A research report submitted to the Faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in the division of General Surgery. Johannesburg 2012 / Oesophageal cancer causes much morbidity and mortality in South Africa. This disease has a 5-year survival of less than 10% despite improvements in therapy. Most patients present with advanced disease and are suitable only for palliative care. Current standard of palliative care for patients with end-stage oesophageal cancer that present with dysphagia include brachytherapy and stenting. Brachytherapy improves survival and has a more stable quality of life in the long term when compared to stenting. Conversely stenting has a more acute relief of dysphagia. In South Africa many patients with malignant dysphagia face socio-economic constraints that cause delays in therapy, especially in patients from rural areas. Many prospective randomized trials of palliative treatment have been done in the developed world, not taking into account socio-economic constraints. We present a study from Tshepong Hospital (Klerksdorp, North West province), a secondary hospital in South Africa.

Background: Oesophageal cancer is the fourth most common cancer in black South African males with an age-standardised incidence rate of 7.31 per 100 000 in 2010, and sixth in black South African females, 3.59 per 100 000. The adoption of lifestyle behaviours such as tobacco and alcohol use was on the rise in that decade, amongst black South Africans living in Johannesburg. Aim: The overall aim was to investigate the association of smoking and alcohol use on oesophageal cancer amongst 18 to 74-year-old black South Africans in Johannesburg from 1999 to 2009. Methods: Secondary analysis were done based on a matched case-control study design. We used the conditional univariate and matched multiple logistic regression for statistical analysis as the main analysis. Gender was ascertained as an effect modifier therefore the analysis were done separately for males and females. Sensitivity analysis of the findings were tested using the unconditional univariate and unmatched multiple logistic regression. Results: Heavy smokers had an increased likelihood of oesophageal cancer as shown in the conditional multivariate logistic regression (AOR = 9.0; 95% CI: 5.2 – 15.5) in males and (AOR = 5.2; 95% CI: 1.3 – 20.1) in females. Alcohol consumption was a much stronger risk factor for oesophageal cancer among female heavy drinkers (AOR = 2.1; 95% CI: 1.5 – 2.9) relative to the light drinkers, controlling for other variables. There was a significant interaction of tobacco use and alcohol drinking as they acted synergistically to increase the likelihood of oesophageal cancer among current heavy smokers and heavy drinkers, (AOR = 15.0; 95% 7.2 – 31.3) in males and (AOR = 2.7; 95% 0.6 – 11.2) in females, compared to non-drinkers. iv Conclusion: We established that over the ten-year study period, smoking and alcohol use were both associated with oesophageal cancer independently and as combined exposures. An increase in sin tax on cigarettes and alcohol as well as increased education on the risk factors associated with the development of oesophageal cancer could be used as interventions to decrease the burden of this disease. Keywords: Smoking, Alcohol, Cancer, South Africa / LG2018

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (M Med (Anatomical Pathology))--University of Limpopo, 2010. / Background Esophageal squamous cell carcinoma (SCC) remains a disease of poor prognosis. Early diagnosis is compromised by the delayed onset of symptoms. By the time of surgical intervention metastases and organ infiltration have already occurred this reduces the prognosis significantly and the 5-year survival rate of operative advanced esophageal SCC remains poor. In order to select an appropriate therapeutic regime and guard against both over- and under treatment, reproducible prognostic markers are needed at the time of diagnosis. The study evaluates the phenotypic expression of E-cadherin and β- catenin in SCC of the esophagus. Methods: The expression patterns of both β-catenin and E-cadherin was determined using immunohistochemistry technique in patients with esophageal SCC with the application of the Broders and Brynes grading systems in assessing clinical outcome. Forty four cases were randomly selected, one case was esophagectomy, and 43 were endoscopic biopsies with one case of Broders Grade I, 37 Grade II and 6 Grade III and 9 cases had pattern 2 and 35 had pattern 3 with Brynes Grade. Results: The reduced expression of E-cadherin and β-catenin was 45.5% and 47.7% respectively. No significant level was observed with E-cadherin (P= 0.20) and for β-catenin (P= 0.18) but the low protein level of both biomarkers was associated with tumor cell differentiation with Broders classification. The reduced expression of E-cadherin on invasive tumor front was 27% and 57% for reduced expression of β-catenin. The level of significance was found to be (P=1.00) for E-cadherin expression and (P=0.02) for β-catenin. E-cadherin and β-catenin showed reduced expression on invading tumor front and β-catenin was associated with tumor cell invasiveness. Conclusion: The expression of E-cadherin and β-catenin with regard to Broders classification showed no significance on tumor cell differentiation and these expressions do not play a role in guiding nor predict the behavior or progression of the tumor. However, the assessment β-catenin on the tumor invasive front (Brynes) shows a high correlated with tumor behavior as it is involved in regulation E-cadherin function.

No description available.

No description available.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [109]-122).

Mok Chi Ho, Samuel. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1987. / Includes bibliographical references.

Esophageal cancer is the eighth most common cancer in the world. Cancers of the esophagus account for 3.8% of all cases of cancers, with approximately 482,300 new cases reported in 2008 worldwide. In the United States alone, it is estimated that approximately 18,000 new cases will be diagnosed in 2013, and 15,210 deaths are expected. Despite advances in surgery and chemoradiation therapy, these advances have not led to a significant increase in survival rates, primarily because diagnosis often at an advanced and incurable stage when treatment is more difficult and less successful. Accurate, objective methods for early detection of esophageal neoplasia are needed. Here, quantitative classification algorithms for high resolution miscroendoscopic images were developed to distinguish between esophageal neoplastic and non-neoplastic tissue. A clinical study in 177 patients with esophageal squamous cell carcinoma (ESCC) was performed to evaluate the diagnostic performance of the classification algorithm in collaboration with the Mount Sinai Medical Center in the United States, the First Hospital of Jilin University in China, and the Cancer Institute and Hospital, the Chinese Academy of Medical Science in China. The study reported a sensitivity and specificity of 93% and 92%, respectively, in the training set, 87% and 97%, respectively, in the test set, and 84% and 95%, respectively, in an independent validation set. Another clinical study in 31 patients with Barrett’s esophagus resulted in a sensitivity of 84% and a specificity of 85%. Finally, a compact, portable version of the high resolution microendoscopy (HRME) device using a consumer-grade camera was developed and a series of biomedical experimental studies were carried out to assess the capability of the device.