world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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Fig. 5.73 Drinking the scalding beverage maté is<br />
associated with an increased risk of oesophageal<br />
<strong>cancer</strong>.<br />
Balloon<br />
mated that 90% of squamous cell carcinomas<br />
are attributable to tobacco and alcohol,<br />
with a multiplicative increase in risk<br />
when individuals are exposed to both factors<br />
[3]. The consumption of scalding hot<br />
beverages, such as maté in South America<br />
(Fig. 5.73), is a risk factor [4], malignancy<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
Singapore<br />
Chinese<br />
Malay<br />
Indian<br />
1960 1970 1980 1990 2000<br />
Sponge<br />
Fig. 5.74 Devices used to collect histological samples<br />
from the oesophagus, used for screening in<br />
Iran.<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
Japan, Myagi<br />
Males<br />
Females<br />
1960 1970 1980 1990 2000<br />
being the outcome of chronic mucosal<br />
injury. Other risk factors include consumption<br />
of pickled vegetables, betel<br />
chewing in South East Asia, and oral consumption<br />
of opium by-products in the<br />
Caspian Sea area. Conflicting <strong>report</strong>s<br />
have proposed a role for human papillomaviruses<br />
in squamous cell carcinoma<br />
[5]. Other environmental risk factors<br />
include nitrosamines, food contamination<br />
with fungi such as Geotrichum candidum<br />
and Fusarium sp. (Food contaminants,<br />
p43) and deficiency of vitamins A and C,<br />
molybdenum, copper and zinc.<br />
Adenocarcinoma of the oesophagus has<br />
been associated with chronic gastrooesophageal<br />
reflux, which most often<br />
underlies repetitive mucosal injury and<br />
predisposes to metaplasia [6]. This<br />
tumour type is directly associated with<br />
Barrett oesophagus, a premalignant<br />
lesion.<br />
Detection<br />
Although endoscopic or cytologic screening<br />
may be useful for early diagnosis in<br />
regions of high incidence, there are no<br />
widely accepted protocols for such interventions.<br />
Cytologic screening of high-risk<br />
asymptomatic populations is carried out<br />
in China with a swallowed balloon<br />
catheter and in Japan with a swallowed<br />
encapsulated brush (Fig. 5.74). Endoscopic<br />
dye-staining with Lugol’s iodine or<br />
toluidine blue aids detection of early<br />
lesions.<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
India, Bombay<br />
Males<br />
Females<br />
1960 1970 1980 1990 2000<br />
The vast majority of patients initially<br />
complain of progressive dysphagia,<br />
which may not become apparent until<br />
some two-thirds of the lumen has been<br />
obstructed, especially in the case of<br />
squamous cell carcinoma [7]. Regurgitation<br />
and pain on swallowing are frequent,<br />
as is weight loss. Laryngeal nerve<br />
involvement may be indicated by hoarseness.<br />
Patients with adenocarcinomas of<br />
the cardia may also suffer from gastrointestinal<br />
bleeding [8]. A barium swallow<br />
(ingestion of liquid containing barium<br />
prior to X-ray) (Fig. 5.76) may indicate<br />
narrowing or mucosal irregularity, whereas<br />
a chest X-ray may reveal late signs<br />
such as the presence of a mass, tracheal<br />
compression, aspiration pneumonia or<br />
metastases. Endoscopic ultrasonography<br />
is currently the most accurate staging<br />
method, but is not widely available. CT<br />
scanning remains the mainstay of staging<br />
prior to resection, supplemented by<br />
laparoscopy (for lower one-third <strong>cancer</strong>s)<br />
or bronchoscopy (for upper one-third<br />
<strong>cancer</strong>s).<br />
Pathology and genetics<br />
Squamous cell carcinoma (Fig. 5.77)<br />
develops from squamous epithelium<br />
according to a classical dysplasia-carcinoma<br />
sequence (Multistage carcinogenesis,<br />
p84). The most common site of squamous<br />
cell carcinoma is the middle third of<br />
the oesophagus. Microscopically, most<br />
squamous tumours contain islands of<br />
Fig. 5.75 Trends in incidence of oesophageal <strong>cancer</strong> differ considerably according to geography and reflect differences in prevalence of the two main histological<br />
types. D.M. Parkin et al. (2001) Eur J Cancer, 37 Suppl. 8: S4-66.<br />
224 Human <strong>cancer</strong>s by organ site<br />
Sponge Mesh<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
USA<br />
Black (m)<br />
White (m)<br />
Black (f)<br />
White (f)<br />
1960 1970 1980 1990 2000<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
UK<br />
Males<br />
Females<br />
1960 1970 1980 1990 2000<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
.25<br />
Slovakia<br />
Males<br />
Females<br />
1960 1970 1980 1990 2000