Gastrointestinal and Liver Tumors

The clinicopathological characteristics of cases who underwent hepatectomy are summarized in Table 5. All 12 gastric cancer cases with synchronous liver metastasis underwent gastrectomy plus hepatectomy. Five cases underwent hepatectomy for metachronous liver metastasis. One patient underwent hepatectomy twice for synchronous metastasis and metachronous metastasis after 24 months. For the macroscopic type of primary site, there were 11 type 2 cases, 4 type 3 cases, 1 type 4 case, and 1 type 5 case.

Two cases had distant lymph node metastasis. All 17 hepatectomy cases had within 3 metastatic nodules. There were no cases with distant organ metastasis. On histology, 4 were tub1, 6 were tub2, 2 were pap, 3 were por, and 2 were por1. The primary tumor size of all hepatectomy cases except 1, which was type 4 cancer, was less than mm. The clinicopathological characteristics of cases who underwent hepatectomy. All hepatectomy cases underwent gastrectomy. For gastrectomy, 10 patients underwent distal gastrectomy, and 7 patients underwent total gastrectomy.

For the lymph node dissection, 3 patients underwent D1, 12 patients underwent D2, and 2 patients underwent D3. For the hepatectomy, 12 patients underwent partial resection, 3 patients underwent left lateral segmentectomy, 1 patient underwent extended right posterior segmentectomy, and 1 patient underwent left lobectomy after HAI. Three patients underwent partial resection and radiofrequency ablation RFA.

Four patients did not receive systemic chemotherapy. Five patients underwent hepatectomy combined with HAI. For residual tumor, there were 7 R0 cases and 10 R2 cases. All 5 metachronous metastasis cases underwent R0 surgery. All 3 cases with multiple Stage IV factors underwent R2 surgery. The duration after first surgery was from 4 to 24 months, and the average duration was Cases who underwent hepatectomy for liver metastasis from gastric cancer.

On the prognosis of hepatectomy cases, the 1-year survival rate was There was no significant difference between partial resection and systemic resection Table 7. For stromal volume, the survival curve of medullary type cases was significantly higher than those of intermediate and scirrhous types. For lymph node metastasis, the survival curves of N0, N1, and N2 cases were significantly higher than of N3 cases. With respect to the number of Stage IV factors, the survival curve of H1-only cases was significantly higher than that of multiple Stage IV factor cases.

For residual tumor, the survival curve of R0 cases was significantly higher than that of R2 cases. The survival curve of metachronous metastasis was significantly higher than that of synchronous metastasis. All three cases that underwent RFA were alive more than three years after surgery. The prognosis of gastric cancer cases with liver metastasis is extremely poor because most patients with gastric cancer with concomitant liver metastases are excluded as candidates for curative surgery accompanied by hepatic resection due to incurable simultaneous factors, such as peritoneal dissemination, widespread lymph node metastases, and direct invasion to adjacent structure.

Moreover, many cases have multiple metastatic lesions in both lobes of the liver. In the present study, H1-only cases accounted for only 44 cases Histology, systemic chemotherapy, and HAI were independent prognostic factors. Differentiated histological type, systemic chemotherapy, and HAI were associated with a good prognosis in gastric cancer patients with liver metastasis. Moreover, all HAI cases underwent gastrectomy, and 14 of 17 cases were H1-only cases.

Therefore, gastrectomy and H1-only were thought to be absolutely necessary for a good prognosis. The response rate of HAI was The prognosis was significantly better for patients who underwent chemotherapy associated with HAI than for patients who underwent systemic chemotherapy only.

However, the number of patients alive for more than 5 years after surgery was only one, who had CR. Several authors reported that non-surgical treatments, including systemic or hepatic arterial infusion chemotherapy, do not achieve satisfactory results, and in patients treated by gastrectomy and chemotherapy, median survival times are reported to range from 2.

In the review of the literature, the hepatectomy rate was low, and it was indicated in only 0. In the present cases, 6 7. The effectiveness of hepatic resection has not been well defined. The cumulative survival rate reported in early studies was generally poor, reflecting a generalized disease. The long-term results after liver resection for metastases from gastric cancer show a wide range. In the present hepatectomy cases, the 1-year survival rate was Thus, we believe that there was a clinical benefit from resection of hepatic metastases from gastric carcinoma. Therefore, it is crucial to clarify the condition of 5-year survivors and to determine the indications for liver surgery.

The actual accepted selection criteria are: Contraindications to hepatic resection are: In the present study, the survival curves of N0, N1, and N2 cases were significantly higher than of N3 cases. Finally, for residual tumor, the survival curve of R0 cases was significantly higher than that of R2 cases. Regarding the primary gastric cancer, Ochiai et al. However, Miyazaki et al. In the present cases, non-significant differences were observed in survival rate in terms of depth of invasion, venous invasion, and lymphatic invasion, but significant differences were seen in survival rates in terms of stromal volume and lymph node metastasis.

