Department of GHPD, BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh
Department of Medicine, East West Medical College, Turag, Uttara, Dhaka, Bangladesh
Background and objectives:Esophageal malignancy is a fatal disease. Squamous cell cancer and
adenocarcinoma are two most common types. The present study aimed to describe
demographic characteristics, clinical features, histological types and associated
among the selected Bangladeshi patients with esophageal cancers.
Methods:This cross-sectional descriptive study was
conducted from January to December 2016 at two hospitals in Bangladesh. Total
35 adult patients diagnosed as having esophageal cancer were consecutively and
purposively included in this study. Age, gender, history of chewing betel nut
and smoking, clinical presentation and laboratory parameters were recorded
systematically in a predesigned data sheet.
Results:Among the 35 patients
with esophageal cancer, 80% were more than 50 yrs of age while 71.4% and 28.6% were
male and female respectively. Out of these cases, 27 (77.1%) had squamous cell
carcinoma (SCC) and 8 (22.9%) had adenocarcinoma. Out of 27 SCC, 15 (55.6%) had lesion in mid-esophagus, 9 (33.3%) in lower
and 3 (11.1%) in upper esophagus. All adenocarcinoma were present in
lower esophagus. History of smoking and chewing betel nut were not
significantly associated with esophageal cancers.
Conclusions: Esophageal carcinoma was
common in elderly male and SCC was more frequent compared to
adenocarcinoma. Further study with
larger number of samples is required to determine the role of smoking and betel
nut chewing in esophageal cancers in Bangladeshi population.
IMC J Med
Sci 2017; 11(2): 36-39
Address for Correspondence:Dr.
Md. Nazmul Hoque, Consultant and Head, Department of GHPD, Ibrahim Medical
College & BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka,
Bangladesh. Email: firstname.lastname@example.org
Esophageal cancer usually
presents at an advanced stage, and thus curative treatment is limited and the
prognosis is poor .In
spite of the recent development in cancer therapy, esophageal cancer remains
one of the least treatment-responsive malignancies . Even in developed
countries, more than 85% of patients die within two years of diagnosis, making
it the sixth most common cause of cancer-related deaths in the world .
The main histologic types of esophageal cancer are squamous cell
carcinoma (SCC) and adenocarcinoma . Esophageal cancer is generally more
common in men than in women. The male-to-female ratio is 3 to 4:1. Esophageal
cancer occurs most commonly during the sixth and seventh decades of life .
Approximately, 50% to 60% of squamous cell esophageal cancers occur in the
middle third of the esophagus, 33% involve the distal esophagus, and 10% occur
in the proximal esophagus . In Western cultures,
retrospective evidence has implicated cigarette smoking and chronic alcohol
exposure as the most common etiologic factors for squamous cell carcinoma .
High body mass index, gastro esophageal reflux disease (GERD), and resultant
Barrett esophagus are often the associated factors for esophageal adenocarcinoma
[8, 9]. Caustic injuries, betel nut, certain fungus and smoking have been
implicated to promote esophageal cancer in south Asia [10, 11].
Therefore, a better understanding of the
socio-demographic characteristics, etiology and risk factors of esophageal
cancer would be useful for its primary prevention [12,13]. At present, only
limited information is available on esophageal cancer among Bangladeshi
population. . Therefore, the present study aimed to describe the
demographic characteristic, clinical presentation, histological types of
esophageal cancer among selected Bangladeshi patients.
This cross-sectional descriptive study was conducted from January to
December 2016 at two hospitals of Bangladesh located in Feni district and Dhaka
city. Feni district is located 128 km from Dhaka city in the south-eastern part of Bangladesh. Endoscopicaly
diagnosed 35 adult consecutive cases of esophageal carcinoma were included. In
this study either sex was consecutively and purposively included. Previously
diagnosed case of carcinoma esophagus under treatment and patients with
inconclusive histological findings were excluded from the study. Age, gender, history
of chewing betel nut and smoking, clinical presentation and laboratory
parameters were recorded systematically in a predesigned data sheet. Upper gastrointestinal (GI) endoscopy was done by Olympus
CV 150 machine and 6 to 8 pieces of tissues were taken by Olympus biopsy
forceps. Collected tissue was immersed in formalin container for histopathology
examination. Histopathology was done by experienced pathologists. Patients were
initially classified as esophageal cancer by gross endoscopic findings and
later confirmed by histopathology examination. The data were presented as
percentage and mean and relevant statistical tests were employed to determine significant
association or differences among variables.
