Carcinoma of the Esophagus and Gastric Cardia

398 Pages·1984·25.229 MB·English

by  Bo Qi Liu, Bing Li (auth.), Guo Jun Huang BS, MD, FCCP, Ying K’ai Wu MB, ChB, FACS (Hon) (eds.)

Carcinoma of the
Esophagus
and Gastric Cardia
Edited by
Guo Jun Huang and Wu Ying K'ai
With 295 Figures in 429 Separate Illustrations,
Some in Color and 59 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo 1984
Guo Jun (Kuo Chun) Huang, BS, MD, FCCP
Professor and Chairman, Department of Surgical Oncology,
Cancer Institute and Hospital, Chinese Academy of Medical
Sciences, Panjiayiao, Beijing, P. R. China
Wu Ying K'ai (Y. K. Wu), MB, ChB, FACS (Hon)
Professor of Cardiothoracic Surgery, Director of Beijing Heart,
Lung, and Blood Vessel Medical Center, Beijing, P. R. China
ISBN -13: 978 -3-642-69185-0 e-ISBN -13: 978-3-642-69183-6
DOl: 10.10071978-3-642-69183-6
Ubrary of Congress Cataloging in Publication Data
Main entry under title: Carcinoma of the esophagus and gastric cardia. Bibliography: p.
Includes index. 1. Esophagus-Cancer. 2. Cardia-Cancer. 3. Esophagus-Cancer-China.
4. Stomach-Cancer-China. I. Huang, Guo Jun, 1920-. II. Wu, Ying-K'ai, 1910-. [DNLM:
1. Esophageal neoplasms. 2. Stomach neoplasms. WI 250 C2645) RC280.E8C37
1984 616.99'432 84-5308
This work is subject to copyright. All rights are reserved, whether the whole or part of the
material is concerned, specifically those of translation, reprinting, re-use of illustrations,
broadcasting, reproduction by photocopying machine or similar means, and storage in data
banks. Under § 54 of the German Copyright Law, where copies are made for other than
private use, a fee is payable to 'Verwertungsgesellschaft Wort', Munich.
@ Springer-Verlag Berlin Heidelberg 1984
Softcover reprint of the hardcover 1st edition 1984
The use of registered names, trademarks, etc. in this publication does not imply even in the
absence of a specific statement, that such names are exempt from the relevant protective
laws and regulations and therefore free for general use.
2124/3140-543210
Preface
This book has its roots in a monograph on cancer of the esophagus
and gastric cardia edited by us in 1965 and published in Chinese on
ly. Along with a number of colleagues in various fields, we summa
rized our work in the epidemiology, pathology, diagnosis, radiother
apy, and surgery of carcinoma of the esophagus and gastric cardia,
carried out chiefly at Peking Union Medical College Hospital, Fu
wai Hospital, and the Cancer Institute of the Chinese Academy of
Medical Sciences during the 25 years from 1939 to 1964. In the
18 years since the publication of that monograph, further progress
has been made in China in various aspects of research and surgical
treatment. Abundant material has been accumulated on the long
term results of surgery, and a number of newer principles and meth
ods for diagnosis and management have been evolved. In order to
meet the need for the exchange of scientific and technical informa
tion, both domestically and internationally, we have invited a group
of our current colleagues working on the different aspects of carci
noma of the esophagus and gastric cardia to contribute to the pre
sent volume, which is being printed in both Chinese and English.
The Chinese edition, like the original monograph, is being publish
ed by Shanghai Science and Technology Publishers. Through the
kind invitation of Dr. Heinz Gotze, the English text is being publish
ed for international circulation by Springer-Verlag. We wish to ex
press our heartfelt appreciation to both publishers, whose encou
ragement and assistance have made the completion of this new
monograph possible at this time.
We also want to express our thanks to all the contributors, who
have done a splendid job in summarizing the scientific achieve
ments to date in their own particular fields. No attempt has been
made to go into the voluminous international literature, in order to
keep the volume to a moderate size. We hope the book will serve its
purpose as an introduction to our experience and achievements in
carcinoma of the esophagus and gastric cardia in China. We believe
that the progress in early diagnosis and the prospect of being able to
prevent cancer altogether should encourage future work.
