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Esophageal cancer: the appropriate staging 3° Course on Endoscopy in Gastrointestinal Oncology Rome, March 2011 Riccardo Rosati, MD FACS Professor of Surgery University of  Milan Head Dept. General & Minimally-Invasive Surgery Istituto Clinico Humanitas IRCCS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Esophageal cancer - Introduction
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],7° Edition of the AJCC  Cancer Staging Manual - 2010 Rice TW, Ann Surg Oncol 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gastrointestinal tumors – New classification of the UICC 2010 New classification Old classification N-  Regional lymph nodes Nx  Regional lymph nodes cannot be assessed N0  No regional lymph node metastasis N1  Metastasis in 1-2 regional lymph nodes N2  Metastasis in 3-6 regional lymph nodes N3  Metastasis in 7 or more regional lymph nodes
[object Object],[object Object],[object Object],[object Object],[object Object],Staging: goals
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Staging
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EUS - Advantages
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EUS accuracy in preoperative staging EUS and EUS FNA: possible impact on patient management changes
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CT in preoperative staging
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PET and PET/CT - Technical issues
[object Object],[object Object],[object Object],[object Object],Role of PET and PET/CT A: FDG-non avid tumor, T2 by EUS B: FDG-avid tumor, T2 by EUS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Role of staging laparoscopy
[object Object],[object Object],[object Object],[object Object],[object Object],Assessment of response to neoadjuvant therapy ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Assessment of response to neoadjuvant therapy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Assessment of response to neoadjuvant therapy
R.T. 67 yo adenocarcinoma lower esophagus cT2-3, N1 ycT0, N0 CT: Al Sarraf 3 cycles RT 45 Gy 3/2011: transthoracic esophagectomy with laparoscopic gastrolysis ypT1b, N1 (1/36) EGDS: linear scar EGDS: large ulcerated mass ¾ esoph lunen 9/2010 2/2011
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Develompments in response prediction to neoadjuvant therapy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Predictive response to neoadjuvant therapy
Tumor grade p= 0.00001 Nodal status p= 0.0005 Tumor grade and nodal status p= 0.00003 Radical vs residual disease p= 0.00005 Survival and prognostic factors ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Conclusions

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Esophageal cancer staging and treatment course

  • 1. Esophageal cancer: the appropriate staging 3° Course on Endoscopy in Gastrointestinal Oncology Rome, March 2011 Riccardo Rosati, MD FACS Professor of Surgery University of Milan Head Dept. General & Minimally-Invasive Surgery Istituto Clinico Humanitas IRCCS
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  • 16. R.T. 67 yo adenocarcinoma lower esophagus cT2-3, N1 ycT0, N0 CT: Al Sarraf 3 cycles RT 45 Gy 3/2011: transthoracic esophagectomy with laparoscopic gastrolysis ypT1b, N1 (1/36) EGDS: linear scar EGDS: large ulcerated mass ¾ esoph lunen 9/2010 2/2011
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Editor's Notes

  1. Mammalian cells initiate cell cycle arrest at different phases of the cell cycle in response to various forms of genotoxic stress to allow time for DNA repair, and thus preserving their genomic integrity. The protein kinases checkpoint kinase 1 (Chk1), checkpoint kinase 2 (Chk2), and mitogen-activated protein kinase–activated protein kinase 2 (MK2) have all been shown to be involved in cell cycle checkpoint control. Recently, cell cycle checkpoint abrogation has been proposed as one way to sensitize cancer cells to DNA-damaging agents due to the expected induction of mitotic catastrophe. Due to their overlapping substrate spectra and redundant functions, it is still not clear which kinase is mainly responsible for the cell cycle arrests conferred by clinically relevant chemotherapeutics