Ahmed, I

Rizvi, I H

Sheikh, M Y

English

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eCommons@AKUDepartment of Radiology Medical College, PakistanJune 1992Oesophageal carcinoma caused by betel nutM Y. SheikhI H. RizviI AhmedFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationSheikh, M. Y., Rizvi, I. H., Ahmed, I. (1992). Oesophageal carcinoma caused by betel nut. Journal of Pakistan Medical Association,42(6), 145-146.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/226OESOPHAGFAL CARCINOMA CAUSED BY BETEL NUTPages with reference to book, From 145 To 146 Mohammad Younus Sheikh ( Department of Radiology, The Aga Khan University Medical Centre, Karachi. ) Imtiaz Hussain Rizvi, Iftikhar Ahmed ( Departments of Radiology, The Aga Khan University Medical Centre, Karachi. ) INTRODUCTION Number of food stuffs and other oesophageal pathologies have been implicated to carcinoma of theoesophagus but to the best of our knowledge, no relation to Commercially available betel nuts has beendescribed. We present a case of a young female developing carcinoma of the oesophagus which may bedue to excessive use of commercially available sweetened betel nuts (raseeli supari).CASE REPORT A 30 year old lady presented with history of dysphagia. She gave history of taking 8-10 packets ofcommercially available betel nuts (raseeli supari) every day for last 10-12 years. Oesophagogram wasperformed which demonstrated an area of irregular narrowing and shouldering involving lower third ofthe oesophagus (Figure).Biopsy of the lesion proved it to be poorly differentiated squamous cell carcinoma. Lesion was thoughtto be inoperable and after palliative surgery patient was referred for radiotherapy. She expired 9 monthsafter the diagnosis.DISCUSSION The evidence on the aetiology of the carcinoma of the oesophagus is largely indirect, based onepidemiological studies and circumstantial inference derived from other coexisting oesophagealpathologies. Carcinoma of the oesophagus is largely a disease of middle aged males; incidence beingfour times higher in males. Blacks are affected more commonly by the disease1. Different etiologicalfactors have been implicated in different parts of the world, for example in Iran and China carcinoma ofthe oesophagus is probably due to deficiency of different nutrients like vitamin A, riboflavin, thiamineand pyridoxine and minerals like zinc and molybdenum1-3. Ingestion of hot beverages, coarse foodstuffs and presence of nitrates in the food have also been implicated in the causation of chronicoesophagitis which is thought to be precancerous2. In Saudi Arabia water contamination by petroleum,containing benzene and polycyclic hydrocarbons have been postulated to be the causative factor4.German workers exposed to ethylene oxide showed increased incidence of oesophageal carcinoma5while in Sweden chimney sweeps exposed to polycycic aromatic hydrocarbons had an increasedincidence of oesophageal carcinoma6. Dietary habits like consumption of alcohol and smoking1,7,8 arealso associated with this disease. Burnt and unburnt tobacco contains nitrosonornicotine which isthought to be the offender carcinogen. Fungal contamination of the food is also carcinogenic7,8.Different oesophageal pathologies have been associated with cancer. These include achalasia1,7,8oesophageal webs in Plummer Vinson Syndrome7, Zenkér’s diverticulum1,8 strictures caused by Lyeingestion7,8 and hiatus hernia leading to Barrett’s oesophagus8,9. An interesting association betweensome skin disorders: and oesophageal carcinoma has been noted. These include epidermal dysplasialike tylosis and epidermolysis bullosa1,7. Long standing celiac disease is also associated with thedisease. In our case there appears to be a very strong association between oesophageai cancer anclingestion of large amount of commercially available sweetene4 betel nut (raseeli supari). As the patientdid not belong to the susceptible age group and sex, betel nut is the most likely etiologic agent. Thequestion whether the carcinogen is betel nut itself or artificial sweeteners and colouring agents, needsto be evaluated.REFERENCES 1. Dayal, Y arid DeLellis, R.A. The gastrointe stinal tract, in pathological basi s of diseases. By RarnziS. Cotran, Vinay Kumar and Stanley L Robbins. 4th ed. Philadelphia. Saunders, 1989. pp. 835-362. Munoz, N., Crespi, M., Grassi, A., Qing, W.G., Qiong. S. and Cai, L.Z. Precursor lesionsofoesophageal cancerin high-risk populations in Iran and China. Lances, 1982;1:816-79.3. Noetzel, C., Mobarhan, S., Negal, P., Layden, T. and Junigk, A. Vitamin A and riboflavin nutriture inpatients with oesophagial cancer, oesophagesl disorders, psthophysiology and therapy. Edited by T.R.DeMeester and 0.8. Skinner. New York, Raven Press, 1985, pp.319-26.4. Amer, MM., el-Yazigi, A., Hannan, MA. and Mohammed, M.E. Contamination and oesophagealcancer of Qasim region. Saudi Arabia. Gastroenterology, 1990;98:1141-47.5. Klesselbach, N., Him, K., Lange, H.J. and Korallus, U. A multicentre mortality atudyof workersexposed to ethylene oxide. Br.J. Industrial Med., 1990;47:182-88.6. Gustavsson, P., Gustavsaon, A. and Hogstedt, C. Excess of cancer in Swedish chimney sweeps. Br.).Industrial Med., 1988;45:777-81.7. Moertel, CC. Alimentary tract, in cancer medicine. Edited by James F. Holland, Emil Frel.Philadelphia, Lea and Febiger, 1982, pp.1753-54.8. Enterline, H.T. and Thompson, J.J. The oeaophagus, in principles and practice of surgical pathology.Edited by Seven C. Silverberg. New York, Wiley, 1983, pp. 805-6.9. Cooper, B.T. and Barbezat CO. Barrette’s oeaophagus: a clinical study of 52 patients. Q.J. Med.,1987;62:97-108.

Oesophageal carcinoma caused by betel nut

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Oesophageal carcinoma caused by betel nut

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