Esophageal cancer and risk factors

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Esophageal cancer and Risk factors : 

Esophageal cancer and Risk factors Taniya Koswatta PGIA –University of Peradeniya

Esophageal cancer : 

Esophageal cancer The esophagus 10-inch long, hollow, muscular tube connects the throat to the stomach. Esophageal cancer (esophagus cancer) when cells in the lining of the esophagus grow uncontrollably and eventually form a tumor.

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Esophageal cancer (EC) is the 8th most common incident cancer in the world and, because of its high fatality rate Ranks 6th among all cancers in mortality. 2009, -16,470 adults (12,940 men and 3,530 women) in the U.S will be diagnosed with esophageal cancer. 14,530 deaths (11,490 men and 3,040 women) An “esophageal cancer belt” extends from northeastern China to the Middle East, including the Caspian region of Iran, Hunan Province in northern China, and many countries of the former Soviet Union

Type of esophagus cancer : 

There are various subtypes, Adenocarcinoma of the esophagus (approx. 50-80% ) lower part of the esophagus, near the stomach. Squamus cell carcinoma of the esophagus upper part of the esophagus. Very rare tumors (less than 1%) Type of esophagus cancer

Adenocarcinomas : 

Endoscopic image -adenocarcinoma seen at gastro-esophageal junction. Adenocarcinomas Cancers that start in gland cells Occurs mainly -----lower part esophagus Associated with History of gastroesophageal reflux disease Barrett's esophagus

Squamous cell carcinomas : 

Squamous cell carcinomas Lining of Esophagus--- squamous cells Can occur anywhere along the length. Associated with. Alcohol use Tobacco consumption, Certain nitrogen compounds. Esophageal Squamous Cell Carcinoma

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Stage 0: Abnormal cells are found only in the inner layer of the esophagus. It's called carcinoma in situ. The stages of esophageal cancer

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Stage I: Through the inner layer to the submucosa. Stage II : Through the inner layer to the submucosa, Spread to lymph nodes. Invaded the muscle layer. Outer layer of the esophagus

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Stage III Through the outer layer, Spread to lymph nodes. Invaded nearby structures, such as the airways Stage IV: Spread to distant organs, such as the liver.

Symptoms of esophageal cancer : 

Symptoms of esophageal cancer Difficult or painful swallowing(dysphagia) Pain in the throat or back, behind the breastbone or between the shoulder blades Severe weight loss Hoarseness or chronic cough Vomiting Coughing up blood

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Age------increases with age, (55 and 85. ) Gender Men >women. Tobacco use Alcohol use Barrett's esophagus/ Medical history Diet---- low in fruits and vegetables increase risk Hot foods and drinks Consumption of carbonated soft drinks Obesity Drugs - H2 receptor antagonists Anyone who has had other head and neck cancers. Risk factors

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NEJM,2003 Table 1. Risk factors for esophageal cancer

Risk factors : 

Risk factors Tobacco & Alcohol Chewing, smoking, alcohol habits and dietary habits. Indicated 1.1 times excess risk for chewers of pan (betel-leaf) with tobacco, 1.8-fold excess risk for bidi smokers 2-fold for cigarette smokers, 1.8-fold excess risk for alcohol drinkers. Smoke include: Carbon monoxide Nicotine Hydrogen cyanide Ammonia Volatile aldehydes

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Includes carcinogens Benzene Aromatic amines 2-naphthylamine 4-aminobiphenyl Vinyl chloride Ethylene oxid Arsenic Chromium Cadmium Nitrosamines Polynuclear aromatic hydrocarbons

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Alcohol Carcinogenicity of alcohol is not known, because alcohol itself does not bind DNA, is not mutagenic including its conversion Alcohol alcohol dehydrogenase Acetaldehyde acting as a solvent for other carcinogens, and causing nutritional deficiency N-Nitroso compounds Nitrosamines Nitrosamides Formed by the endogenous reaction of nitrites with amines or amides Reduction of nitrates to nitrites by oral bacteria is a major contributor to the formation of N-nitroso compounds and it has been associated with higher risk of EC and gastric cancer.

