Esophageal Cancer in Northeast of Iran

Background: Esophageal cancer is the 7th most common cancer in Iran. The northern part of the country shows the highest incidence for this malignancy. In this study we present some epidemiological and clinicopathological characteristics of patients with esophageal carcinoma in this region.

Methods: In a cross sectional study, 238 Esophageal cancer patients were enrolled in a prospective study of neoadjuvant chemo-radiation treatment in a 4-year period (2006- 2009). In an oncology clinic their epidemiologic characteristics and clinicopathological findings were registered in a preplanned file. Data consisted of age, sex, race, occupation, residential location, smoking, addiction history, signs and symptoms, blood biochemistry profile, imaging and endoscopic findings. The data were analyzed with the SPSS software.

Results: The mean age of the patients was (55% female) 59 years. They were mostly Fars (63%) and Turkmen (13%). Seventy two percent were residents of rural area, 20% were smokers and 22.3% were opium addict and its analogues. Only 1.3% of patients consumed alcohol. The most common presenting symptom was dysphagia (93.7%), mainly grade III dysphagia (53%). Location of tumor in esophagus was in the middle third in 53.4% and lower segment in 44.5%. Sixty five percent of the patients had an abnormal esophagogram. On endoscopic evaluation the most common types of tumors were polypoid, vegetative and fungoid, respectively. Mean tumor length was 5.7 cm. The most common histology type was squamus cell carcinoma (99.1%) which was moderately differentiated in 51.3% of these patients. No significant relationship was found between the grade of dysphagia with the macroscopic type and the pathologic grade of the tumor in this study.

Conclusion: Squamous cell carcinoma comprised more than 99% of all esophageal cancers in our patients and this histological type is the prominent type in the Northeast of Iran. Middle esophageal segment is the major site for this type of cancer which unfortunately most patients present with grade III. Dysphasia reflects the advanced stage of the disease.