Epidemiology

Cancer of the oesophagus is one of the cancers of the digestive tract of the most serious prognosis. Incidence and death rates are higher for populations other than the white race (5-years long survival rate in the United States in years 1992 - 1999 equalled 15% for the white race and 9%for others). As far as the incidence rate is concerned, the cancer is classified on the 13th position among men and on the 29th position among women. As far as the death rate is concerned, it is classified on the 12th and 25th positions respectively.

The following regions are characterized by the highest incidence rate: north Iran, southern republics of the former USSR and the north of China - over 100 for 100,000 (Asian belt of cancer of the oesophagus). Medium incidence rate - Sri Lanka, India, South Africa, France, Switzerland: 10-50 for 100,000; low - Europe, Japan, Great Britain, Canada - under 10 for 100,000.

Increasing tendency for adenocarcinoma (before 1980, it constituted about 15%, nowadays it's about 35-37%) - in the USA and in Europe. The incidence rate of cancer of the cardia area is also increasing.

Etiology

Tobacco use - increases the risk of adenocarcinoma, no connection with the occurrence of squamous carcinoma. Alcohol abuse - increases the risk of squamous carcinoma. Joint effects of tobacco and high-proof spirits use increase the risk of cancer of the oesophagus about 100 times. Obesity - increases the risk of the incidence about 2 times. Diet poor in fruit increases the risk of squamous carcinoma about 2 times. Lack of carotene, selenium, E vitamin, scarcity of hot meals and consumption of spoiled fruit have influence on the incidence of adenocarcinoma and squamous carcinoma.

Culturally inclined dietary habits increase the risk of incidence in Asia, south Africa, south America and the Middle East; in Europe and in the USA these are tobacco use and alcohol abuse.

Additional risk factors: Tylosis Plantaris, Plummer syndrome / Vinson and Patterson / Kelly, Achalasia, Pre-existing presence of caustic substances, Pre-existing cancers of respiratory and digestive tract, Barrett's oesophagus Infections of Helicobacter Pyroli and Human Papilloma Virus.

Symptoms Dysphagia, often preceded by discomfort of swallowing lasting several months, and loss of weight are the first symptoms in 90% of patients. Difficulties with swallowing may not be perceptible even if the narrowing of the oesophagus reaches 66%. There are 4 degrees of dysphagia: I grade - ability to swallow solids, II grade- ability to swallow ground food III grade - ability to swallow liquids only IV grade - aphagia

The following symptoms appear frequently: bringing up food, stomachaches and pneumonia. In more advanced cases: bloodstained vomit, blood spitting (because of tracheoesphageal fistula), retrosternal aches (infiltration of mediastinum structures), hoarseness, and cough (invasion of tracheal lymph nodes and infiltration of recurrent laryngeal nerve).

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