1 / 25

Ca Cardia “Out of the Black Box”

Ca Cardia “Out of the Black Box”. Dr Daniel Ng NDH / AHNH. Case Illustration. M/64 Ex-smoker Painless progressive dysphagia x 2-3 months Weight loss+ Physical examination unremarkable. Case Illustration. Ca Cardia. Before 1987 Adenocarcinoma of cardia Bad surgical result

blaze
Download Presentation

Ca Cardia “Out of the Black Box”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ca Cardia“Out of the Black Box” Dr Daniel Ng NDH / AHNH

  2. Case Illustration • M/64 Ex-smoker • Painless progressive dysphagia x 2-3 months • Weight loss+ • Physical examination unremarkable

  3. Case Illustration

  4. Ca Cardia Before 1987 • Adenocarcinoma of cardia • Bad surgical result • Difficult discussion No clear definition

  5. Ca Cardia 1987 • J Rudiger Siewert • AEG classification

  6. Anatomical Cardia

  7. AEG Classification Type I Distal esophagus cancer within 5cm from cardia Type II Directly located at endoscopic cardia, 1cm above and below this border Type III Subcardial cancer within 5cm from cardia J Am Coll Surg Vol.205, No.4S, Oct 2007

  8. Epidemiology J Am Coll Surg Vol.205, No.4S, Oct 2007

  9. Epidemiology J Am Coll Surg Vol.205, No.4S, Oct 2007

  10. Type II Tumour • Barrett’s dysplasia vs Ca stomach • Intestinal metaplasia • Globlet cells in 100 specimens • Only 28% • 72% can be understood as gastric cancer J Am Coll Surg Vol.205, No.4S, Oct 2007

  11. Epidemiology • Incidence increasing • AEG I • Western countries • AEG II / III • Asian countries Journal of Surgical Oncology 2005;92:160-168

  12. Lymphatic Metastasis • AEG I • Less frequent lymph vessel invasion • Mediastinal lymph nodes • AEG II and III • Lower mediastinum • Coeliac trunk • Direct retroperitoneal metastasis J Surg Oncol 2005;13:139-146

  13. Prognosis J Am Coll Surg Vol.205, No.4S, Oct 2007

  14. Surgical Strategies • R0 resection • Independent prognostic factor • Complete resection of primary tumour • Complete resection of lymphatic drainage World J Gastroenterol 2006 November 7;12(41):6608-6613

  15. Type I Tumour • Complete removal of the precancerous Barrett’s esophagus • Esophagectomy • Mediastinal lymph node dissection World J Gastroenterol 2006 November 7;12(41):6608-6613

  16. Transhiatal vs Transthoracic N Engl J Med, Vol.347, No.21

  17. Transhiatal vs Transthoracic N Engl J Med, Vol.347, No.21

  18. Type II / III Tumours • Total gastrectomy • Lymph node dissection • Intra-abdominal • Mediastinal World J Gastroenterol 2006 November 7;12(41):6608-6613

  19. Type II / III Tumours

  20. Left Thoracoabdominal vs Transhiatal Lancet Oncol 2006;7:644-51

  21. Left Thoracoabdominal vs Transhiatal Lancet Oncol 2006;7:644-51

  22. Case Illustration • What surgical approach would you adopt?

  23. Future Discussions • Neoadjuvant therapy • Molecular characterization • Sentinel lymph node biopsy • PET hand device

  24. Thank You Question and Answer

More Related