nine patients a definitive closure of the leak was achieved and the stent could subsequently be removed. Two patients died due to severe sepsis in spite of sufficient stent placement. Because of early recurrence of very malign small cell cancer the stent remained in situ in one patient. In conclusion, stent implantation for intrathoracic esophageal anastomotic leaks is feasible and compares favorable with the results of surgical reexploration. It is an easily available minimally-invasive procedure which may reduce leak-related mortality and morbidity.	esophagus
Comparison of two diverse populations, British Columbia, Canada, and Ardabil, Iran, indicates several variables associated with gastric and esophageal cancer survival.	BACKGROUND: Geographic variation and temporal trends in the epidemiology of esophageal and gastric cancers vary according to both tumor morphology and organ subsite. This study compares 1-year survival of gastric and esophageal cancers between two distinct populations: British Columbia (BC), Canada, and Ardabil, Iran. METHODS: Data for invasive primary esophageal and gastric cancer patients were obtained from the population-based cancer registries for BC and Ardabil. The relative survival rate was calculated using WHO Statistical Information System (WHOSIS) life-tables for each country. Chi-square and Fisher's exact tests were used to compare survival differences between BC and Ardabil. T-tests, chi-square tests, and Fisher's exact test were used to compare patient characteristics and tumor factors between the populations. RESULTS: The overall 1-year age-standardized relative survivals for gastric cancer were 48% and 21% in BC and Ardabil, respectively (p < 0.01). The overall 1-year age-standardized relative survival for esophageal cancer was 33% and 17% in BC and Ardabil, respectively (p < 0.05). Overall and separately for each gender, age group, tumor location, and histology, there was greater 1-year survival of the gastric cancer patients in BC compared to Ardabil. For esophageal cancer; patients under age 65, patients with tumors in the middle or upper third of esophagus, and patients with squamous cell carcinoma had significantly better survival in BC than in Ardabil. CONCLUSION: Findings of this study point to differences in disease characteristics and patient factors, not solely differences in healthcare systems, as being responsible for the survival difference in these populations.	esophagus
Possible association between a genetic polymorphism at 8q24 and risk of upper gastrointestinal cancer.	Over recent years, genome-wide association studies have contributed to our understanding of genetic susceptibility to sporadic cancer. In this study, we assessed the association between upper gastrointestinal cancer risk and four genome-wide association studies-identified single nucleotide polymorphisms (SNPs), implicated earlier in prostate and colorectal cancer susceptibility. Genotyping for each SNP was performed in two independent Caucasian population-based case-control studies. The first study comprised 290 gastric cancer cases and 374 controls. The second study included 185 noncardia gastric cancers, 123 cardia cancers, 158 oesophageal cancers and 209 controls. Odds ratios (ORs) were computed from logistic models and adjusted for potential confounding variables. An inverse association was observed between the SNP rs1447295, located at 8q24, and gastric cancer risk in the first study population (OR=0.63; 95% confidence interval: 0.41-0.97). A positive association was observed for the same SNP and oesophageal squamous cell carcinoma in the second study population (OR=7.43; 95% confidence interval: 1.37-49.98). No significant associations were detected in either study for the three remaining SNPs (rs6983297, rs10505477 and rs719725). Our data represent novel findings on heritable susceptibility to gastric and oesophageal cancer and warrant validation in additional populations.	esophagus
Advances in endoscopic diagnosis and treatment of Barrett's esophagus.	Barrett's esophagus (BE) is defined as abnormal specialized columnar metaplasia with intestinalization in place of the normal squamous esophageal epithelium. Gastroesophageal reflux disease is a known risk factor for BE; nonetheless BE is also detected in asymptomatic individuals. Other risk factors for BE include smoking, male gender, age over 50 and obesity. Patients diagnosed with BE (without dysplasia) are recommended to undergo endoscopic surveillance every 3-5 years. Advances in imaging techniques (such as narrow band imaging, autofluorescence imaging and confocal laser endomicroscopy) have the potential to improve the detection of dysplasia and early cancer, thus making surveillance a more cost-effective endeavor. Patients with high grade dysplasia (HGD) and early cancer have a high rate of progression to invasive adenocarcinoma and traditionally these patients were treated with esophagectomy. The rapid advancement of endoscopic therapeutic techniques along with a low risk of complications have made endoscopic therapy an acceptable alternative to an esophagectomy in patients with HGD and early cancer. Several endoscopic treatment techniques such as endoscopic mucosal resection, multipolar electrocoagulation, photodynamic therapy, argon plasma coagulation, cryotherapy, and radiofrequency ablation have been studied for endoscopic treatment.	esophagus
