Objective: To document presenting symptoms, investigations and management for Australian patients with oesophageal adenocarcinoma (OAC), gastro‐oesophageal junction adenocarcinoma (GOJAC) and oesophageal squamous cell carcinoma (OSCC). Design, setting and participants: Cross‐sectional study of a population‐based sample of 1100 Australian patients aged 18–79 years with histologically confirmed oesophageal cancer diagnosed in 2002–2005, using data from cancer registries and treatment centres, supplemented with clinical information collected through medical record review in 2006–2007 and mortality information collected in 2008. Main outcome measures: Prevalence of primary symptoms, and staging investigations and treatment modalities used. Results: The primary presenting symptom was dysphagia, which was self‐reported by 41%, 39% and 48% of patients with OAC, GOJAC and OSCC, respectively. Less common symptoms were reflux, chest pain, bleeding and weight loss. All patients underwent endoscopy, most had a staging computed tomography scan (OAC 93%, GOJAC 95% and OSCC 93%), and about half had positron emission tomography scans (OAC 51%, GOJAC 44% and OSCC 42%). Pretreatment tumour stage was reported in 25% of records, and could be derived from results of investigations in a further 23%, but the remaining half lacked sufficient information to ascribe a pretreatment stage. Curative treatments were attempted for 60% of OAC, 88% of GOJAC and 65% of OSCC patients. Surgery was performed on 52% of OAC, 83% of GOJAC and 41% of OSCC patients. About two‐thirds of surgical patients received additional therapies. Conclusions: With anticipated increases in oesophageal cancer incidence, the resources required to diagnose and manage patients with oesphageal cancer are also likely to rise. Our data provide a baseline from which to plan for the future care of patients with cancers of the oesophagus.

BackgroundSessile serrated adenomas with BRAF mutation progress rapidly to cancer following the development of dysplasia (SSAD). Approximately 75% of SSADs methylate the mismatch repair gene MLH1, develop mismatch repair deficiency and the resultant cancers have a good prognosis. The remaining SSADs and BRAF mutant traditional serrated adenomas (TSA) develop into microsatellite stable cancers with a poor prognosis. The reason for this dichotomy is unknown. In this study, we assessed the genotypic frequency of the MLH1–93 polymorphism rs1800734 in SSADs and TSAs to determine if the uncommon variant A allele predisposes to MLH1 promoter hypermethylation.MethodsWe performed genotyping for the MLH1–93 polymorphism, quantitative methylation specific PCR, and MLH1 immunohistochemistry on 124 SSAD, 128 TSA, 203 BRAF mutant CRCs and 147 control subjects with normal colonoscopy.ResultsThe minor A allele was significantly associated with a dose dependent increase in methylation at the MLH1 promoter in SSADs (p = 0.022). The AA genotype was only observed in SSADs with MLH1 loss. The A allele was also overrepresented in BRAF mutant cancers with MLH1 loss. Only one of the TSAs showed loss of MLH1 and the overall genotype distribution in TSAs did not differ from controls.ConclusionsThe MLH1–93 AA genotype is significantly associated with promoter hypermethylation and MLH1 loss in the context of SSADs. BRAF mutant microsatellite stable colorectal cancers with the AA genotype most likely arise in TSAs since the A allele does not predispose to methylation in this context.

Allergic disease is one of the most prevalent chronic medical conditions in the world. Allergen avoidance has been accepted as a form of treatment for allergic disease; however, the success of treatment is often dependent on how patients choose to manage their condition. The purpose of this study was to explore how allergic conditions affect the lives of allergy sufferers and what information they believe would be useful to other allergy sufferers in the management of their allergic condition. Patients suffering from non-life-threatening allergies stated that their allergy affected many aspects of their life, such as their work, their social life, their emotional state, their physical appearance and, hence, their interactions with others. The chronic symptoms of their condition caused the greatest concern to patients. Many of these participants 'accepted their condition' and undertook controlling-measures as part of their daily life. In contrast, patients suffering from life-threatening allergies stated that their allergy did not affect their life. Knowledge of their allergic condition was more important than acceptance. The findings elicited from allergy sufferers identified how nurses can educate patients about their condition and assist them in learning to live with their condition.

Allergic disease is one of the most prevalent chronic medical conditions in the world. Allergen avoidance has been accepted as a form of treatment for allergic disease; however, the success of treatment is often dependent on how patients choose to manage their condition. The purpose of this study was to explore how allergic conditions affect the lives of allergy sufferers and what information they believe would be useful to other allergy sufferers in the management of their allergic condition. Patients suffering from non-life-threatening allergies stated that their allergy affected many aspects of their life, such as their work, their social life, their emotional state, their physical appearance and, hence, their interactions with others. The chronic symptoms of their condition caused the greatest concern to patients. Many of these participants 'accepted their condition' and undertook controlling-measures as part of their daily life. In contrast, patients suffering from life-threatening allergies stated that their allergy did not affect their life. Knowledge of their allergic condition was more important than acceptance. The findings elicited from allergy sufferers identified how nurses can educate patients about their condition and assist them in learning to live with their condition.