Tag Archives: Esophageal cancer

Cancer on Sale

Many Indians like to chew paan — meetha or khatta — after a good meal. It aids digestion, freshens the breath and acts as a mild stimulant. The soporific effects of the heavy meal are counterbalanced. Best of all, it is also believed to have aphrodisiac properties when mixed with the right spices in the right proportion. This may be the reason why it is often offered after a traditional wedding feast to the newlyweds and departing guests.
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Paan may be prepared at home or bought from the ubiquitous paan shop. Making a good paan involves smearing mineral slaked lime (calcium hydroxide) on betel leaves, and then adding spices, flavouring substances and pieces of supari or areca nut. After that, the leaf is folded around these ingredients and held together by a clove. Tobacco may also be added. Some habitual paan consumers push the prepared leaf into the cleft between the cheeks and the gums and leave it there. Chewing paan is dangerous, but when the stuff is mixed with tobacco, it is lethal.

Sometimes tobacco may be flavoured and chewed alone without a betel leaf. Such stuff is known by various names such as paan masala and gutka. Pieces of supari may also be sweetened and eaten separately.

Supari, paan and chewing tobacco are often considered harmless and non-addictive. Nothing could be further from the truth. Such stuff suppresses appetite and produces a “high”. What’s more, the nitosamines (cancer causing chemicals found in tobacco, betel leaves and supari) released can precipitate type 2 diabetes.

The lime in paan acts to keep the active ingredients (polyphenols, alkaloids and tannins) in the betel nut in its freebase form. The tobacco contains nicotine and polycyclic aromatic hydrocarbons. Paan may also contain sugar. One of the chemicals in the nut — called arecoline — promotes salivation. This facilitates rapid absorption of this chemical cocktail from under the tongue.

Paan turns the saliva orange red which stains the lips and teeth. Also, the sugar and various other chemicals destroy the enamel of the teeth. They eventually turn black and get ground down to the gums.

The chemicals released while chewing paan irritate the lips and cheeks. They cause changes in the cells, leading them to become precancerous. The lining of the inner cheek turns white (leukoplakia). It may start to bleed or form an ulcer that eats away into the flesh and opens out into the cheek. A tumour may form and protrude into the mouth. As the carcinogen-laden saliva proceeds towards the stomach through the esophagus (tube leading to the stomach), its lining becomes affected and cancer can occur there as well.

Chewing paan is an ancient tradition. The habit leads to cancers of the mouth or esophagus, which set in when the consumer is between 50 and 60 years. Generally, such people also follow an unhealthy lifestyle, a diet with little or no fresh fruits and vegetables, and inadequate exercise. Such cancer is the most commonly diagnosed cancer in males in Assam. For Indian women in general, it is the second biggest reason for cancer. Mouth and esophageal cancer is relatively rare in other parts of the world.

Esophageal cancer is difficult to diagnose in the early stages as the symptoms are often vague and non-specific. Tiredness and fatigue may make the person lethargic. There may be chest pain or unexplained loss of weight which may make the person appear ill. Later, as the tumour grows, it blocks the lumen of the esophagus causing difficulty in swallowing solids.

Treatment of mouth and esophageal cancer involves surgery, radiation and chemotherapy. Stents may have to be placed to prevent blockage. In the case of esophageal cancer, a part of the intestine may be used to replace the esophagus. Sometimes a feeding tube may have to inserted through the stomach to bypass the esophagus. Treatment is expensive and long-drawn. Results are fairly good if the ailment is diagnosed early. Unfortunately, this is often not the case.

An expert committee formed by the government in September 1997 recommended a blanket ban on the manufacture, distribution and sale of all forms of chewing tobacco like paan masala, gutka and zarda. Unfortunately, supari was left out of the committee’s purview. However, despite legislation these products are openly sold. What’s worse is that teenagers too are becoming addicts.

The government has been dragging its feet over enforcing legislation to regulate use of these carcinogenic and addictive products. This is partly because the paan, supari and zarda industries collectively employ over 50 million people in its raw material procurement, manufacture and distribution networks. These people constitute a large vote bank which successive governments are reluctant to lose. But this is a very dangerous  situation for millions and millions other common people.

The choice is therefore yours — a healthy and happy life or harmful substances that may lead to cancer.

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Cultural Aspects of Smokeless Tobacco Use and the Impact of Chewing Pan Masala in the Oral Cancer Scenario :

Source: The Telegraph (Kolkata, India)

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Esophagitis

Alternative Names: Inflammation – esophagus

Definition:
Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

YOU MAY CLICK TO SEE THE PICTURE.……..Eosinophilic esophagitis

Herpes esophagitis

Endoscopic image of peptic stricture showing n...

