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  • br Conflict of interest br Introduction For decades cancer

    2019-05-07


    Conflict of interest
    Introduction For decades, cancer has been the leading cause of death in Taiwan. In 2012, esophageal cancer was the eighth most common cancer globally, with 456,000 new cases presenting that year. Esophageal cancer caused approximately 400,000 deaths in 2012, up from 345,000 in 1990. Rates vary widely among countries, with approximately 50% of all cases occurring in China. Esophageal cancer is approximately 3 times more common in men than in women. The esophagus is a muscular tube that moves food and liquids from the throat to the stomach. In esophageal cancer, malignant (cancer) cells form in the esophageal tissues. The 2 main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma, have different sets of risk factors. Squamous cell carcinoma is associated with lifestyle-related factors such as smoking and alcohol. By contrast, adenocarcinoma is associated with the effects of long-term PR957 reflux. Tobacco, which is more commonly used by men and those older than 60 years, is a risk factor for both types. The treatment course for esophageal cancer depends on the tumor location, size, and stage. Certain patients undergo esophagectomy followed by chemotherapy or chemoradiation, whereas others receive neoadjuvant chemotherapy and radiation before esophagectomy. Certain patients with extensive disease, who are not candidates for aggressive treatment, receive palliative therapy to improve dysphagia, so that they can eat. Such patients may undergo percutaneous gastrostomy or jejunostomy to enable the patients to receive nutrition directly into the stomach or the intestine, and to allow for soft and liquid food intake. Malnutrition is common among patients with esophageal cancer. Cancer-associated malnutrition has numerous consequences, including increased infection risk, poor wound healing, reduced muscle function, and poor skin turgor, which result in skin breakdown. The Scored Patient-Generated Subjective Global Assessment (PG-SGA) score, which can be used as an objective measure for demonstrating the outcome of nutrition intervention and the SGA have been developed specifically for use in the cancer population. They include the following: (1) Patients complete the medical history component, thereby saving time; (2) the PG-SGA contains more nutrition impact symptoms, which are crucial to patients with cancer; and (3) the SGA has a scoring system that allows patients to be triaged for nutritional intervention (Fig. 1). Compared with other digestive and nondigestive forms of cancer, the highest incidence of malnutrition (79%) was observed in patients with esophageal cancer. The side effects caused by esophageal cancer treatment are major contributors to malnutrition and wasting syndrome, which typically present in these patients. Jejunostomy feeding may be used because of the patient\'s inability to use the mouth, stomach, or esophagus for feeding because of dysfunction. Nutritional problems resulting from jejunostomy feeding are due to the lower digestive tract of the small intestine, which causes diarrhea. This leads to the malabsorption of essential nutrients in the small intestine, thus leading to malnutrition and weight loss. The elemental diet is an ingestion diet used during jejunostomy feeding of liquid nutrients in an easily assimilated form. The formula also contains carbohydrates, fats, vitamins, and minerals. Many patients require special nutritional support after surgery, and elemental diets may aid in the management of such patients. A peptide-based formula is recommended to preserve and restore gut integrity during periods of illness, and helps prevent the consequences of tube-feeding intolerance to improve outcomes.
    Case report Positron emission tomography (PET) and computed tomography (CT) revealed a tumor in the upper two-thirds of the esophagus with a maximal length of 14.38 cm and at least 6 enlarged lymph nodes. Complete computer-controlled radiation therapy was performed on June 12, 2015, and a chest CT 2 weeks later revealed partial tumor response and shrinkage of the right upper paratracheal lymph node. The patient (cT3N3MO, stage III c) underwent esophagectomy with gastric tube reconstruction, lymph node dissection, and jejunostomy (J tube) for enteral nutrition (EN) on July 6, 2015 (Fig. 2).