DNA methylation in thoracic neoplasms.	Thoracic neoplasms, which include lung cancers, esophageal carcinoma, and thymic epithelial tumors, are the leading causes of tumor-related death and a major health concern worldwide. The development of neoplasms is a multistep process involving both genetic and epigenetic alterations. A growing body of research provides evidence that aberrant DNA methylation, including DNA hypermethylation in promoter regions, global DNA hypomethylation and the overexpression of DNA methyltransferases, plays an important role in tumorigenesis. In this review, we summarize published observations of methylation pattern disruptions in thoracic tumors, and discuss how these abnormalities contribute to the development of cancers. We review recent findings showing that suppressing the activity of the DNA methylating enzymes DNMTs can have potent anti-cancer effects, and discuss the possibility of developing novel therapies for thoracic tumors based on DNMT inhibition.	esophagus
The radiosensitization effect of NS398 on esophageal cancer stem cell-like radioresistant cells.	This study aimed to investigate the cancer stem cell (CSC) properties of radioresistant esophageal cancer cells and the radiosensitization effect of NS398, a cyclooxygenase (COX)-2 inhibitor, on them. Fractionated irradiation was applied to acquire radioresistant esophageal cancer cells. Clone formation assay was employed to detect cell radiosensitivity and cloning formation ability. Cell viability was determined by methyl tetrazolium colorimetry assay. Cell cycle distribution and apoptosis were detected by flow cytometry. Tumorigenicity was investigated by xenograft tumorigenicity assay. Expression levels of β-catenin were detected by reverse transcription polymerase chain reaction or Western blot. As results, radioresistant Eca109R50Gy cells were obtained through fractional irradiation from Eca109 cells; Eca109R50Gy cells displayed higher ability of proliferation, colony-formation, and 40 times tumorigenic ability as high as that of the Eca109 cells in vivo. Meantime stem cell marker β-catenin was elevated in Eca109R50Gy cells. All of the above implied that Eca109R50Gy cells have some properties of CSCs. NS398 enhanced the radiosensitivity of Eca109R50Gy cells accompanied by down-regulating the expression of β-catenin. In conclusion, radioresistant Eca109R50Gy cells carried some CSC-like properties; NS398 enhanced the radiosensitivity of CSC-like Eca109R50Gy cells and this function may partly through down-regulating the expression of β-catenin. These findings both stress the important role of CSCs in esophageal cancer radioresistance and provide new insight on possible application of COX-2 inhibitors on CSCs.	esophagus
[Four resected cases with basaloid carcinoma of esophagus--comparison of 5-FU-related enzymes (thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyl transferase (OPRT)) between basaloid carcinoma and squamous cell carcinoma].	We reported herein four resected cases with basaloid carcinoma of the esophagus and measured the activity of 5-FU related enzymes (TS, DPD, OPRT) in cancer tissue. These activities compared with those in squamous cell carcinoma. Only one case was diagnosed as basaloid carcinoma by preoperative biopsy specimen at endoscopic examination. The esophagectomy was performed thoracoscopically in all cases, and the abdominal procedure was done with the laparoscopic approach in two cases. Anastomotic leakage occurred in one case. No case had lymph node metastasis. On the other hand, a lymphatic invasion was detected in one case, and venous invasion in two, respectively. Two cases had mediastinal lymph node recurrence. DPD activity and OPRT activity showed no difference between squamous cell carcinoma and basaloid carcinoma. On the other hand, the TS activity was significantly higher in basaloid carcinoma. From the standpoint of 5-FU-related enzyme activities, basaloid carcinoma possibly has more resistance to 5-FU than squamous cell carcinoma.	esophagus