Endoscopic image of peptic stricture showing narrowing of the esophagus near the junction with the stomach due to chronic gastroesophageal reflux in the setting of scleroderma. (Photo credit: Wikipedia)

Esophagus is  the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers and scarring of the esophagus. In rare instances, a condition known as “Barrett’s esophagus” may develop, which is a risk factor for cancer of the esophagus.

Causes:
Esophagitis is frequently caused by the backflow of acid-containing fluid from the stomach to the esophagus (gastroesophageal reflux). You have a higher risk for esophagitis if you have had excessive vomiting, surgery or radiation to the chest (such as in lung cancer), or if you take medications such as aspirin, ibuprofen, potassium, alendronate, and doxycycline.

Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids) may develop infections that lead to esophagitis. Esophageal infection may be due to viruses such as herpes or cytomegalovirus, and fungi or yeast (especially Candida infections).

The infection or irritation may cause the tissues to become inflamed and occasionally form ulcers. You may have difficulty when swallowing and a burning sensation in the esophagus.

Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi or diseases that weaken the immune system. Infections that cause esophagitis include:

*  Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body’s immune system is weak (such as in people with diabetes or HIV). It is usually very treatable with antifungal drugs.

* Herpes. Like Candida, this viral infection can develop in the esophagus when the body’s immune system is weak. It is treatable with antiviral drugs.

Irritation causing esophagitis may be caused by any of the following:

* GERD
* Vomiting
* Surgery
* Medications such as aspirin and anti-inflammatories
* Taking a large pill with too little water or just before bedtime
* Swallowing a toxic substance
* Hernias
* Radiation injury (after receiving radiation for cancer treatment)

You may click to see the related topics below:
Gastroesophageal reflux disease
Esophagitis Candida
Esophagitis CMV
Esophagitis herpes
Symptoms:
Symptoms of esophagitis include:

* Difficult and/or painful swallowing
* Heartburn (acid reflux)
* Mouth sores
* A feeling of something of being stuck in the throat
* Nausea
* Vomiting
*Oral lesions (herps)
If you have any of these symptoms, you should contact your health care provider as soon as possible.

Diagnosis:
Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

* Upper endoscopy . A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.

* Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.

* Upper GI series (or barium swallow). During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment:
Treatment depends on the specific cause. Reflux disease may require medications to reduce acid. Infections will require antibiotics. Possible treatments include:

* Medications that block acid production, like heartburn drugs
* Antibiotics, antifungals or antivirals to treat an infection
* Pain medications that can be gargled or swallowed
* Corticosteroid medication to reduce inflammation
* Intravenous (by vein) nutrition to allow the esophagus to heal, to reduce the likelihood of malnourishment or dehydration
* Endoscopy to remove any lodged pill fragments
* Surgery to remove the damaged part of the esophagus

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

* Avoid spicy foods such as those with pepper, chili powder, curry and nutmeg.
* Avoid hard foods such as nuts, crackers and raw vegetables.
* Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try imitation fruit drinks with vitamin C.
* Add more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings and high protein shakes to your diet.
* Take small bites and chew food thoroughly.
* If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
* Drink liquids through a straw to make swallowing easier.
* Avoid alcohol and tobacco.

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Prognosis:-
The disorders that cause esophagitis usually respond to treatment.

Possible Complications :-
If untreated, esophagitis may cause severe discomfort, swallowing difficulty to the extent of causing malnutrition or dehydration, and eventual scarring of the esophagus. This scarring may lead to a stricture of the esophagus, and food or medications may not be able to pass through to the stomach.

A condition called Barrett’s esophagus can develop after years of gastroesophageal reflux. Rarely, Barrett’s esophagus may lead to cancer of the esophagus.

When to Contact a Medical Professional
Call your health care provider if you have symptoms that suggest esophagitis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.medicinenet.com/esophagitis/article.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001153.htm

Video-Asisted Thoracic Surgery (VATS)

Introduction:
Video-assisted thoracic surgery (VATS) is a recently developed type of surgery that enables doctors to view the inside of the chest cavity after making only very small incisions. It allows surgeons to remove masses close to the outside edges of the lung and to test them for cancer using a much smaller surgery than doctors needed to use in the past. It is also useful for diagnosing certain pneumonia infections, diagnosing infections or tumors of the chest wall, and treating repeatedly collapsing lungs. Doctors are continuing to develop other uses for VATS.
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When compared with a traditional open chest procedure, VATS has reduced the amount of chest wall trauma, deformity, and post-operative pain. While an open procedure generally requires a 30-40 cm incision, video-assisted biopsies can be performed through three 1 cm ports , and a VATS lobectomy, a resection of one lobe of the lung, is performed using a 5-8 cm incision.

