Search

The choice of the most beneficial method of the treatment of patients with esophageal cancer still remains a matter of debate. According majority of epidemiological reports only 10% of esophageal cancer patients has a chance for 5-year survival. Unfortunately, the curative surgical treatment is possible in relatively small number of patients, nevertheless esophagectomy is regarded as a principle method of treatment. Usually it referrers to the group of 50% of patients with locally advanced cancer. Thus, the management of the majority of esophageal cancer patients is palliative. Its main objective is to improve esophageal passage compromised by tumor narrowing esophageal lumen. Maintenance of esophageal passage facilitates food intake and usually postpones the stage of terminal cachexia and thus results in quality of life improvement. As it has been evident from up-to-date research currently used methods of palliative treatment do not significantly improve survival. In this paper we demonstrate a review of currently available methods of palliative treatment of patients with esophageal cancer and brief discussion on our own experience from last four years.

Endoscopic mucosal resection is a minimally invasive technique of resection of large pieces of the superficial layers (the mucosa and partially the submucosa) of the gut wall. In the present study we are presenting currently established indications, recent advances in the technique, early and long-term results of the treatment of esophageal, gastric and colorectal early cancer by endoscopic mucosal resection based on the review of the literature, educational materials and personal experience from the training of the first author (KZ) at the National Cancer Center in Tokyo, Japan. Endoscopic mucosal resection should be indicated for every superficial neoplastic lesion of the gut wall that can be safely removed in its entirety by experienced endoscopic team, and subsequently processed and evaluated properly by cooperating histopathologist specializing in gastrointestinal pathology. Eventually a detailed analysis of a resected specimen enables the precise assessment of curability of the procedure and establishment of the rational management of a patient. Curative endoscopic resection allows for regarding this procedure as sufficient and includes a patient into a follow-up program. Potentially curative endoscopic resection requires to consider the risk of lymph node involvement and discuss with a patient potential benefits and risk associated with surgical treatment or its withholding in reference to patients' age and health condition. Non-curative endoscopic resection requires to recommend an additional local (endoscopic resection, endoscopic ablation, brachytherapy) or surgical treatment after a detailed analysis with a patient a potential benefit and risk associated with each option. Despite enormous advance in medical knowledge the outcome of the gastrointestinal cancer treatment is still far unsatisfactory. Early diagnosis and treatment of less advanced cancer remains the most promising method of improvement of the outcome. We hope that popularization of the knowledge regarding early gastrointestinal cancer may improve their early detection rate and thereby the outcome of the treatment.

The authors presented a case of squamous cell oesophageal cancer in a patient after surgical treatment of achalasia performed five years earlier. The patient complained of the recurrent dysphagia. During endoscopy of the upper gastrointestinal tract a malignant tumor in the lower part of oesophagus was diagnosed and the patient was operated on. He survived for five years.

We are presenting a case report of 57-year-old patient operated on due to primary malignant melanoma of the esophagus. Melanoma was misdiagnosed in biopsy taken during endoscopy. Final precise establishing the character of the lesion was able during histopathological examination of the specimen obtained during surgery. The outcome of the treatment was poor--survival time did not exceed 14 months. Patient died because of pulmonary metastases.