Esophageal Cancer in Young People: A Case Series of 109 Cases and Review of the Literature

Certain geographically distinct areas of the world have very high rates of esophageal cancer (EC). Previous studies have identified western Kenya as a high risk area for EC with an unusual percentage of cases in subjects 30 years of age or younger. To better understand EC in these young patients, we abstracted available data on all 109 young patients diagnosed with EC at Tenwek Hospital, Bomet District, Kenya from January 1996 through June 2009, including age at diagnosis, sex, ethnicity, tumor histology, residence location, and medical interventions. We also attempted to contact all patients or a family member and obtained information on ethnicity, tobacco and alcohol use, family history of cancer, and survival. Sixty (55%) representatives of the 109 young patients were successfully interviewed. The median survival time of these 60 patients was 6.4 months, the most common tumor histology was esophageal squamous cell carcinoma (ESCC) (98%), the M:F ratio was 1.4∶1, and only a few subjects used tobacco (15%) or alcohol (15%). Seventy-nine percent reported a family history of cancer and 43% reported having a family history of EC. In summary, this case series describes the largest number of young EC patients reported to date, and it highlights the uniqueness of the EC experience in western Kenya

A prospective study of vitamin and mineral supplement use and the risk of upper gastrointestinal cancers.

We examined the association of use of multivitamins or single vitamin/mineral supplements with risk of four upper gastrointestinal cancers in the NIH-AARP Diet and Health Study cohort with 11 years of follow-up. After exclusions, 490,593 persons were included in our analytic cohort and 1780 upper gastrointestinal cancers were accrued. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox models with adjustment for potential confounders. We observed no significant associations between multivitamin use and risk for the four cancer outcomes in crude or adjusted models. Among individual vitamin or mineral supplements, use of iron supplements was associated with significantly lower risk of esophageal adenocarcinoma (HR = 0.68, 95% CI = 0.49 to 0.94) and a significantly increased risk of gastric noncardia adenocarcinoma (HR = 1.59, 95% CI = 1.24 to 2.05). For gastric noncardia adenocarcinoma, we saw associations with zinc use (HR = 1.28, 95% CI = 1.01 to 1.62) and vitamin C use (HR = 0.79 95% CI = 0.65 to 0.96). Calcium use, some of which was reported as antacids and used to treat reflux disease, was associated with higher risk of esophageal adenocarcinoma (HR = 1.27, 95% CI = 1.06 to 1.52) and gastric cardia adenocarcinoma (HR = 1.27, 95% CI = 1.03 to 1.56) cancers. We saw no evidence that multivitamin use was associated with reduced risk of four highly fatal upper gastrointestinal cancers, but there were some differences in risk with reported use of individual supplements

Asymptomatic Multiple Lymphomatous Polyposis Identified during Staging Bidirectional Endoscopy of Mantle Cell Lymphoma

Multiple lymphomatous polyposis (MLP) as an extranodal manifestation of mantle cell lymphoma (MCL) in the gastrointestinal tract is rare and not often reported in the literature. We describe the case of a 63-year-old female with asymptomatic MLP found during staging bidirectional endoscopy of MCL. The patient presented only with dyspnea, but was found on physical exam to have diffuse lymphadenopathy, and subsequent positron emission tomography (PET) CT showed extensive lymph node adenopathy consistent with lymphoma. Excisional lymph node biopsy revealed high-risk MCL. Prior to therapy, staging bidirectional endoscopy was performed, which revealed duodenal bulb polyps and diffuse polyposis in the colon. Biopsies showed atypical lymphoid infiltrate identical to the initial excisional lymph node biopsy. The patient underwent aggressive induction therapy, chemotherapy and bone marrow transplantation. Four months later, repeat colonoscopy and biopsies showed normal mucosa, and repeat PET CT showed no evidence of systemic disease. Eight months later, the patient began having symptoms consistent with cauda equina syndrome, and she was found to have leptomeningeal recurrence of MCL. In spite of other medical treatment, the patient’s MCL progressed and she passed away 3 years after the initial presentation

Cohort characteristics by frequency of multivitamin supplement use in the NIH-AARP Diet and Health Study cohort.

<p>Cohort characteristics by frequency of multivitamin supplement use in the NIH-AARP Diet and Health Study cohort.</p

Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for any use of multivitamin supplements for four upper gastrointestinal cancers stratified by sex or smoking in the NIH-AARP Diet and Health Study cohort.

<p>Of the eight tests, only smoking status for esophageal adenocarcinoma showed significant effect modification (P = 0.022), but the estimates in both strata have confidence intervals that include 1.</p

Crude and adjusted^* hazard ratios (HR) and 95% confidence intervals (CI) for use of multivitamin supplements for four upper gastrointestinal cancers in the NIH-AARP Diet and Health Study cohort.

<p>*Adjustments included age at cohort entry, sex, education, smoking status and intensity, alcohol use, fruit intake, vegetable intake, body mass index (BMI), vigorous physical activity, usual physical activity during the day, and total energy intake. ESCC = esophageal squamous cell carcinoma; EADC = esophageal adenocarcinoma; GCA = gastric cardia adenocarcinoma; GNCA = gastric noncardia adenocarcinoma.</p

Adjusted^* hazard ratios (HR) and 95% confidence intervals (CI) for use of individual vitamin or mineral supplements for four upper gastrointestinal cancers in the NIH-AARP Diet and Health Study cohort.

<p>*Adjustments included age at cohort entry, sex, education, smoking status and intensity, alcohol use, fruit intake, vegetable intake, body mass index (BMI), vigorous physical activity, usual physical activity during the day, and total energy intake.</p><p>**Any use defined as reporting use more than once per month. ESCC = esophageal squamous cell carcinoma; EADC = esophageal adenocarcinoma; GCA = gastric cardia adenocarcinoma; GNCA = gastric noncardia adenocarcinoma.</p

Distributions of 60 esophageal cancer patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.

<p>Distributions of 60 esophageal cancer patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.</p