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Epidemiology, Diagnosis, Staging and Multimodal Therapy of Esophageal and Gastric Tumors

食管和胃腫瘤的流行病學(xué)、診斷、分期和多模式治療

Upper gastrointestinal tumors involve the tubular organs from the upper esophagus, the stomach, and the first part of the small intestine. Esophageal and gastric cancers are responsible for high rates of disease, morbidity, and mortality throughout the world. Diagnosis of these tumors involves a combination of clinical symptoms, endoscopy, endoscopic ultrasound, and radiological studies. Treatment depends on input from many medical doctors including gastroenterologists, surgeons, pathologists, medical oncologists, radiologists, and radiation oncologists. Treatment may include endoscopy, surgery, chemotherapy, radiation therapy, or a combination of these approaches. Future directions of diagnosis may include improvements in endoscopy, endoscopic ultrasound, blood testing, and tissue testing.

上消化道腫瘤累及上食管、胃和小腸第一部分的管狀器官。食管癌和胃癌是全世界高發(fā)病率、發(fā)病率和死亡率的原因。這些腫瘤的診斷涉及臨床癥狀、內(nèi)窺鏡檢查、內(nèi)窺鏡超聲和放射學(xué)研究的組合。治療取決于許多醫(yī)生的投入，包括胃腸病學(xué)家、外科醫(yī)生、病理學(xué)家、內(nèi)科腫瘤學(xué)家、放射科醫(yī)師和放射腫瘤學(xué)家。治療可能包括內(nèi)窺鏡檢查、手術(shù)、化學(xué)療法、放射療法或這些方法的組合。未來的診斷方向可能包括改進(jìn)內(nèi)窺鏡檢查、內(nèi)窺鏡超聲檢查、血液檢測(cè)和組織檢測(cè)。

高效搖瓶

Gastric and esophageal tumors are diverse neoplasms that involve mucosal and submucosal tissue layers and include squamous cell carcinomas, adenocarcinomas, spindle cell neoplasms, neuroendocrine tumors, marginal B cell lymphomas, along with less common tumors. The worldwide burden of esophageal and gastric malignancies is significant, with esophageal and gastric cancer representing the ninth and fifth most common cancers, respectively. The approach to diagnosis and staging of these lesions is multimodal and includes a combination of gastrointestinal endoscopy, endoscopic ultrasound, and cross-sectional imaging. Likewise, therapy is multidisciplinary and combines therapeutic endoscopy, surgery, radiotherapy, and systemic chemotherapeutic tools. Future directions for diagnosis of esophageal and gastric malignancies are evolving rapidly and will involve advances in endoscopic and endosonographic techniques including tethered capsules, optical coherence tomography, along with targeted cytologic and serological analyses.

胃和食管腫瘤是涉及黏膜和黏膜下組織層的多種腫瘤，包括鱗狀細(xì)胞癌、腺癌、梭形細(xì)胞腫瘤、神經(jīng)內(nèi)分泌腫瘤、邊緣 B 細(xì)胞淋巴瘤以及不太常見的腫瘤。食管和胃惡性腫瘤的全球負(fù)擔(dān)是巨大的，食管和胃癌分別代表第九和第五最常見的癌癥。這些病變的診斷和分期方法是多模式的，包括胃腸道內(nèi)窺鏡檢查、內(nèi)窺鏡超聲和橫斷面成像的組合。同樣，治療是多學(xué)科的，結(jié)合了治療性內(nèi)窺鏡檢查、手術(shù)、放射治療和全身化療工具。

T75 細(xì)胞培養(yǎng)瓶

Upper GI neoplasia is a complex process involving the organs of the upper digestive tract with a multifactorial etiology and represents a significant burden of disease worldwide. Diagnosis and staging require a multimodal approach, involving endoscopy, endoscopic ultrasonography, endoscopic mucosal resection and submucosal dissection techniques, and imaging CT/PET imaging modalities. Once diagnosis and staging are achieved, treatment involves careful multidisciplinary planning involving gastrointestinal endoscopists, medical oncologists, surgical oncologists, and radiation oncologists to determine the most appropriate therapeutic approach. For early lesions, therapeutic endoscopic approaches include endoscopic mucosal resection and endoscopic submucosal dissection. For locally advanced lesions, adjuvant or neoadjuvant chemotherapy therapy may be required based on staging, prior to surgical resection. Image-guided radiotherapy represents an important adjuvant or neoadjuvant therapy, again depending on stage and anatomy.

Future directions in screening may involve office-based tissue sampling strategies along with serological “l(fā)iquid biopsy” assays. Advances in the diagnosis and staging of gastrointestinal malignancy will rely upon advances in endoscopic imaging, including optical coherence tomography and endoscopic ultrasound. Improvements in endosurgical techniques represent an area of promise for the therapy of early lesions, while advances in surgical oncology, novel chemotherapeutics, and tailored radiotherapy will hopefully allow for decreased disease morbidity and mortality over time.

細(xì)胞培養(yǎng)板

上消化道腫瘤是一個(gè)復(fù)雜的過程，涉及具有多因素病因的上消化道器官，是世界范圍內(nèi)疾病的重大負(fù)擔(dān)。診斷和分期需要多模式方法，包括內(nèi)窺鏡檢查、內(nèi)窺鏡超聲檢查、內(nèi)窺鏡黏膜切除和黏膜下剝離技術(shù)，以及成像 CT/PET 成像模式。一旦實(shí)現(xiàn)診斷和分期，治療需要仔細(xì)的多學(xué)科規(guī)劃，包括胃腸道內(nèi)鏡醫(yī)師、內(nèi)科腫瘤學(xué)家、外科腫瘤學(xué)家和放射腫瘤學(xué)家，以確定最合適的治療方法。對(duì)于早期病變，治療性內(nèi)窺鏡方法包括內(nèi)窺鏡黏膜切除術(shù)和內(nèi)窺鏡黏膜下剝離術(shù)。對(duì)于局部晚期病變，在手術(shù)切除之前，可能需要根據(jù)分期進(jìn)行輔助或新輔助化療。影像引導(dǎo)放療代表了一種重要的輔助或新輔助療法，同樣取決于階段和解剖結(jié)構(gòu)。

篩查的未來方向可能涉及基于辦公室的組織取樣策略以及血清學(xué)“液體活檢”檢測(cè)。胃腸道惡性腫瘤診斷和分期的進(jìn)展將依賴于內(nèi)窺鏡成像技術(shù)的進(jìn)步，包括光學(xué)相干斷層掃描和內(nèi)窺鏡超聲。內(nèi)外科技術(shù)的改進(jìn)代表了治療早期病變的前景，而外科腫瘤學(xué)、新型化學(xué)療法和定制放射療法的進(jìn)步有望隨著時(shí)間的推移降低疾病的發(fā)病率和死亡率。

關(guān)鍵詞： 食管癌,胃癌,胃腸道間質(zhì)瘤,神經(jīng)內(nèi)分泌腫瘤,MALT淋巴瘤,黏膜切除術(shù),黏膜下剝離, esophageal cancer,gastric cancer,gastrointestinal stromal tumor,neuroendocrine tumor,MALT lymphoma,mucosal resection,submucosal dissection

來源：MDPI https://www.mdpi.com/2072-6694/13/3/582/htm