Guo Jun Huang
Wu Ying K'ai
Contents
1. Epidemiology of Carcinoma of the Esophagus in China
Bo Qi Liu and Bing Li . . . . . . . . . . . . . . . . . . . . 1
2. Etiology of Carcinoma of the Esophagus
Ming Xin Li and Shu Jun Cheng. . . . . . . . . . . . . . .. 25
3. Carcinogenesis in the Esophagus
QiuJieXia ............ . ......... 53
4. Pathology of Carcinoma of the Esophagus
Fu Sheng Liu and Chuan Nong Zhou . . . .. ....... 77
5. Pathology of Carcinoma of the Gastric Cardia
Ling Li and Guo Li Pan . . . . . . . . . . .. ....... 117
6. Diagnostic Cytology and Early Detection
Qiong Shen . . . . . . . . . . . . . . . . . . . . . . . . . .. 155
7. Radiologic Diagnosis
Zheng Yan Wang and Ji Hao Su ............... 191
8. Fiberesophagoscopic Diagnosis
Da Wei Zhang . . . . . . . . . . . . . . . . . . . . . . . . . 217
9. Clinical Diagnosis
Guo Jun Huang and Wu Ying K'ai ...... 237
10. Radiotherapy for Carcinoma of the Esophagus
Xian Zhi Gu .......................... 257
11. Surgical Treatment
Wu Ying K'ai and Guo Jun Huang .......... 275
12. Preoperative and Postoperative Care and
Management of Postoperative Complications
Guo Jun Huang ................ . . .285
13. Operative Technique for Carcinoma of the Esophagus
GuoJun Huang and Wu Ying K'ai .............. 313
14. Operative Technique for Carcinoma of the Gastric Cardia
GuoJun Huang and Wu Ying K'ai .............. 349
VIII Contents
15. Palliative Treatment
Guo Jun Huang .. . .................... 361
16. Medical Treatment
YanSun . .. .369
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Contributors
Cheng, Shu Jun, MD
Chief, Division of Genetic Toxicology, Department of Chemical
Etiology and Carcinogenesis, Cancer Institute and Hospital, Chi
nese Academy of Medical Sciences, Beijing, P. R. China
Gu, Xian Zhi (Ku, Hsien-chih), BS, MD
Professor and Chairman, Department of Radiation Oncology,
Cancer Institute and Hospital, Chinese Academy of Medical
Sciences, Beijing, P. R. China
Huang, Guo Jun (Huang, Kuo-chun), BS, MD, FCCP
Professor and Chairman, Department of Surgical Oncology, Can
cer Institute and Hospital, Chinese Academy of Medical
Sciences, Beijing, P. R. China
Li, Bing (Li, Ping), MD
Vice-Director, Cancer Institute and Hospital, Chinese Academy
of Medical Sciences, Beijing, P. R. China
Li, Ling, MD
Department of Pathology, Cancer Institute and Hospital, Chinese
Academy of Medical Sciences, Beijing, P. R. China
Li, Ming Xin (Li, Min-hsin), MS, PhD
Professor and Chairman, Department of Chemical Etiology and
Carcinogenesis, Cancer Institute and Hospital, Chinese Academy
of Medical Sciences, Beijing, P. R. China
Liu, Bo Qi, MD
Department of Epidemiology, Cancer Institute and Hospital,
Chinese Academy of Medical Sciences, Beijing, P. R. China
Liu, Fu Sheng, MD
Vice-Chairman, Department of Pathology, Cancer Institute and
Hospital, Chinese Academy of Medical Sciences, Beijing,
P. R. China
Pan, Guo Li, MD
Department of Pathology, Cancer Institute and Hospital, Chinese
Academy of Medical Sciences, Beijing, P. R. China
Shen, Qiong (Shen, Chuin), MD
Professor of Pathoanatomy, Department of Pathoanatomy,
Henan Medical College, Henan, P. R. China
Su, Ji Hao, MD
Associate Professor and Chairman, Department of Diagnostic
Radiology and Computed Tomography, Henan Cancer Research
Institute, Henan, P. R. China
X Contributors
Sun, Yan (Sun, Yen), MD
Associate Professor and Vice-Chairman, Department of Medical
Oncology, Cancer Institute and Hospital, Chinese Academy of
Medical Sciences, Beijing, P. R. China
Wang, Zheng Yan (Wang, Cheng-yen), MD
Associate Professor and Vice-Chairwoman, Department of Diag
nostic Radiology, Cancer Institute and Hospital, Chinese Acad
emy of Medical Sciences, Beijing, P. R. China
Wu, Ying K'ai (Y. K. Wu), MB, ChB, FACS (Hon)
Professor of Cardiothoracic Surgery, Director of Beijing Heart,
Lung, and Blood Vessel Medical Center, Beijing, P. R. China
Xi a, Qiu Jie (Hsia, Chu-chieh), MD
Associate Professor and Chairwoman, Department of Pathology,
Cancer Institute and Hospital, Chinese Academy of Medical
Sciences, Beijing, P. R. China
Zhang, Da Wei (Chang, Da-wei), MD