With respect to stromal volume, the survival rate of medullary type was significantly higher than that of intermediate and scirrhous types. The macroscopic type of most medullary types was localized, such as type 1 or type 2. There appear to have been no reports to date about the significance of the stromal volume of primary gastric cancer for hepatectomy for metastases from gastric cancer. The number of metastatic nodules in the liver has been reported to be an important prognostic factor. In the present cases, the presence of four or more tumors was a significant poor prognostic factor on univariate analysis, but it was not an independent poor prognostic factor on multivariate analysis.

The favorable surgical outcome for patients with solitary metastases indicates that patients with a solitary metastasis of gastric cancer are good candidates for surgical resection. However, Saiura et al. The number of metastatic nodules in the liver of the present hepatectomy cases was within three, and there was no significant difference in the survival rate between solitary metastasis and multiple 2 or 3 metastases.

Three of five cases with multiple metastatic nodules in the liver underwent RFA. In three patients who were alive for more than 5 years after hepatectomy, 2 patients had a solitary metastatic nodule and 1 patient had two metastatic nodules, and they underwent RFA. All 3 cases who underwent RFA were alive for more than 3 years after surgery. Some authors reported that patients who underwent RFA compared favorably with patients who underwent radical surgery [ 9 , 25 ]. We think that RFA may be effective for patients in whom surgery is contraindicated because their general condition is poor.

The timing of hepatic resection has been reported to be a significant prognostic factor. In some papers, synchronous hepatectomy was a significant poor prognostic factor [ 23 , 26 , 27 ]. Some authors suggested that resection may be indicated only for patients with metachronous isolated metastases [ 23 , 28 ].

Other studies did not demonstrate any differences in terms of survival among the groups [ 19 , 29 , 30 ]. In the present study, the survival rate of metachronous hepatectomy cases was significantly higher than that of synchronous hepatectomy cases. This may depend on the concern about the use of aggressive liver surgery in conjunction with the treatment of gastric cancer under synchronous conditions.

All 3 patients who were alive for more than 5 years underwent hepatectomy metachronously at 9 months or more than 9 months 9M, 12M, 15M after the first surgery for gastric cancer. The diseasefree interval DFI between gastric and hepatic resections has been reported to be a prognostic factor.

The survival rate of segmental or lobular resection cases tended to be higher than that of partial resection cases, but the difference was not significant. The relationship between the extent of hepatic resection and prognosis has not yet been established. In the present study, 3 of 5 patients who underwent segmentectomy or lobectomy had metachronous liver metastasis.

One patient who underwent lobectomy had synchronous metastases, but this case underwent left lobectomy for nodules in S3 and S4 after HAI. The grade of the extent of the hepatic resection is still controversial. In this study, adding HAI chemotherapy to liver surgery did not seem to offer patients a survival benefit. In patients with acid reflux, where contents from the stomach back up into the esophagus, the cells that line the esophagus can change and begin to resemble the cells of the intestine.

This condition is knows as Barrett's esophagus.

Gastrointestinal Cancers | ACG Patients

Those with Barrett's esophagus have a higher risk of developing esophageal cancer. Less common causes of irritation can also increase the chance of developing esophageal cancer. For example, people who have swallowed caustic substances like lye can have damage to the esophagus that increases the risk of developing esophageal cancer. The doctor will generally start by taking a complete history and performing a physical examination. An esophagram, also called a barium swallow, is a series of x-rays of the esophagus. The patient is asked to drink a barium solution, which coats the inside of the esophagus.

Multiple x-rays are then taken to look for changes in the shape of the esophagus. Most patients undergo a test called endoscopy where a thin flexible lighted instrument with a camera at the end is passed through the mouth into the esophagus. This scope allows the doctor to see the inner layer of the esophagus. Biopsies can be taken during this procedure if needed and submitted to the pathologist for examination under a microscope to detect cancer cells.

A CT scan of the neck, chest and abdomen may help to identify if there is any spread of the cancer to other organs in the body so that the doctor can determine appropriate management.

Endoscopic ultrasound is a technique that can be used to provide detailed assessment of the depth of the tumor and involvement of adjacent lymph nodes. This instrument is similar to the endoscope above except there is ultrasound embedded at the tip of the scope. Fine needle aspiration under ultrasound guidance can be performed on any suspicious lymph nodes that are seen. Other measures that may improve symptoms include stretching or dilation, tube prosthesis stent and radiation or laser treatment to reduce the size of the cancer.

Doctors are actively looking at new ways of combining various types of treatment to see if they may have a better effect on treating esophageal cancer. Many patients with esophageal cancer undergo some form of combination therapy with surgery, radiation and chemotherapy. Some patients with very early cancer of the esophagus may undergo an endoscopic resection of the cancer without surgery using techniques such as endoscopic mucosal resection or endoscopic submucosal dissection. The stomach is part of the digestive system and connects the esophagus to the small intestine. Once food enters the stomach the muscles in the stomach help to mix and mash the food using a motion called peristalsis.

Stomach cancer can develop in any part of the stomach and can spread throughout the stomach and to other organs such as the small intestines, lymph nodes, liver, pancreas and colon.

Patients may not have any symptoms in the early stages and often the diagnosis is made after the cancer has spread. The most common symptoms include:.

