High Incidence Of Esophageal Carcinoma Research Articles

Study of modifiable risk factors for instituting evidence-based preventive strategy for carcinoma esophagus in Punjab: A study protocol

Background: In Punjab, esophageal carcinoma has been reported as leading cancer in rural population. Reason for this high incidence of esophageal carcinoma in this region is unknown. The life style of people in Punjab is different from those of other areas in India. Therefore, the risk factors contributing to esophageal carcinoma in Punjab may also be different than the other parts of India. There are no previous studies on risk factors for high incidence of esophageal carcinoma in this region. Use of pesticides is much higher in Punjab state. Also there is no evidence available for association of use of pesticides/fumigants in occurrence of esophageal carcinoma. Hence this study is planned to identify the risk factors, especially the role of chemical toxicity (Pesticides/fumigants/heavy metals) associated with development of esophageal carcinoma among inhibitants of Punjab. Methods: A case-control design will be used to identify potential risk factors associated with development of carcinoma esophagus in Punjab. Cases will be recruited from PGIMER, Chandigarh, Population based cancer registry Mansa, Sangrur, SAS Nagar and Punjab Cancer control cell. For each esophageal cancer case 2 controls will be selected after matching for gender, age and area of residence. A pre designed questionnaire, including demographic characteristics, family cancer history, personal medical history, height, weight, life-style (habits such as smoking, tobacco chewing, alcohol drinking, etc.), dietary habits, fumigants and pesticide usage and practices etc, will be used. Urine samples will be taken for the analysis of pesticide metabolites. Heavy metals analysis will be done in water samples. Oral health will be examined for mucosal changes as well as for oral hygiene. Discussion: This study will results in identification of risk factors for high occurrence of esophagus carcinoma in Punjab, so that measures for early detection, prevention and control of esophagus carcinoma could be initiated.

Tylosis A with squamous cell carcinoma of the oesophagus ina Spanish family

Palmoplantar tylosis is a focal nonepidermolytic palmoplantar hyperkeratosis, which is inherited as an autosomal dominant condition. Two types have been described: an early onset type B tylosis, which occurs in the first year of life and is usually benign, and type A tylosis, which occurs between the ages of 5 and 15 years. Type A tylosis has been associated with a high incidence of oesophageal carcinoma in three families in England, Germany and the USA. This study describes an additional family from Spain with tylosis A, without any known relation to those described before.

Comparison of prevalence, viral load, physical status and expression of human papillomavirus-16, -18 and -58 in esophageal and cervical cancer: a case-control study

BackgroundHuman papillomavirus (HPV) infection is a major risk factor for the development of nearly all cases of cervical cancer worldwide. The presence of HPV DNA in cases of esophageal squamous-cell carcinoma (ESCC) has been reported repeatedly from Shantou, China, and other regions with a high incidence of esophageal carcinoma (EC). However, unlike in cervical squamous-cell carcinoma (CSCC), in ESCC, the characteristics of HPV are unclear. Thus, the role of high-risk HPV types in the carcinogenesis of ESCC remains uncertain.MethodsSeventy cases of ESCC with 60 controls and 39 cases of CSCC with 54 controls collected from patients in Shantou region in China were compared for the distributions of HPV-16, -18 and -58; viral load; and viral integration using real-time PCR assay and HPV-16 expression using immunostaining.ResultsThe detection rates and viral loads of HR-HPV infection were significantly lower in ESCC than in CSCC (50.0% vs. 79.48%, P = 0.005; 2.55 ± 3.19 vs. 361.29 ± 441.75, P = 0.002, respectively). The combined integration level of HPV-16, -18 and -58 was slightly lower in ESCC than in CSCC (P = 0.022). HPV-16 expression was detected in 59.26% of ESCC tissue and significantly associated with tumour grade (P = 0.027).ConclusionsHigh levels of HR-HPV expression and integration may be an indicator of the risk of ESCC, at least for patients in the Shantou region of China. However, a relatively low HPV copy number and infection rate in ESCC is unlikely to play an essential a role in the carcinogenesis of ESCC as in cervical cancer. Factors other than HR-HPV infection may contribute to the carcinogenesis of ESCC.

