Details
Category: Volume 06 Issue 12 December 2018
Hits: 1585

Title: Correlation between duration of Dysphagia and Stage of Esophageal Cancer at the time of presentation - An observational study from a tertiary care centre of Eastern India

Authors: Dr Soumik Ghosh, Dr Amitabha Manna, Dr Arup Chakraborty

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i12.108

Abstract

Introduction

Upper gastrointestinal (UGI) cancers (of the oesophagus and stomach) characteristically present at a late stage in the world. This contributes to the poor overall 5-year survival rates of patients with UGI cancer, which are 13 % for those with oesophageal cancer 1. BB

The management of esophageal cancer remains clinically challenging, not only in terms of identifying patients at high risk, but also because of the overall poor prognosis of the disease. Most esophageal cancers are diagnosed after symptoms develop and tumors are locally advanced.2

In contrast, in countries like India, there is a higher incidence of esophageal squamous cell carcinoma (SCC) in comparison to developed countries. Currently, SCC is the most common type of esophageal cancer in the Indian subcontinent.[3]  

The National Cancer Registry Programme (NCRP) instituted by the Indian Council of Medical Research (ICMR) has information on cancer incidence and mortality in the community covering 10% of the country's population.  Although the coverage is still low, it gives a fair idea of the pattern of cancer incidence emerging in various regions or parts of the country. The Northeast registry tops the chart in relation to carcinoma of the esophagus, for both men and women.[4]

Population-based data suggest that esophageal cancer incidence peaks in the sixth decade in most parts of the world.[5] 

Typical symptoms of esophageal carcinoma are dysphagia[6], vomiting, loss of body weight, and gastrointestinal bleeding, Most esophageal cancers are diagnosed after symptoms like dysphagia develop and tumors are locally advanced.[7]. [8]. 

In the earliest stages, when it's easiest to treat, esophageal cancer has very few symptoms, so unfortunately it's rarely caught early. As esophageal cancer begins to progress and advance to the later stages, symptoms become more apparent, and the cancer becomes more difficult to treat.[9]

Survival rates depend on several factors, including the stage of the cancer when it is first diagnosed. As the stage advances, the overall survival decreases. The 5-year survival rate of people with cancer located only in the esophagus is 43%. The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 23%. If it has spread to distant parts of the body, the survival rate is 5%.[10]

In this study we assessed the average duration of dysphagia at the time of presentation and the stage at the time of presentation at Medical College & Hospital, Kolkata, to state the necessity of  earliest investigative work up  to detect esophageal cancer at early stage to improve treatment outcome and overall survival in this cancer.

