Late malignant transformation of chronic corrosive oesophageal strictures

sophageal cancer is one of the least studied and deadliest cancers worldwide. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease. Recent advances in the diagnosis, staging, and treatment of this neoplastic condition have led to small but significant improvements in survival. These new observations serve as the focus of this review. Cancers arising from the esophagus, including the gastroesophageal junction, are relatively uncommon in the United States, with 13,900 new cases and 13,000 deaths anticipated in 2003. 1 The lifetime risk of this cancer is 0.8 percent for men and 0.3 percent for women. 2 The risk increases with age, with a mean age at diagnosis of 67 years. 2,3 Esophageal cancer is the seventh leading cause of death from cancer among American men, particularly black men, who have a higher incidence of this disease (13 cases per 100,000 persons) than do men in other racial or ethnic groups. 2 Worldwide, esophageal cancer is the sixth leading cause of death from cancer. 4 More than 90 percent of esophageal cancers are either squamous-cell carcinomas or adenocarcinomas. 3 On rare occasions, other carcinomas, melanomas, leiomyosarcomas, carcinoids, and lymphomas may develop in the esophagus as well. Approximately three quarters of all adenocarcinomas are found in the distal esophagus, whereas squamouscell carcinomas are more evenly distributed between the middle and lower third. 3,5 The cervical esophagus is an uncommon site of disease. The pathogenesis of esophageal cancer remains unclear. Data from studies in animals suggest that oxidative damage from factors such as smoking or gastroesophageal reflux, which cause inflammation, esophagitis, and increased cell turnover, may initiate the carcinogenic process. 6 Once cancer develops, it may spread rapidly; 14 to 21 percent of submucosal cancers (T1 lesions) and 38 to 60 percent of cancers that invade muscle (T2 lesions) are associated with spread to lymph nodes. 5,7 At the time of the diagnosis of esophageal cancer, more than 50 percent of patients have either unresectable tumors or radiographically visible metastases. Smoking is associated with an increased risk of both squamous-cell carcinoma and adenocarcinoma of the esophagus (Table 1). 8,9 The ingestion of tobacco condensates is thought to bring tobacco carcinogens, particularly nitrosamines, in contact with the esophageal mucosa. 10 The risk of esophageal cancer correlates directly with the quantity of cigarettes smoked per day and the duration of smoking.

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“…15,16 Persons who have ingested lye or other caustic fluids should be monitored carefully for the development of this cancer. 17…”

Section: Chronic Irritationmentioning

confidence: 99%

Esophageal Cancer

Enzinger¹,

Mayer²

2003

N Engl J Med

2,555

1,978

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“…A smaller lesion, developing in a lye stricture, is responsible for earlier dysphagia, although the duration of symptoms is longer in these patients, who are already suffering from dysphagia. Third, the intra-and peri-tumoral fibrosis might prevent the early cancer spread [8], with lymph node and visceral metastases developing only at a later phase. Nevertheless, with data collected so far, this can be only considered a hypothesis, still to be verified by further analysis of more, prospectively observed patients.…”

Section: Discussionmentioning

confidence: 99%

“…SC may occur 3-4 decades after caustic ingestion, frequently at the physiological narrowings of the oesophagus [7]. A possible explanation for the carcinogenetic process in the setting of caustic injury is the bad nutritional status of scar tissue [8].…”

Section: Discussionmentioning

confidence: 99%

Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis

Ruol

Rampado

Parenti

et al. 2010

European Journal of Cardio-Thoracic Surgery

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“…One of the largest series reported to date comes from Csikos et al . in 1985, describing the outcome of 36 patients with carcinomas that followed corrosive strictures treated with surgery 16 . The median interval following injury to the diagnosis of carcinoma was 46.1 years.…”

Section: Discussionmentioning

confidence: 99%

Two cases of esophageal carcinoma following corrosive esophagitis successfully treated with chemoradiation therapy

Burmeister

Walpole²,

Thomas

et al. 2007

Asia-Pac J Clncl Oncology

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Background: Ingestion of corrosive substances can be associated with severe damage to the esophagus, resulting in strictures. It is also known to be associated with an increased incidence of esophageal carcinoma. In many such cases surgery to cure the cancer is compromised by earlier surgery for corrosive damage or due to fibrosis. Methods: We reviewed a database of 1246 patients collected between 1988 and 2006 with esophageal cancer. Squamous cell carcinomas arising in two patients with previous corrosive esophagitis were identified. Results: Both patients were treated with definitive cisplatin-based chemoradiation therapy. In both cases a complete response occurred and after a minimum follow up of 4 years, both cases remain in remission. Conclusions: We conclude that definitive chemoradiation therapy can be successful in the management of squamous cell carcinoma arising patients with corrosive esophagitis.

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Late malignant transformation of chronic corrosive oesophageal strictures

Cited by 56 publications

References 15 publications

Esophageal Cancer

Esophageal Cancer

Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis

Two cases of esophageal carcinoma following corrosive esophagitis successfully treated with chemoradiation therapy

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