Özefagus Kanseri
Özet
Özofagus kanseri gün geçtikçe artan sıklıkta kanser olarak bilinmektedir. Hastalar genelde yutma güçlüğü, bulantı, kusma ve kilo kaybı ile tanısı konmaktadır. Alt tiplerinden özofagus squamoz hücreli kanseri (SCC) en sık görülmekteyken adenokanser alt tipi ise özellikle batılı ülkelerde yaygınlığı artmaktadır. Hastalığın evrelemesi tedavi ve takipte oldukça önem arz etmektedir. Evreleme yöntemi olarak pozitron emisyon tomografisi, bilgisayarlı tomografi, magnetik rezonans görüntüleme, endoskopi ve endoskopik ultrason gibi yöntemler kullanılmaktadır.
Hastalıktan şüphelenildiğinde ilk olarak endoskopi yapılır. Endoskopide adenokanserler genelde distalde görülürken scc hastaları özofagusun proksimal veya orta kesiminde görülmektedir. Lokal evrelemede endoskopik ultrason yöntemi kullanılırken uzak organ tutulumu göstermede PET-CT kullanımı yaygındır.
Erken evre hastalıkta öncelikle lokal tedaviler önerilmektedir. Bu lokal tedaviler endoskopi ile yapılabilirken tümör evresi arttıkça cerrahi yöntemler değerlendirilir. Operabl olup lokal ileri olan hastalara önce kemoradyoterapi sonra cerrahi uygun görülmektedir. Operasyon sonrası hastalarda rezidü tümör varlığında nivolumab tedavisi tercih edilirken R0 rezeksiyon yapılan hastalar sıkı takip edilmelidir.
Metastatik veya rezeke edilemeyen tümörlerde ise kemoterapi, immünoterapi ve hedefe yönelik ajanlar kullanılmaktadır. O nedenle tanı anında kansere özgü biyobelirteçler çalışılması önerilmektedir.
Esophageal cancer is an increasingly common cancer. Patients are usually diagnosed with dysphagia, nausea, vomiting and weight loss. Among its subtypes, esophageal squamous cell carcinoma (SCC) is the most common, while the adenocarcinoma subtype is increasing in prevalence, especially in western countries. Staging of the disease is very important in treatment and follow-up. Positron emission tomography, computed tomography, magnetic resonance imaging, endoscopy and endoscopic ultrasound are used as staging methods.
When the disease is suspected, endoscopy is performed first. On endoscopy, adenocarcinomas are usually seen distally, whereas SCc patients are seen in the proximal or middle part of the esophagus . While endoscopic ultrasound is used for local staging, PET-CT is commonly used to show distant organ involvement.
Local treatments are primarily recommended in early stage disease. While these local treatments can be performed with endoscopy, surgical methods are evaluated as the tumor stage increases. For operable and locally advanced patients, chemoradiotherapy and then surgery is considered appropriate. While nivolumab treatment is preferred in the presence of residual tumor in postoperative patients, patients with R0 resection should be followed up closely.
In metastatic or unresectable tumors, chemotherapy, immunotherapy and targeted agents are used. Therefore, it is recommended to study cancer-specific biomarkers at the time of diagnosis.
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