alarming occurence of esophageal cancer in Balochistan

To evaluate the prevalence, geographical features and disease characteristics of Cancer of Esophagus in patients registered at Centre for Nuclear Medicine and Radiotherapy [CENAR]. From January 1991 to December 2001 832 cases of esophageal cancer were seen at CENAR Hospital Quetta. Only cases confirmed by Histopathology and for whom the esophagus was the primary site of tumor were included in the study. The mean age of the patients was 50 + 13year]. The geographical background and disease characteristics were elaborated, by calculating statistical ratios and percentages of various demographic variables, in different subgroups of patients. Cancer of esophagus is 3 rd commonest tumor [11.3% of total registered cases] and on average, the annual proportion of esophageal cancer constitutes a figure of 11 cases per hundred patients diagnosed at CENAR Hospital. It is third common tumor in male and 4 th common in female, with Male to female ratio of 1.37. It is about 1.33 times more common in Balochistan than in Afghanistan. Naswar and beetle nut chewing [31%], malnutrition [56%] and Alcohol [13%] were among the common risk factors present in this study population. About 90% of the cases were of Squamous cell variety and 85% of the patients were diagnosed when disease has progressed to stage 3/4 and upto 60% cases involve lower third of esophagus. Forty percent of the patients were in 4th decade of life at time of diagnosis. The areas that surround CENAR Hospital in Balochistan Province seem to be a high-risk belt for esophageal cancer. It is also common in Afghanistan and Peshawar. Naswar and beetle nut chewing along with malnutrition and alcohol might be important contributory risk factors

Comparison of survival periods and response in three modes of treatment for Cancer esophagus at CENAR Quetta

Esophageal cancer is a fatal disease, with mortality matching the incidence. Balochistan province and Afghanistan happen to fall in the "Esophageal Cancer Belt". This study was designed to compare survival periods and response in three different modes of treatment for cancer of esophagus at CENAR Quetta i.e Radiotherapy Plus Surgery, Radiotherapy plus Surgery plus single agent chemotherapy and Radiotherapy plus Surgery plus combined chemotherapy. During 1997, 59 patients with histopathological evidence of Ca esophagus were referred to CENAR from primary health care centers in Balochistan and Afghanistan. These 59 patients were divided into three groups. Group:I [n=22] treated by local irradiation plus surgery. Group:II [n=20] treated by local irradiation plus surgery plus Single agent chemotherapy i.e 5 florouracil. Group:III [n=17] treated by local irradiation plus surgery plus combination chemotherapy i.e Cis-Platinum and 5-florouracil. All patients were evaluated by endoscopic examination at 2 month intervals. This study of 59 patients [mean age 55'13 years and male to female ratio of 1:3], shows that 2 year survival is 29% and median survival period is 9 month for all the patients. For group I, median survival period = 5 month, 2 year survival =18% and complete response =17%. For group II, Median survival period = 9 months, 2 year survival =30% and complete response =20%. For group III, Median survival period = 11 months, 2 year survival = 41% and complete response = 22%. This study shows that overall survival is poor in cancer of esophagus and combined chemotherapy along with surgery and radiotherapy gives better results as compared to other two groups. Also single agent chemotherapy plus surgery plus radiotherapy give better results than radiotherapy plus surgery