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OESOPHAGUS CANCER

http://meddev.uio.no/elaring/lcms13/ernaeringslaere/nutr-cancer-epidemiology/illustrations/oesophagus.jpg

See chapter 7.3 page 253 in the WCRF/AICR Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.

pdf Cancers

462,000 new cases in 2002

Marked geographical differences (Oesophageal cancer belt).

Occurs around four times more commonly in low- to middle- than in high-income countries. (In rural Linxian in China, it is the leading cause of death.)

Higher incidence in males (2/3 of cancer occurs in males).

Great majority = squamous cell carcinoma.

Survival = poor (75% die within a year)

http://meddev.uio.no/elaring/lcms13/ernaeringslaere/nutr-cancer-epidemiology/illustrations/incidence_2008_oesophagus.jpg

Non-dietary risk factors:

  • Smoking tobacco
  • Barrett’s oesophagus

Pathogenesis:

  • Direct DNA damage, or cell damage, death and hyperproliferation
  • Role of mutated oncogenes/ tumour suppressor genes
  • Natural history of the disease: Normal oesophagus → Chronic oesophagitis → Atrophy → Dysplasia → Cancer

Increased risk:

  • Alcohol (acetaldehyde)
  • Tobacco
  • Thermal damage
  • Various chronic proliferative lesions (Barrett’s oesophagus)
  • Body fatness

CONVINCING EVIDENCE - decreases risk:

  • None

CONVINCING EVIDENCE - increases risk:

  • Alcohol
  • Body fatness

PROBABLE EVIDENCE - decreases risk:

  • Vegetables, fruits
  • Foods containing beta-carotene and vitamin C

PROBABLE EVIDENCE - increases risk:

  • Maté - herbal infusion drink (as drunk in parts of South America - scalding hot through metal straw)


LIMITED/SUGGESTIVE EVIDENCE - decreases risk:
Foods containing dietary fibre, folate, pyridoxine and vitamin E

LIMITED/SUGGESTIVE EVIDENCE - increases risk:
Red meat and processed meat
High-temperature drinks


Most effective means of preventing:

  • NOT to use tobacco

Most effective dietary means of preventing:

  • Consumption of varied diets high in fruits and vegetables
  • Avoiding alcohol


Discussion question:
Oesophagus cancer incidence is twice as high in men as in women.
What could be the reason(s) for that?