https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/173 Sat, 18 Mar 2017 13:27:26 +0000 Abstract 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. Esophageal cancer usually presents at an advanced stage, and thus curative treatment is limited and the prognosis is poor [1].In spite of the recent development in cancer therapy, esophageal cancer remains one of the least treatment-responsive malignancies [2]. 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 [3]. The main histologic types of esophageal cancer are squamous cell carcinoma (SCC) and adenocarcinoma [4]. 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 [5]. 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 [6]. In Western cultures, retrospective evidence has implicated cigarette smoking and chronic alcohol exposure as the most common etiologic factors for squamous cell carcinoma [7]. 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].   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 significant (0.1782).   Table-1: Baseline 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     Discussion Worldwide 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 [12]. The treatment for esophageal cancer is protracted and is fatal in a significant number of cases. Therefore, in the current study we have tried to elucidate the socio-demographic characteristics, possible associated factors and histological types of esophageal cancer among Bangladeshi population. 2026 Ibrahim Medical College. All rights reserved.