Two faces of oesophageal cancer - epidemiology and etiology

Abstract

Summary:

Oesophageal cancer is the eighth most common form of cancer worldwide. The past 30 years have seen significant changes in the epidemiology of the two major histological types of oesophageal cancer-squamous cell carcinoma and adenocarcinoma.This paper aims to summarise the two types of esophageal cancer in terms of epidemiology and etiology. PubMed, Web of Science and selected specialist Czech and foreign literature were searched forthe most recent findings on the etiology and risk factors of oesophagus. GLOBOCAN 2008 and the web portal of epidemiology of malignant tumours (SVOD) served as sources of epidemiological data such as incidence, mortality and survival rates. The highest incidence of oesophageal squamous cell carcinoma is in developing countries. While the incidence and prevalence of oesophageal squamous cell carcinoma remains about the same, a significant increase in oesophageal adenocarcinoma can be seen in Western countries. The etiology of oesophageal cancer is multifactorial. Excessive alcohol consumption and smoking are major risk factors in oesophageal squamous cell carcinoma. Atrophy of the gastric mucosa, consumption of hot food or pickled vegetables, and low socioeconomic levels also increase the risk of oesophageal squamous cell carcinoma. Groups at risk of oesophageal adenocarcinoma include males, whites, those with oesophageal reflux disease and those who are obese or have Barrett's oesophagus. On the other hand, sufficient consumption of fruit and vegetables and the use of nonsteroidal anti-inflammatory drugs, including aspirin, have been confirmed as protective factors for both histological types. In view of the fact that the incidence of oesophageal cancer in the Czech Republic is on the increase, knowledge of its risk, as well as protective factors, is important for the success of preventive measures. A change in eating habits and reduced consumption of alcohol and smoking can significantly lessen the incidence of and mortality from oesophageal squamous cell carcinoma. Regarding oesophageal adenocarcinoma, attention should be also paid to gastrooesophageal reflux disease, achalasia and its precancerosis, Barrett's oesophagus. Changes in lifestyle, such as weight loss, are further ways in which the incidence of oesophageal adenocarcinoma might be reduced. An important role is also played by education against smoking or, in patients with gastrooesophageal reflux disease, antireflux therapy.