Associate Professor and Vice-Chairman, Department of Surgical
Oncology, Cancer Institute and Hospital, Chinese Academy of
Medical Sciences, Beijing, P. R. China
Zhou, Chuan Nong, MD
Central Laboratory, Cancer Institute and Hospital, Chinese
Academy of Medical Sciences, Beijing, P. R. China
Chapter 1
Epidemiology of Carcinoma of the
Esophagus in China
Bo Qi Liu and Bing Li
1 Introduction 2
2 Mortality 2
Relative Mortality by Site 2
3 Trends of Incidence 8
4 Geographic Distribution 9
4.1 Clustering Phenomenon 9
4.2 Variation Between Districts 9
4.3 Irregular Concentric Distribution Pattern 11
5 Distribution by Population Group 15
5.1 Sex 15
5.2 Age 15
5.3 Ethnicity and Immigration 17
6 Distribution in Rural and Urban Communities 18
7 Hyperplastic Changes of the Esophageal Epithelium 20
8 Incidence in Animals 21
9 Summary 23
References 24
2 Bo Qi Liu and Bing Li
1 Introduction
Cancer of the esophagus, a common malignancy in various parts of the world, was ftrst re
corded in China over 2000 years ago, under the name of "Ye Ge" ("i ~), meaning dyspha
gia and belching. Descriptions of this disease are found in a number of traditional Chi
nese medical texts, some authors attributing it to "heavy indulgence in heated liquors" [1].
It is also stated in the text of Yi-Guan as "commonly seen in the elderly and rarely devel
oping in young people."
Ever since the founding of the new China, medical researchers have carried out exten
sive investigations into the epidemiology of esophageal cancer. In 1969, cancer registra
tion was initiated in order to obtain data on incidence and mortality. From 1973 to 1975, a
3-year retrospective survey of cancer mortality covering a total population of 850 million
people was undertaken, with analysis of the geographic distribution and mortality of
esophageal cancer. In 1974, a multidisciplinary group of scientists started work in north
China, the northwestern part of Sichuan, and parts of Guangdong, Xinjiang, and Jiangsu
provinces on the etiology and genesis of esophageal carcinoma. Since 1970, six fteld sta
tions devoted to the treatment and prevention of esophageal carcinoma have been estab
lished in the high-risk areas, greatly facilitating the research into this malignancy.
2 Mortality
The rate of death from esophageal cancer varies greatly between different countries and
regions. Data obtained by WHO and published in 1977 show that mortality, standardized
to the world population, was highest in both sexes in China, with Puerto Rico coming sec
ond and Singapore third. Cumulative mortality up to 74 years of age was 4.05% for Chi
nese men and 1.96% for Chinese women. The incidence in Chinese men is double that in
Singapore, and mortality in Chinese women is 5 times as high as that in Puerto Rican
women (Table 1.1, Fig. 1.1). Among the 29 provinces, municipalities, and autonomous re
gions in China (mortality information from Taiwan is not available), 20 have a higher mor
tality standardized to the world population for men, and 23 for women, than those of
Puerto Rico and Singapore (Fig. 1.2). Linxian county in Henan province has the highest
incidence of all (Figs. 1.3, 1.4). Among the ftve continents, the highest incidence is in Asia
and Africa.
Relative Mortality by Site
In China, deaths from cancer of the esophagus constitute 26.46% of all cancer deaths in
men and 19.74% in women, both ftgures surpassing those in all other countries (Table 1.1).
Esophageal cancer ranks second only to cancer of the stomach (Table 1.2). However, the
position of esophageal cancer among all malignancies varies greatly in different parts of
China. It can be as high as 70% in the high-risk areas, taking the ftrst place in the table,
and as low as a few percent in the low-risk areas. Among the 29 provinces, municipalities,
and autonomous regions, it occupies the ftrst place for male cancer deaths in nine, the sec
ond place in eight, the third or fourth place in ten, and the ftfth place in two. Female mor
tality occupies one ofthe ftrst ftve places in 23 and one of the ftrst eight in the other six [2].