Analysis of the Relationships between Esophageal Cancer Cases and Climatic Factors Using a Geographic Information System (GIS): a Case Study of Ardabil province in Iran

Esophageal cancer is a mjaor health problems in many parts of the world. A geographical information system (GIS) allows investigation of the geographical distribution of diseases. The purpose of the present study was to explore the relationship between esophageal cancer and effective climatic factors using GIS. The dispersion distribution and the relationship between environmental factors effective on cancer were measured using Arc GIS. The highest degree of spread was in Germi town and the least was in Ardabil city. There was a significant relationship between effective environmental factors and esophageal cancer in Ardabil province. The results indicated that environmental factors probably are influential in determining the incidence of esophageal cancer. Also, these results can be considered as a window to future comprehensive research on esophageal cancer and related risk factors

TGFβ1 single-nucleotide polymorphism C-509T alters mucosal cell function in pediatric eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic Th2 antigen-driven disorder associated with tissue remodeling. Inflammation and remodeling lead to esophageal rigidity, strictures, and dysphagia. TGFβ1 drives esophageal remodeling including epithelial barrier dysfunction and subepithelial fibrosis. A functional SNP in the TGFβ1 gene that increases its transcription (C-509T) is associated with elevated numbers of esophageal TGFβ1-expressing cells. We utilized esophageal biopsies and fibroblasts from TT-genotype EoE children to understand if TGFβ1 influenced fibroblast and epithelial cell function in vivo. Genotype TT EoE esophageal fibroblasts had higher baseline TGFβ1, collagen1α1, periostin, and MMP2 (p < 0.05) gene expression and distinct contractile properties compared with CC genotype (n = 6 subjects per genotype). In vitro TGFβ1 exposure caused greater induction of target gene expression in genotype CC fibroblasts (p < 0.05). Esophageal biopsies from TT-genotype subjects had significantly less epithelial membrane-bound E-cadherin (p < 0.01) and wider cluster distribution at nanometer resolution. TGFβ1 treatment of stratified primary human esophageal epithelial cells and spheroids disrupted transepithelial resistance (p < 0.001) and E-cadherin localization (p < 0.0001). A TGFβ1-receptor-I inhibitor improved TGFβ1-mediated E-cadherin mislocalization. These data suggest that EoE severity can depend on genotypic differences that increase in vivo exposure to TGFβ1. TGFβ1 inhibition may be a useful therapy in subsets of EoE patients

An investigation of the progression from Barrett's esophagus to adenocarcinoma

Barrett's esophagus is a metaplasia of the epithelium of the lower esophagus from a normal squamous appearance to a columnar appearance more typically found in the stomach. It is normally caused by prolonged gastric reflux. While Barrett's esophagus is not usually the direct cause of adverse symptoms, it does put a person at greater risk for developing esophageal adenocarcinoma, one of the least treatable cancers currently known. While the progression from gastric reflux to Barrett's esophagus is fairly clear, the relationship between Barrett's esophagus and esophageal adenocarcinoma is not as well understood. Not all patients diagnosed with Barrett's esophagus will go on to develop esophageal adenocarcinoma. There are several factors that may have some impact on this progression, including obesity, lifestyle, and genetic predisposition. The purpose of this study was to evaluate the literature to determine the potential impacts of each of these factors on development of esophageal adenocarcinoma. While obesity and lifestyle clearly have some impact on development of esophageal adenocarcinoma, it was found that the exact nature of that impact is still unclear. Obesity leads to several consequences, including increased gastroesophageal reflux, hormonal changes, and reduction in the bacterium H. pylori, all of which have been shown to have some impact on metaplasia in the esophagus. Lifestyle choices, including alcohol or tobacco use, also have been shown to have at least some effect on development of esophageal adenocarcinoma. The literature also reveals that inherited risk factors, namely genetic predisposition, may play a role in development of esophageal adenocarcinoma. Genetic predisposition to obesity may have some impact, but other studies have identified genetic variations that seem to directly influence development of esophageal adenocarcinoma. While it is clear that there are several factors that influence development of esophageal adenocarcinoma, we do not yet understand the complete etiology. By continuing to study these risk factors, we will be able to develop new treatments to combat the rising incidence of Barrett's esophagus and esophageal adenocarcinoma

Investigation of NQO1 genetic polymorphism, NQO1 gene expression and PAH-DNA adducts in ESCC. A case-control study from Iran