References

  1. Cancer Research UK  http://www.cancerresearchuk.org/cancer- Accessed March 4, 2.
  2. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2013 Sub (2000–2011) - Linked To County Attributes - Total U.S., 1969–2012 Counties.: National Cancer Institute, DCCPS, Surveillance Research Program. Cancer Statistics Branch. Released April 2014 (updated 5/7/2014), based on the November 2013 submission.
  3. Cherian JV, Sivaraman R, Muthusamy AK, Jayanthi V. Carcinoma of the esophagus in Tamil Nadu (South India): 16-year trends from a tertiary center. J Gastrointestin Liver Dis 2007;16:245-9
  4. Three-Year Report of the Population Based Cancer Registries 2012-2014: Report of 27 PBCRs; National Cancer Registry Programmed. Bangalore: Indian Council Medical Research; 2016.
  5. Malkan G, Mohandas KM. Epidemiology of digestive cancers in India. I. General principles and esophageal cancer. Indian J Gastroenterol 1997;16:98-102
  6. Aymaz S, Huegle U, Mueller-Gerbes D, Dormann A: Maligne Obstruktion im Gastrointestinaltrakt. Gastroenterologe 2011;6:387–393.
  7. Robert Koch-Institut: Krebs in Deutschland, ed 9. Berlin, Gesellschaft der epidemiologischen Krebsregister e.V. (GEKID) und Zentrum für Krebsregisterdaten (ZfKD) im Robert Koch-Institut, 2013
  8. Behrens A, Pech O, Graupe F, May A, Lorenz D, Ell C: Barrett-Karzinom der Speiseröhre: Prognoseverbesserung durch Innovationen in Diagnostik und Therapie. Dtsch Arztebl Int 2011;108:313–319.
  9. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708).
  10. Walsh et al., 1996; Bosset et al., 1997; Kelsen et al., 1998, 2007; Medical Research Council Oesophageal Cancer Working Group, 2002; Tepper et al., 2008
  11. Lao -Sirieix P, Fitzgerald RC. Screening for oesophageal cancer. Nat Rev Clin Oncol 2012; 9: 278-287 [PMID: 22430857 DOI: 10.1038/nrclinonc.2012.35
  12. Dawsey SM, Fleischer DE, Wang GQ, Zhou B, Kidwell JA, Lu N, Lewin KJ, Roth MJ, Tio TL, Taylor PR. Mucosal iodine staining Cancer 1998; 83: 220-231
  13. Yokoyama A, Oda J, Iriguchi Y, Kumagai Y, Okamura Y, Matsuoka M, Mizukami T, Yokoyama T. A health-risk appraisal model and endoscopic mass screening for esophageal cancer in Japanese men. Dis Esophagus 2013; 26: 148-153
  14. Lu YF, Liu ZC, Li ZH, Ma WH, Wang FR, Zhang YB, Lu JB.Esophageal/gastric cancer screening in high-risk populations in Henan Province, China. Asian Pac J Cancer Prev 2014; 15: 1419-1422
  15. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
  16. Yang J, Wei WQ, Niu J, Liu ZC, Yang CX, Qiao YL. Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China. World J Gastroenterol 2012; 18: 2493-2501
  17. Uedo N, Iishi H, Tatsuta M, Yamada T, Ogiyama H, Imanaka K, Sugimoto N, Higashino K, Ishihara R, Narahara H, Ishiguro S. A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers Gastrointest Endosc 2005; 62: 521-528
  18. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013.
  19. Available from:  http://www.globocan.iarc.fr. [Last accessed on 2017 Apr 24. Graham DY, Schwartz JT, Cain GD, et al. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 1982;82:228-31
  20. Winawer SJ, Sherlock P, Belladonna JA, et al. Endoscopic brush cytology in esophageal cancer. JAMA 1975;232:1358.
  21. Zargar SA, Khuroo MS, Jan GM, et al. Prospective comparison of the value of brushings before and after biopsy in the endoscopic diagnosis of gastroesophageal malignancy. Acta Cytol 1991;35:549-52
  22. Robert Koch-Institut: Krebs in Deutschland, ed 9. Berlin, Gesellschaft der epidemiologischen Krebsregister e.V. (GEKID) und Zentrum für Krebsregisterdaten (ZfKD) im Robert Koch-Institut, 2013.
  23. Cerfolio, R.J., Bryant, A.S., Ohja, B. et al. The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg. 2005; 129: 1232–1241.
  24. Kato H, Sato A, Fukuda H, Kagami Y, Udagawa H, Togo A, Ando N, Tanaka O, Shinoda M, Yamana H, Ishikura S   Jpn J Clin Oncol. 2009 Oct; 39(10):638-43
  25. Journal of Thoracic Disease, Vol 6, Suppl 3 May 2014.
  26. Chun SW, Lee SA, Jung IY, et al. Inter-rater Agreement for the Clinical Dysphagia Scale. Ann Rehabil Med. 2011; 35: 470-476)
  27. Edge SB American Joint Committee on C. AJCC cancer staging handbook from the AJCC cancer staging   manual. New York: Springer; 2010. American Cancer S

Corresponding Author

Dr Amitabha Manna

Assistant Professor, Dept. of Radiotherapy, Medical College & Hospital, Kolkata, , India