Detection of a Putative Novel Wolinella Species in Patients with Squamous Cell Carcinoma of the Esophagus

Certain regions of South Africa exhibit an extraordinarily high incidence of esophageal carcinoma that develops via an esophagitis-dysplasia-carcinoma sequence. Bacteria belonging to the family Helicobacteraceae are candidates for involvement in the initiation of the esophagitis. We investigated patients with esophageal carcinoma for the occurrence of Helicobacter-related species. Biopsies from tumor and nonlesional tissue of the esophagus from nine patients with squamous cell carcinoma were investigated for Helicobacteraceae using a PCR-based method targeting the 16S rRNA gene. Four out of nine patients tested negative, while samples from the other five patients revealed an infection by different Helicobacter species. Sequence analysis of the PCR fragments led to the identification of a hitherto unknown bacterium in three of these patients. Phylogenetically, this bacterium was assigned to the genus Wolinella within the family of Helicobacteraceae. Helicobacter pylori was identified in three patients, and one revealed a coinfection with the novel Wolinella species. Helicobacteraceae were detected in approximately 50% of South African patients with esophageal carcinoma. Furthermore, a novel bacterium was identified that might be linked to the enhanced incidence of esophagitis and subsequent malignant disease in South Africa.

Strategy to reduce esophageal cancer by dietary reformation

From 1920 to 1940, many people were affected by esophageal carcinoma in villages in the mountains of Nara Prefecture in Japan. However, a movement for the improvement of living conditions, especially concerning food, diminished the incidence of cancer of the esophagus. Today Xinjiang in China, esophageal cancer is also one of the main causes of death. Therefore, we analyzed in Xinjiang whether the improvement of dietary habits can reduce mortality of esophageal cancer. The mortality of esophageal cancer and related matters obtained from the Japanese Literature and Governmental Information, Xinjiang Medical School Cancer Center Hospital, and the Chinese Literature were analyzed. The Kazaks have a higher incidence of esophageal cancer and a lower male/female ratio than other ethnic groups and Japanese people. Kazaks eat very hot meals rapidly, and male Kazaks are more likely to drink hard liquors. In Japan, people in regions with high alcohol consumption tend to have increased mortality of esophageal cancer, but regions with high smoking rates show no correlation with esophageal cancer mortality. There were no data relevant to the incidence of esophageal cancer and alcohol consumption or smoking rates in Xinjiang. The male mortality rate in Nara Prefecture was much higher than that in other areas in the 1930s, but it decreased gradually and eventually reached national levels. The female mortality rate in Nara decreased at a sluggish pace, but retained a several-fold incidence rate until the 1980s. In 1995, women in Nara reached the national level at last. The male/female ratio was low in Nara all the time, and alcohol consumption in Nara was low, too. Recently, it has been indicated that alcohol consumption is strongly related to esophageal cancer. However, women in Xinjiang do not drink strong liquor at all. One of their causes of esophageal cancer is dietary habits, which concerns both genders. Therefore, the incidence of esophageal carcinoma could be reduced by dietary reform in Xinjiang, where women as well as the overall population have a high incidence of esophageal carcinoma.

Detection of human papillomavirus in esophageal carcinoma.

The aim of the study was to assess the prevalence of human papillomavirus (HPV) in the esophagus in the coastal region of Eastern Guangdong, Southern China, an area with a high incidence of esophageal carcinoma. Fresh surgical resection esophageal specimens were obtained from 176 esophageal carcinoma patients admitted to the Tumor Hospital of Shantou University Medical College. The samples were subjected to polymerase chain reaction (PCR) to detect HPV infection using consensus and type-specific primers for HPV type 6, 11, 16, and 18. The incidence rate was 65.5%, 69.1%, and 60% in tissues of cancerous, paracancerous and normal mucosa, respectively. Further analysis of the distribution of HPV types in the three sections of tissues showed that the high-risk HPV types 16 and 18 were found mainly in the cancer cells (43.2%), whereas the low-risk HPV types 6 and 11 were seen mainly in the normal mucosa (52.3%). The total infection rate of the high-risk HPV types 16 and HPV 18 was the highest in cancerous tissues (54.5%), followed by paracancerous tissues (19.5%), and the lowest in normal mucosa (11.7%). There was high incidence of HPV infection in the esophageal epithelium in Eastern Guangdong, Southern China, where esophageal carcinoma is prevalent. HPV was seen in the normal, paracancerous and cancerous tissues, with the high-risk HPV type 16 and 18 more common in cancerous tissues. The results indicate that the high incidence of esophageal carcinoma in this area is associated with HPV infection.