How do you prepare for the test?
Discuss the specific procedures planned during your chest surgery ahead of time with your doctor. VATS is done by either a surgeon or a trained pulmonary specialist. You will need to sign a consent form giving the surgeon permission to perform this test. Talk to your doctor about whether you will stay in the hospital for any time after the procedure, so that you can plan for this.

You may need to have tests called pulmonary function tests (see page 33) before this surgery, to make sure that you can recover well.

If you are taking insulin, discuss this with your doctor before the test. If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.

You will be told not to eat anything for at least eight hours before the surgery. An empty stomach helps prevent the nausea that can be a side effect of anesthesia medicines.

Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.

What happens when the test is performed?

VATS is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.

VATS is usually done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. Your anesthesiologist can use this tube to make you breathe using only one of your lungs. This way the other lung can be completely deflated and allow the surgeon a full view of your chest cavity on that side during the procedure.

If VATS is being used only to evaluate a problem on the inside of the ribcage (not the lung itself), then it can sometimes be done using regional anesthesia. With regional anesthesia, you are not asleep during the surgery, but are given medicines that make you very groggy and that keep you from feeling pain in the chest. This is done with either a spinal block or an epidural block, in which an anesthesiologist injects the anesthetic through a needle or tube in your back or neck. You do your own breathing with this type of anesthesia, but one of your lungs will be partly collapsed to allow the doctors to move instruments between the lung and the chest wall.

When you meet with the thoracic surgeon, a physical exam will be performed and your treatment options will be discussed. The thoracic surgeon will discuss the benefits and potential risks of the surgical procedure that is recommended for you.

In general, preoperative tests include: (links will open in a new window)

*Blood tests
*Pulmonary function test (breathing test)
*CT scan
*Electrocardiogram

Your surgeon will determine if any additional preoperative tests are needed, based on the type of procedure that will be performed. If a cardiac (heart) evaluation is necessary, a consultation with a cardiologist will be scheduled in our internationally-renowned Miller Family Heart & Vascular Institute.

As part of your preoperative evaluation, you will meet with an anesthesiologist who will discuss anesthesia and post-operative pain control.

The thoracic surgery scheduler will schedule any additional tests and consultations that have been requested by your surgeon. In general, after your first meeting with your surgeon, all tests are scheduled on a single returning visit for your convenience.

You spend the surgery lying on your side. A very small incision (less than an inch long) is made, usually between your seventh and eighth ribs. Carbon dioxide gas is allowed to flow into your chest through this opening, while your lung on that side is made to partly or completely collapse. A tiny camera on a tube, called a thoracoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen.

If you are having a procedure more complicated than inspection of the chest and lung, the doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These additional incisions are usually made in a curving line along your lower ribcage. A wide variety of instruments are useful in VATS. These include instruments that can cut away a section of your lung and seal the hole left in your lung using small staples, instruments that can burn away scar tissue, and tools to remove small biopsy samples such as lymph nodes from your chest.

At the end of your surgery, the instruments are removed, the lung is reinflated, and all but one of the small incisions are stitched closed. For most patients, a tube (called a chest tube) is placed through the remaining opening to help drain any leaking air or fluid that collects after the surgery.

If you are having general anesthesia, it is stopped so that you can wake up within a few minutes of your VATS being finished, although you will remain drowsy for a while afterward.

How long will you stay in the hospital after thoracoscopic surgery?
The length of your hospital stay will vary, depending on the procedure that is performed. In general, patients who have thoracoscopic lung biopsies or wedge resections are able to go home the day after surgery. Patients who have a VATS lobectomy are usually able to go home 3 to 4 days after surgery.
Risk Factors:
It is easier for patients to recover from VATS compared with regular chest surgery (often called “open” surgery) because the wounds from the incisions are much smaller. You will have a small straight scar (less than an inch long) wherever the instruments were inserted. There are some potentially serious risks from VATS surgery. Air leaks from the lung that don’t heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. About 1% of patients have significant bleeding requiring a transfusion or larger operation.

Sometimes, especially if cancer is diagnosed, your doctors will decide that you need a larger surgery to treat your problem in the safest manner possible. Your doctors might discuss this option with you ahead of time. That way, if necessary, the doctors can change over to a larger incision and do open chest surgery while you are still under anesthesia. Death from complications of VATS surgery does occur in rare cases, but less frequently than with open chest surgery.

General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections.

Irritation of the diaphragm and chest wall can cause pain in the chest or shoulder for a few days. Some patients experience some nausea from medicines used for anesthesia or anxiety.

