OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• neoplasia / cancer / tumours

• the most common tumours of the oesophagus are primary oesophageal tumours - in Australia, over 70% are SCC, the remainder are adenocarcinoma.
• survival is still poor, particularly if late diagnosis as metastatic disease at diagnosis reducing 12 month survival rates to a third of those with local disease only.
  • 12 month survival rates: local disease ~50%; regional disease 43%; distant 12%¹⁾;
  • 60 month survival rates: local disease 22%; regional disease 12%; distant 2%²⁾;
• risk factors include:
  • smoking
  • alcohol intake
    • mitochondrial ALDH2*2 E487K gene mutation causing impaired aldehyde dehydrogenase activity
      • an ALDH2-deficient drinker who drinks two beers per day has six to ten times the risk of developing eosophageal cancer as a drinker not deficient in the enzyme, especially if they also smoke as the enzyme also metabolizes acrolein which is a highly reactive aldehyde produced by environmental exposure to pollutants such as cigarette smoke.
      • most people with this enzyme deficiency are descendants of the Han dynasty in China (thus extends to the Japanese - 40% of whom have this gene mutation) in whom it may be protective against Entamoeba infections³⁾
      • it is rare in Caucasians
      • these people may be at risk of metabolic insults and hepatocyte apoptosis due to “aldehyde storm” following exposures to alcohol and acrolein when glutathion stores are low ⁴⁾
      • is also associated with osteoporosis, Alzheimer's disease, and coronary artery spasm in relation to tobacco smoke exposure
  • Barrett's oesophagus metaplasia due to chronic GOR
  • chronic gastro-oesophageal reflux is also an independent risk factor
  • drinking hot beverages such as hot tea without milk

• NSW 1972-2005⁵⁾:
  • 72% were SCC and others, and these affected men and women almost equally although incidence was marginally higher in men
    • age distribution similar to that of adenocarcinoma
    • incidence is slowly falling since 1982 in both men and women
  • 28% were adenocarcinoma and mainly affected men (over 4x incidence of women)
    • most were diagnosed in 60-80 year olds (this age group accounted for 60% of cases, while ~20% were in those older than 80 yrs and only 6% were in those under 50 years).
    • incidence in men has been steadily rising, quadrupling since 1984 from 1 case per 100,000 to 4 cases per 100,000, presumably related to obesity, smoking, alcohol intake, perhaps also due to the falling incidence of Helicobacter pylori infection and increasing GOR.