BPD results in significant weight loss. However, 1 in 4 patients are hypocalcemic, and 1 in 2 have a low vitamin D, despite multivitamin supplementation. BPD patients require routine calcium and vitamin D supplementation for life. Long-term sequelae from these abnormal serum levels are not known.
SummaryThe current ICD-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion. This study compares the epidemiological and clinical features of each subtype and subsite of adenocarcinomas of the oesophagus and stomach, to assess requirements for a new classification of these carcinomas. Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinomas identified throughout the period 1974-1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2.5 million. The incidence of adenocarcinomas of the lower oesophagus and cardia trebled in males, and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. Adenocarcinomas of the lower oesophagus and of the cardia were similar for median age at diagnosis, male to female ratio, percentage of patients who smoked and survival; both were significantly different from carcinomas of the subcardia in these respects. These data imply that adenocarcinomas of the lower oesophagus and cardia are the same disease. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a distinct subsite, to facilitate surveillance, management and research.
Patients with surveillance-detected adenocarcinoma of the oesophagus are diagnosed at an earlier stage and have a better prognosis than those who present with symptomatic tumours.
Summary Deletions of tumour-suppressor genes can be detected by loss of heterozygosity (LOH) studies, which were performed on 23 cases of adenocarcinoma of the oesophagus, using 120 microsatellite prmers coverng all non-acrocentric autosomal chromosome arms.The chromosomal arms most frequently demonstrating LOH were 3p (644% of tumours). 5q (45%), 9p (52%), lip (61%) Correspondence to: JK Field studies can lead to the identification of tumour-suppressor genes that are inactix ated in the metaplasia-dxsplasia-carcinoma progression. and may therefore be useful as biomarkers of future carcinogenesis in patients w-ith Barrett's metaplasia and dx splasia undergoing endoscopic surveillance. Previous alleleotype analx ses have detected LOH in more than 40%c of oesophageal adenocarcinomas on chromosome arms lp. 4q. 5q. 9p. 13q. 17p and 18q (Barrett et al. 1996a andHammoud et al. 1996). These allelotype studies AWere undertak-en Awith 43 and 39 microsatellite primers respectixely. We have performed the most comprehensive genomic study of oesophageal adenocarcinoma to date. coxering all of the non-acrocentnrc chromosome arms w-ith 120 microsatellite pnrmers. enabling identification of putatiVe tumour-suppressor gene sites in oesophageal adenocarcinoma.
MATERIALS AND METHODS PatientsTwentv-three cases of adenocarcinoma of the oesophagus diagnosed betmeen 1992 and 1996 were studied. Twenty of these patients were male and their mean age xxas 68 y-ears. At present. six of these patients are alix e w ith no signs of recurrent disease.
DNA extractionTissue from the tumour and from normal gastric mucosa were obtained from endoscopic biopsies and from surgical resections. snapped frozen in liquid nitroaen and stored at -70 C. Areas of tumour containincg minimal stromal cells wxere microdissected and DNA extracted from the microdissected tissues usinc the Nucleon II extraction kit (Scotlab).950
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