To B or not to B: is tylosis B truly benign?: Two North American genealogies

Tylosis is a rare, autosomal dominant syndrome presenting with hyperkeratosis of the palms and soles of the feet. Two types have been identified. Late onset tylosis (type A) is reported to be associated with a high incidence of esophageal carcinoma, whereas early onset tylosis (type B) appears to be a benign disorder. This distinction has significant implications for surveillance and prognosis. We report two families exhibiting early onset type B tylosis, spanning five and seven generations, respectively, and believe these to be the first two extensive genealogies of tylosis type B reported in North America. They serve to verify the features of type B tylosis and its benign prognosis. The world literature is reviewed and clinical relevance is discussed. Recommendations for follow-up of afflicted individuals are proposed.

Surgical treatment for carcinoma of the oesophagus in Chinese language publications

This review is a meta-analysis of Chinese language publications on surgical treatment for oesophageal cancer. Between 1980 and 1994, 17,815 patients had surgery for carcinoma of the oesophagus. The male:female ratio was 3.9:1 and mean age was 51.9 (range 16-80) years. Mean resectability rate was 86.7 per cent and hospital mortality rate was 3.8 per cent. The crude 5-year and 10-year survival rates for all patients were 29.6 and 16.4 per cent respectively. For patients with stage 0 and stage I tumours, the 5-year survival rate was 95 and 89 per cent respectively, significantly greater than that for those with stage II, III and IV tumours (19.4 per cent, P < 0.01). The 5-year survival rate of all 2226 patients with tumour resection after radiotherapy was 38.0 per cent. There was no significant difference in survival following combination therapy compared with surgery alone. When compared with a report for the interval 1940-1979, there was no significant difference in the resectability, hospital mortality or 5-year survival rates. Oesophageal carcinoma remains a disease with dismal prognosis but surgery still offers the best chance of long-term survival. Adjuvant therapy has not yet proved an advantage in terms of survival but can be useful for palliation. Mass screening might improve survival but only in a population with a high incidence of oesophageal carcinoma.

Effect of chewing Qat on mucosal histology and prevalence of Helicobacter pylori in the oesophagus, stomach and duodenum of Yemeni patients

This investigation was aimed at assessing whether the Yemeni habit of chewing Qat on a regular basis had a significant effect on the upper alimentary tract. Seventy patients with dyspepsia attending Al-Thawra Hospital in Taiz, Yemen Republic were examined by endoscopy. Biopsies were taken from the oesophagus, stomach and duodenum. The patients included 28 who gave a history of daily Qat intake, 21 with less frequent intake and 21 who took none. The only statistically significant finding associated with daily Qat intake was a higher prevalence of duodenal ulcer, particularly in females. However, a strong association was also found between heavy smoking and ulcer, with most ulcer patients who chewed Qat daily being heavy smokers. Chewing Qat was not associated with a higher prevalence of oesophageal dysplasia, making it unlikely to be the cause of the perceived high incidence of oesophageal carcinoma in Yemen. There was a high prevalence of gastric H. pylori colonization (93%) and columnar-lined lower end of oesophagus (18%), as well as low prevalence of intestinal metaplasia of stomach (4%); this was not, however, related to chewing Qat. Further epidemiological and histological studies are needed to assess the significance of these findings in relation to the incidence of oesophageal and gastric carcinoma in Yemen.

Diet and esophageal cancer: A case-control study

A case control study of osophageal cancer was conducted among black male and female residents of Washington, D.C., to assess the influence of the intake of food groups, alcohol, and smoking to the esophageal cancer. Twenty-three pairs (23 cases and 23 controls) were interviewed. Cases ate more pork (p<0.005), bacon, hot dogs, sausages (p<0.025) and drank more beer, champale, malted liquor (p<0.01), and canned beer (p<0.01). They also smoked more frequently (p<0.05). Pork consumption is higher among blacks and this could be one of the reasons for high incidence of esophageal carcinoma in this population. The processing of pork and pork products may be associated with esophageal cancer rather than the pork itself. Although we have made some preliminary observations regarding the relationship of nutrition to esophageal cancer in the black population, further studies need to be conducted to identify specific nutrient deficiency, if any, in these cases.