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Hot foods and drinks Drinking 65 °C coffee increased the intraesophageal temperature by 6–12 °C, depending on the sip size. These drinks have chemicals that may cause or prevent cancer, which may confound the effect of thermal irritation. Low intake of fresh fruit and vegetables Non-starchy vegetables probably protect against EC. High intake of fruit and vegetables probably decreases EC risk by approximately 20% 50 gram of fruit or vegetable intake per day Obesity Increases intra-abdominal pressure Risk of gastroesophageal reflux and BE

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Consumption of carbonated soft drinks Have contributed to the rising incidence of EA, Because these drinks are acidic and may increase reflux by causing gastric distension H2 receptor antagonists (H2 blockers), Cimetidine Ranitidine Neutralizing the gastric pH, bacteria to proliferate increased production of carcinogens such as nitrosamines and acetaldehyde

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Genetic susceptibility Inherited susceptibility to EC in certain high-risk groups in China, Multifactorial inheritance suggest that a variety of polygenes and environmental factors contribute to the disease. Moderate sib-sib correlation – brother- brother correlation was even higher. Currently, a rare autosomal dominant disorder defined by a genetic abnormality on chromosome 17q25 is the only recognised familial syndrome that predisposes patients to squamous cell carcinoma. Aberrant CpG island hypermethylation of MGMT gene is closely related with the genesis and progression of esophageal squamous cell carcinoma.

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Tests and diagnosis Using a scope to examine esophagus (endoscopy) X-rays Collecting a sample of tissue for testing (biopsy) Computerized tomography (CT) Positron emission tomography (PET) Thoracoscopy and laparoscopy MRI cancer staging

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Source: The Cleveland Clinic Center for Continuing Education © 2000-2010

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Table 1. Staging of Esophageal Carcinoma

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Standardized (world) mortality of esophageal cancer in selected countries in males in the year 2002. source :epidemiology of esophageal cancer

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Standardized (world) mortality of esophageal cancer in selected countries in females in the year 2002. source :epidemiology of esophageal cancer

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Source: Vital Statistics of Japan, Statistics and Information Department, Ministry of Health and Welfare

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Treatment Surgery Chemotherapy Anticancer drugs to kill cancer cells. Radiation therapy High-energy rays to kill or shrink cancer cells. Gene therapy Photodynamic therapy First injecting a chemical to blood Collets the tumor for few days laser light is focused on the cancer through endoscope light change the chemical into new one It will kill cancer cells

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Conclusion Early detection higher survival rate Reducing risk factors more chance for survival Males have high risk than the females China peoples have high probability for facing EC (Genetic susceptibility) Precaution Getting natural fruit and vegetables, reducing consumption alcohol, tobacco and be healthy Due to high mortality rate Treatment is important

Reference : 

Reference Cancer Facts & Figures Statistics adapted from the American Cancer Society's publication, 2009. www.cancer.gov/cancertopics/pdq/.../esophageal(2010/02/24) India B. Ganesh, , Sanjay D. Talole,and Rajesh Dikshit Accepted 11 September 2009. Tobacco, alcohol and tea drinking as risk factors for esophageal cancer: http://www.ncbi.nlm.nih.gov/pubmed (2010/03/08) Farin Kamangar, Wong-Ho Chow, Christian Abnet, Sanford Dawsey,. 2009; Environmental Causes of Esophageal Cancer(1): 27–vii. http://www.ncbi.nlm.nih.gov/pubmed(2010/03/18) Helena Kollarova*, Lucie Machova, Dagmar Horakova, Gabriela Janoutova, Vladimir Janout Epidemiology of esophageal cancer – an overview article Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007, 151(1):17–28.http://www.ncbi.nlm.nih.gov/pubmed (2010/30/10) Guohong Z, Min S, DuenMei W, Songnian H, Min L, et al. (2010) Genetic Heterogeneity of Oesophageal Cancer in High-Incidence Areas of Southern and Northern China. PLoS ONE 5(3): e9668. doi:10.1371/journal.pone.0009668 http://www.ncbi.nlm.nih.gov/pubmed (2010/03/18) Jesus Vioque*1,2, Xavier Barber3, Francisco Bolumar2,4, Miquel Porta2,5, Miguel Santibáñez1, Manuela García de la Hera1,2, Eduardo Moreno-Osset6 for the PANESOES Study Group,1 August 2008, Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain http://www.biomedcentral.com/1471-2407/8/221(2010/30/21)

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