What will happen after your thoracoscopic surgery?
Your thoracic surgery team, including your surgeon, surgical residents and fellows, surgical nurse clinicians, social workers and anesthesiologist, will help you recovery as quickly as possible. During your recovery, you and your family will receive updates about your progress so you’ll know when you can go home.

Your health care team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

Most patients stay in the hospital for at least one day after a VATS procedure to recover from the surgery. Most patients have a chest tube left in the chest for a few days, to help drain out leaking air or collections of fluid. You should notify your doctor if you experience fever, shortness of breath, or chest pain.

Follow-Up Appointment: A follow-up appointment will be scheduled 7 to 10 days after your surgery. Your surgeon will assess the wound sites and your recovery at your follow-up appointment and provide guidelines about your activities and return to work.

Most people who undergo minimally invasive thoracic surgery can return to work within 3 to 4 weeks.

How long is it before the result of the test is known?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/video-assisted-thoracic-surgery.shtml
http://www.cancernews.com/data/Article/242.asp
http://my.clevelandclinic.org/thoracic/services/video_assisted.aspx

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Black Raspberries Slow Cancer by Altering Hundreds of Genes

New research strongly suggests that a mix of preventative agents found in concentrated black raspberries could more effectively inhibit cancer development than single agents aimed at shutting down a particular gene.

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Researchers examined the effect of freeze-dried black raspberries on genes altered by a chemical carcinogen in an animal model of esophageal cancer. The carcinogen affected the activity of 2,200 genes in the animals’ esophagus in only one week. However, 460 of those genes were restored to normal activity in animals that consumed freeze-dried black raspberry powder.

Black raspberries contain many vitamins, minerals, phenols and phytosterols, which are known to individually prevent cancer in animals.
Sources:
Science Blog August 28, 2008
Cancer Research August 1, 2008, 68, 6460-6467

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Fruit And Veg May Slash Gullet Cancer Risk

An increased intake of fruit and vegetables may cut the risk of Barrett’s oesophagus, a precursor to oesophageal cancer, suggests a new study form California.
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Healthy dietary habits, rich in fruit and vegetables, was associated with a 65 per cent reduction in the occurrence of Barrett’s oesophagus, according to the new study involving 913 people and published in the American Journal of Epidemiology.

The study, by researchers from Kaiser Permanente Northern California and the University of California, also heaps more pressure on the Western diet pattern, high in fast food and meat, with the data indicating an adverse effect on the risk of Barrett’s oesophagus

Barrett’s oesophagus is cause by acid reflux, and although it can occur early in life, most sufferers are in their 40s and 50s. Although it has been reported to be a precursor to oesophageal cancer, 90 per cent of patients are said to never develop into cancer, and although some speculation as to dietary and drug history, the reason why this is so is not really known.

The new study, which recruited 296 people with Barrett’s oesophagus, 308 people with gastroesophageal reflux disease but no Barrett’s oesophagus, and 309 healthy controls, used a 110-item food frequency questionnaire to evaluate dietary patterns.

Lead author Ai Kubo and co-workers report that two major dietary patterns were observed amongst the participants, with subjects classified as eating either the Western or “health-conscious” diet. The latter was characterised by being high in fruits, vegetables, and non-fried fish.

The researchers report that strong adherence to the health-conscious diet was associated with a 65 per cent reduction in the risk of developing Barrett’s oesophagus.

Moreover, while an increased risk was suggested by stronger adherence to the Western diet pattern, no dose-effect relation was reported by Kubo and co-workers.

“Results suggest strong associations between a diet rich in fruits and vegetables and the risk of Barrett’s oesophagus,” concluded Kubo.

The study does have limitations, most notable is the use of the FFQ to establish dietary patterns. Such questionnaires are susceptible to recall errors by the participants, and may no reflect dietary changes. Significant further research is needed. A mechanistic study to elucidate the bioactive constituents of the fruit and vegetables which may be responsible for the benefits is also necessary.

The “five-a-day” message is well known, but applying this does not seem to be filtering down into everyday life. Recent studies have shown that consumers in both Europe and the US are failing to meet recommendations from the WHO to eat 400 grams of fruit and vegetables a day.

A report from the European Union showed that global fruit and vegetable production was over 1,230 million tonnes in 2001-2002, worth over $50 bn (€41 bn). Asia produced 61 per cent, while Europe and North/Central America both producing nine per cent.

Source: American Journal of Epidemiology
Published online ahead of print, doi:10.1093/aje/kwm381
“Dietary Patterns and the Risk of Barrett’s Esophagus”
Authors: A. Kubo, T. R. Levin, G. Block, G.J. Rumore, C.P. Quesenberry Jr, P. Buffler, D.A. Corley