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No one knows the exact reason why a person gets stomach cancer. Researchers have learned that there are certain risk factors associated with the development of stomach cancer. Those over the age of 55 years are more likely to get stomach cancer. Men are affected twice as often as women and African Americans are affected more commonly than Caucasians. Stomach cancer is more common in some parts of the world such as Japan, Korea, parts of Eastern Europe and Latin America. Some studies do suggest that a type of bacteria known as Helicobacter pylori , which can cause inflammation and ulcers in the stomach, can be an important risk factor for developing gastric cancer.

Studies show that people who have had stomach surgery or have a condition such as pernicious anemia, or gastric atrophy which result in lower than normal production of digestive juices can be associated with an increased risk of developing gastric cancer. In addition to taking a complete history and performing a physical exam, your doctor may do one or more of the following tests:.

Upper GI series — The patient is asked to drink a barium solution.

Subsequently x-rays of the stomach are taken. The barium outlines the inside of the stomach helping to reveal any abnormal areas that may be involved with cancer. This test is used less often than it used to be, and patients now often undergo endoscopy see below first. Endoscopy — A lighted, flexible tube with a camera, called an endoscope, is inserted through the mouth into the esophagus and then into the stomach.

Sedation is given prior to insertion of the endoscope. If an abnormal area is found, biopsies tissue samples can be taken and examined under a microscope to look for cancer cells. If cancer is found, the doctor may schedule additional staging tests to determine if the cancer has spread. A CT scan may be used to determine if cancer has spread to the liver, pancreas, lungs or other organs near the stomach.

Staging of gastric cancer may also be performed by using endoscopic ultrasound. Endoscopic ultrasound can help to determine the depth of spread of the tumor into the wall of the stomach and involvement of adjacent structures as well as assess for any enlarged lymph nodes that may be invaded with cancer cells. Treatment plans may vary depending on the size, location, extent of tumor and the patient's overall health. Surgery is the most common treatment. The surgeon can remove part of the stomach gastrectomy or the entire stomach.

Lymph nodes near the tumor are generally removed during surgery so that they can be checked for cancer cells. Researchers are exploring the use of chemotherapy before surgery to help shrink the tumor and after surgery to help kill residual tumor cells. Chemotherapy is given in cycles with intervals of several weeks depending on the drugs used. Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing.

A Study of Gastric Cancer Cases with Liver Metastasis

Radiation destroys the cancer cells only in the treated area. Some patients with very early cancer of the stomach that is involving only the superficial layers of the stomach wall, may undergo an endoscopic resection of the cancer without surgery using techniques such as endoscopic mucosal resection or endoscopic submucosal dissection. Doctors are looking at the combination of surgery, chemotherapy and radiation therapy to see what combination would have the most beneficial effect. The liver is one of the largest organs in the body, located in the upper right portion of the abdomen.

The liver has many important functions, including clearing toxins from the blood, metabolizing drugs, making blood proteins, and making bile which assists digestion. Hepatocellular carcinoma is a cancer that arises in the liver. It is also known as hepatoma or primary liver cancer. HCC is the fifth most common cancer in the world. This rise is thought to be because of chronic hepatitis C, an infection that can cause HCC. In the United States, most cancers that are found in the liver are ones that spread or metastasize from other organs. Cancers that commonly metastasize to the liver include colon, pancreatic, lung and breast cancer.

Abdominal pain is the most common symptom of HCC and usually is present when the tumor is very large or has spread. Unexplained weight loss or unexplained fevers are warning signs in patients with cirrhosis. Sudden appearance of abdominal swelling ascites , yellow discoloration of the eyes and skin jaundice , or muscle wasting suggests the possibility of HCC. Alcohol related liver disease is also a risk factor for the development of HCC. There are certain chemicals that are associated with liver cancer-aflatoxin B1, vinyl chloride and thorotrast.

Aflatoxin is the product of a mold called Aspergillus flavus and is found in foods such as peanuts, rice, soybeans, corn and wheat. Also thorotrast is no longer used for radiologic tests, and vinyl chloride, is a compound found in plastics. Hemochromatosis, a condition in which there is abnormal iron metabolism, is strongly associated with liver cancer. Individuals with cirrhosis from any cause such as the hepatitis virus, hemochromatosis and alphaantitrypsin deficiency are at increased risk of developing HCC. The diagnosis of HCC cannot be made by routine blood tests. Screening by a blood test for the tumor marker, alpha- fetoprotein AFP , and radiological imaging must be performed.

Some doctors advocate measurement of AFP and imaging every 6- 12 months in patients with cirrhosis in an effort to detect small HCC.

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Radiological imaging studies are very important and may include one or more of the following-ultrasound, CT scan MRI magnetic resonance imaging and angiography. Ultrasound examination of the liver is frequently the initial study if HCC is suspected. CT scan is a very common study used in the USA for the workup of liver tumors. The ideal study is multi-phase CT scan with the use of oral and IV contrast. MRI can provide sectional views of the body in different planes. MRI can actually reconstruct images of the biliary tree and the arteries and veins of the liver.

Angiography is a study where contrast material is injected into a large artery in the groin. X-ray pictures are then taken to evaluate the arterial blood supply to the liver.