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neo_oesophagus

oesophageal cancer

introduction

  • 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
      • an ALDH2-deficient drinker who drinks two beers per day has six to ten times the risk of developing esophageal cancer as a drinker not deficient in the enzyme
        • most people with this enzyme deficiency are descendants of the Han dynasty in China (thus extends to the Japanese) in whom it may be protective against Entamoeba infections3)
        • it is rare in Caucasians
    • 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

epidemiology

  • NSW 1972-20054):
    • 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.
1) , 2) , 4)
MJA Sept 2009 Vol 191 Number 6
neo_oesophagus.txt · Last modified: 2012/02/17 13:59 by 127.0.0.1

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