We evaluated the effect of NQO1 genetic variation on PAH-DNA adducts in esophageal squamous cell carcinoma (ESCC) in northeast Iran. Golestan Province in northeast of Iran has one of the highest esophageal cancer incidences in the world. The study included 93 ESCC cases and 50 control individuals who were seen at the clinical cancer center in Golestan province. NQO1 C609T genotypes were determined by PCR-RFLP analysis. NQO1 gene expression in tissue samples was determined by quantitative real-time PCR. Immunohistochemical techniques were used to detect PAH-DNA adducts in ESCC and normal esophageal tissues. The distributions of NQO1 genetic polymorphism between cases and the control group were not significantly different. NQO1 gene expression was not higher in tumor tissues than in normal esophageal tissues adjacent to the ESCC; expression was higher in tumor tissues that had the NQO1 T allele. NQO1 gene expression was high in normal esophageal tissues. The level of PAH-DNA adducts was significantly higher in ESCC tissues of cases than in normal tissues adjacent to tumor tissues and in normal esophageal tissues of healthy controls. There were no significant differences between the adduct levels of normal esophageal tissues of patients and controls. There was also no significant relationship between cigarette smoking and PAH-DNA adducts. We concluded that PAHs are a risk factor for ESCC and that PAH-DNA adducts have potential as a biomarker for risk of ESCC

Zenker’s diverticulum and squamous esophageal cancer: a case report

Zenker’s diverticulum represents a rare esophageal lesion developed especially in the elderly population due to herniation of esophageal mucosa above the cricopharyngeus muscle. The condition leads to food retention, regurgitation, aspiration, and dysphagia in affected patients. Progressive dysphagia also characterizes malignant diseases of the esophagus like squamous esophageal carcinoma that typically appears in male patients in the seventh decade of life, with a history of cigarette smoking and alcohol abuse. We report a case of a male patient who presented with dysphagia for both solids and liquids along with significant weight loss, and who was diagnosed with medium esophageal cancer associated with Zenker’s diverticulum

Risk factors of esophageal cancer in Turkmen Sahra of Iran

Present study was carried out in three years' duration (2002-2004) to investigate the risk factors of esophageal cancer in Iranian Turkmens (Northeast of Iran; where the esophageal cancer is the most common world wide). Concerning registered cases of esophageal cancer in the region, 139 cases were selected. Controls matching in terms of age and sex were 500 healthy individuals. Furthermore, a questionnaire was designated with several questions including: personal characteristics, family history of cancer, possible disease background, and addiction to cigarettes or drugs, and presence of any particular dietary habits. The questionnaires filled with free will (voluntarily) by cases and controls. The collected data was analyzed by SPSS 10.0 software. The mean age of people under study was 60 years. The studied cases were significantly correlated with their first line relatives in term of cancer contraction (P=0.001 and OR=7.6). It was also significant in second and third line relatives (P=0.042 and OR=3.38). There was a significant correlation considering the consumption of stale food and butter with esophageal cancer. As a conclusion, in addition to mentioned risk factors, some other factors as mode of nourishment, employment status, special hygienic habits and inheritance were important factors in esophageal cancer etiology among the studied subjects

Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node

Esophageal cancers usually exhibit lymph-node metastases. Although a solitary lymph-node metastasis is occasionally found, the involvement of an intrathoracic paraaortic node is rare. We present here an intrathoracic mid-esophageal cancer case in which an accompanying solitary retroaortic mass was found within the posterior mediastinum by integrated positron emission tomography/computed tomography. For diagnosis, thoracoscopic resection of the mass was performed from a left thoracic approach, and histology revealed it to be a squamous cell carcinoma metastasized from the esophageal cancer. Upon radical esophagectomy after neoadjuvant therapy as a T3N1M0 Stage IIIa (AJCC/UICC) cancer, the esophageal cancer was found to have invaded unexpectedly deeply in the vicinity of the descending aorta. Another lymph node within the paraaortic region was also involved (T4N1M0 Stage IIIc). The present case and other cases we review here inform our understanding of metastasis to intrathoracic paraaortic nodes as follows:1) its existence may indicate extensive lymph-node metastasis or direct tumor invasion nearby, and 2) it may be accompanied by other lymph-node involvements in this region, even if it appears solitary upon preoperative investigation. Thus, for radical esophagectomy, sufficient lymph-node dissection is required, even at locations not reached by the usual right thoracic approach. Definitive chemoradiotherapy may be a better choice for preoperatively recognized T3 esophageal cancer when the cancer is accompanied by paraaortic lymph node metastasis

Evaluation of the neo-glottal closure based on the source description in esophageal voice

The characteristics of esophageal voice render its study by traditional acoustic means to be limited and complicate. These limitations are even stronger when working with patients lacking minimal skills to control the required technique. Nevertheless the speech therapist needs to know the performance and mechanics developed by the patient in producing esophageal voice, as the specific techniques required in this case are not as universal and well-known as the ones for normal voicing. Each patient develops different strategies for producing esophageal voice due to the anatomical changes affecting the crico-pharyngeal sphincter (CPS) and the functional losses resulting from surgery. Therefore it is of fundamental relevance that practitioners could count on new instruments to evaluate esophageal voice quality, which on its turn could help in the enhancement of the CPS dynamics. The present work carries out a description of the voice of four patients after undergoing laryngectomy on data obtained from the study of the neo-glottal wave profile. Results obtained after analyzing the open-close phases and the tension of the muscular body on the CPS are shown