A total of 35 consecutive cancer esophagus cases
were enrolled. The mean age was
61.3 years and the range was 40 to 85 years while 80% were more
than 50 years of age (Table-1). Of the 35 cases, 71.4% was male and 28.6% was female. Regarding the status of smoking it was
found that 19 (54.3%) were either smoker or ex-smoker (Table I). Among
the 35 cases, overall 62.9% cases had the history of betel nut chewing
irrespective of the types of esophageal cancer. All the patients having esophageal cancer
had dysphagia, of which 19 (54.3%) patients had relative dysphagia (dysphagia
only for solid foods) and remainder 16 (45.7%) patients had absolute dysphagia
(both solid and liquid; Table-2). The mean duration of the symptoms was 1.4
months. Out of 35 cases, 27 (77.1%) had SCC and 8 (22.9%) had adenocarcinoma by
histological examination (Table-2). Endoscopic examination revealed that all adenocarcinoma were present in the lower
part of the esophagus. Out of 27 SCC, 15 (55.6%) had lesion in mid-esophagus, 9
(33.3%) in lower and 3 (11.1%) in upper esophagus (Table-2). Table-3 shows that the habit of betel nut chewing was
present in higher proportion of patients (70.4%; 19/27) with SCC compared to patients with adenocarcinoma (37.5%); 3/8).
But the difference was not significant (p= 0.0907). On the
other hand, history of smoking was present in 75% of cases with adenocarcinoma
compared to 48.1% in cases with SCC. But the difference was not statistically
characteristics of 35 esophageal cancer cases
Table-2: Major clinical
features, endoscopic and histological findings of the study population
Table-3: Betel nut chewing and
smoking habits of study population with SCC and adenocarcinoma
esophageal cancer is the sixth leading cause of death due to cancer, accounting
for about 5% (407,000 deaths) of all cancer deaths annually.It is the eighth most common cancer worldwide . The treatment for esophageal cancer is protracted and is fatal
in a significant number of cases. Therefore, in the current study we have tried
the socio-demographic characteristics, possible associated factors and
histological types of esophageal cancer among Bangladeshi population.
In this study we have found that 80%
cases had age more than 50 years.In the United States from 2001 to 2005, the
median age at diagnosis for cancer of the esophagus was 69 years . In high
incidence regions, the disease has no gender
specificity, while SCC is more common in men in low incidence region . In our study, we have found that out
of 35 esophageal cancer cases, 71.4% was male.
It has been reported
that in the United States, the incidence of esophageal SCC is decreasing
whereas the rate of adenocarcinoma is rising dramatically . But
in our series, squamous cell carcinoma was more common (77.1%) compared to
adenocarcinoma (22.9%) and we have found that the majority (55.5%) of the SCC
were at the middle third of the esophagus, which correlates with other study .
Chewing of betel
nuts or betel quid (areca nuts wrapped in betel leaves), which is widespread in
certain regions of Asia, have been implicated in the development of esophageal
SCC [19,20]. Though we have found that higher proportion (70.4%) of cases of
SCC had history of using betel nut compared
to adenocarcinoma (37.5%), the difference was not statistically significant (p= 0.0907). Further case
control or cohort study with larger number of study population is required to
find out whether betel nut chewing is a risk factor for SCC in our population. In
our study, about half of the patients (54.3%) were smoker and the rate of
smoking was higher in patients with adenocarcinoma compared to cases with SCC.
But there was no significant (p=0.1782) association
of adenocarcinoma with smoking habit (Table-3).
Current study had
some potential limitations. It was a descriptive cross-sectional small scale
study with only 35 samples from two centers. We recommend that further prospective cohort or case
control studies with larger sample should be undertaken to find out whether
betel nut chewing and smoking are potential risk factors for esophageal cancer
in Bangladeshi population.
Conflict of interest: None declared.
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