Enhancement of formation of the esophageal carcinogen benzylmethylnitrosamine from its precursors by Candida albicans.

Previous studies in Linxian, an area of China with a high incidence of esophageal carcinoma, showed that fungal infections are common in the esophageal epithelium of patients with either premalignant changes or early esophageal carcinoma. Fungi of the genus Candida were the most frequent invaders. In these areas nitrate and nitrite are often present in high concentrations in drinking water and staple grains. The present studies have established the ability of Candida albicans to augment the nitrosative formation of the esophagus-specific carcinogen, benzylmethylnitrosamine (NBMA; N-nitroso-N-methylbenzylamine). Stationary C. albicans cultures, with pH held at 6.8, were incubated with the precursors of NBMA, benzylmethylamine (BMA; N-methylbenzylamine) and NaNO(2). There was a significant increase in the amount of NBMA formed in these cultures, compared to precursors-only controls. The amount of NBMA synthesized depended on fungal cell number. Exponentially growing cultures were also able to cause NBMA formation. The identity of the NBMA was confirmed by high-performance liquid chromatographic coelution with authentic NBMA in three solvent systems and by mass spectroscopy. Boiled cells and conditioned medium in which cells had been incubated were not effective in enhancing nitrosation. Cultured Candida released acidic metabolites that reduced the pH of the medium when only a low concentration of buffer was present. Spontaneous nitrosation of BMA was enhanced under these acidic conditions. Thus, C. albicans infecting the esophageal epithelium could cause local formation of NBMA by both cell-mediated catalysis and extracellular decrease in pH.

Carcinogenicity of some folk medicinal herbs in rats.

Twelve medicinal herbs were bioassayed to correlate a high incidence of esophageal carcinoma in natives of different places with their habitual consumption of these products. Outbred NIH Black rats were given 72 weekly sc injections of the total aqueous extracts of the plant materials. The tanninrich plant extracts from Areca catechu and Rhus copallina produced local tumors in 100 and 33%, respectively, of the experimental animals. Other materials included Diospyros virginiana and extracts from plants not rich in tannins. Diospyros and extracts of Sassafras albidum and Chenopodium ambrosiodes were tumorigenic in over 50% of the treated animals.

Carcinogenicity of Camellia sinensis (Tea) and Some Tannin-Containing Folk Medicinal Herbs Administered Subcutaneously in Rats23

In an attempt to correlate the high incidence of esophageal carcinoma in natives of certain places with their habit of using herbaceous folk medicines, we performed bioassays of several plant extracts and the fractions prepared from them. Fourteen extracts and fractions from 6 plants were injected sc into NIH Black rats. The tannin fractions from Quercus falcata pagodaefolia, Diospyros virginiana, and Camellia sinensis were very active and produced tumors at the injection site in 66% or more of the treated animals. Tannin fractions from 3 other plants and total aqueous extracts from 5 to 6 tested plants were also tumorigenic rats. The induced tumors were malignant fibrous histiocytomas similar, if not identical, to those encountered in humans. The experiment indicated a possibility of induction of tumor in man by the tested plant materials.

Comparative studies on dysplasia of esophageal epithelium in four prefectures of Japan (Miyagi, Nara, Wakayama and Aomori) with reference to risk of carcinoma.

Distal two-thirds of the esophagus without macroscopically detectable malignant lesions from a total of 248 autopsy cases were examined for epithelial dysplasia on histological sections from serial blocks. The autopsy specimens had been obtained from Miyagi. Nara and Wakayama prefectures known for high incidence of esophageal carcinoma in Japan, and Aomori prefecture where the incidence of the disease is low. Epithelial dysplasia was classified into mild, moderate, and severe including carcinoma in situ according to the grade of epithelial atypism. Of 248 cases 91 (36.7%) had epithelial dysplasia and 30 (12.1%) had moderate and severe dysplasia. In one of the cases of severe dysplasia, in situ carcinoma was diagnosed. Lesions of dysplasia of the resected specimen were displayed in a diagram for the distribution of the abnormal epithelium. Cases of higher grade dysplasia tended more extensive in area and were slightly dominant in the distal third of the esophagus. Possible relationships of dysplasia with long-standing irritation to the esophagus and with precancerous lesions were discussed.