Esophageal carcinoma in Southern Thailand.

BACKGROUND: Southern Thailand is an area with a high frequency of esophageal carcinoma. This paper presents basic data regarding esophageal carcinoma patients from this region. METHODS: Patients with histopathological confirmed esophageal carcinoma were retrospectively reviewed. The age, sex, location of tumor and resectability were studied. RESULTS: A total of 813 cases of esophageal carcinoma were reviewed, male:female ratio was 3.54:1 (634:179). Average age in males was 64.62 years and 64.30 years in females. The peak age-incidence was 51-70 years. Squamous cell carcinoma was most commonly found in the mid thoracic portion of the esophagus with 369 cases (45.39%), 70 cases (8.61%) were found in the cervical portion of the esophagus. Adenocarcinoma cancer was found at the esophagogastric junction in 47 cases (5.78%). Only 293 cases (36.04%) were operable. Respiratory tract involvement was noted in 49 cases. CONCLUSION: The most common type of esophageal cancer in Southern Thailand is squamous cell carcinoma, as in other countries in Asia. The status of the patients, advanced age and locally advanced tumor were major factors of our low operable rate.

Experience with oesophageal carcinoma in Songklanagarind Hospital.

Clinical data from 175 patients with squamous cell carcinoma of the oesophagus or cardia admitted to Songklanagarind Hospital between 1982 and 1988 were analysed to evaluate the effects on survival of various tumour and treatment variables. Most tumours (greater than = 86%) were in stage III or IV. Forty-seven percent of stage-IV tumours and 99 per cent of those in stages I, II or III were resectable. One-year and 3-year survival rates of resected stage-III patients (57.3% and 27.5%) were significantly higher than those of resected stage-IV patients (33.3% and 0%). Resection conferred no benefit over radiotherapy chemotherapy or no treatment on the survival of stage-IV cases beyond one year. Combined chemotherapy/radiotherapy/resection of stage-III and stage-IV patients gave no statistically significant improvement in survival. Among resected patients, only lymph node involvement was associated with significantly lower survival (relative risk compared to no involvement = 2.3, 95% CL: 1.2, 4.6), while the fungating type of tumour was possibly associated with improved survival (relative risk compared with all other types = 0.24, 95% CL: 0.05, 1.1).

Surveillance of oesophageal carcinoma in southern Thailand in 1988.

The lower subregion of the south of Thailand has an overall higher incidence and mortality associated with oesophageal cancer than does the upper subregion. The increased incidence in the lower south is more marked among females than among males, but the male/female incidence ratio in the lower subregion is still high (3.7:1). There is evidence also of an increased incidence in the eastern provinces compared with that in western provinces. Available data on occupation and district of residence provide no clues to the cause of the distinct geographic pattern of incidence within the southern region.

Early detection of oesophageal carcinoma in southern Thailand.

The use of balloon cytology technique for detection of oesophageal carcinoma has been tested in 73 non-symptomatic patients and 53 patients with symptoms of oesophageal carcinoma from the high incidence of Southern Thailand. Cytological findings were compared with findings of esophagoscopy and oesophageal biopsy. Among symptomatic patients, scope/biopsy revealed 29 positive for carcinoma, against which balloon cytology yielded 9 false negatives (sensitivity 69%), but no false positives. All false negatives were of the stenosing type of tumour. One of 3 early cases of carcinoma revealed by the balloon technique among asymptomatic patients could not be detected by oesophagoscopy, biopsy or oesophagogram, but was confirmed by repeated cytological examination. The basic properties of the balloon cytology technique appear to justify its use as a routine diagnostic tool among high-risk patients for oesophageal carcinoma in Southern Thailand.

Corrosive oesophagitis: Radiological study.

Thirty-six oesophagograms of 24 patients after ingestion of 75-90% formic acid in suicide attempts were reviewed. AII oesophagograms were obtained in the acute, subacute, and chronic phases. In the acute and suhacute phases, the radiographic findings consisted of mucosal oedema, submucosal oedema or haemorrhages, ulcerations, sloughing of the moucosa, atony and dilatiation. Stricture of the oesophsgus was present in the chronic phase. The severity of the corrosive oesophagitis was considerably related to the concentration, amount, and duration of contact between the caustic agent and the oesophageal mucosa.

Cervical oesophageal webs: Report of two cases.

Two cases of oesophageal webs, admitted at Songklanagarind Hospital, were diagnosed by symptoms and signs of Plummer-Vinson syndrome :- dysphagia, glossitis, anaemia; and by darium oesophagography and oesophagoscopy. The patients were treated with oesophageal dilatation and the results were satisfactory. Relevant literatures have also been reviewed.

Achalasia of the oesophagus: Experiences of surgical treatment.

During a 5-year period, 14 patients were treated for achalasia of the oesophagus. The male-to-female ratio was 1:1.3, and a mean age of 43.4 years. The chief presenting complaint was dysphagia (71.4%). The radiological findings were mild degree 21.3%, moderate degree 71.5% and severe degree 7.2%. Oesophagomyotomy was perforemed in 13 patients, resulting excellent result 53.8%, good result 23.1%, fair result 15.4% and poor result 7.7%. This report showed the surgical technique and follow up of these patients in the past 5 years.

Corrosive oesophagitis after formic acid ingestion.

The occurrence of corrosive oesophagitis following ingestion of formic acid has been studied. Twelve patients with this condition were seen by the authors in Songklanagarind Hospital during the three years period, January 1983 to December 1985. The sex ratio, male: female was 1 : 5. The ingestion of formic acid was due to attempted suicide in 83.3% of patients, and accidental in 16.7% of patients. Oesophagoscopy was done in all patients in every case. Pathological changes were seen in the oesophagus, in seven cases also in the stomach, and in one case even in the duodenum. The treatment varied from simple oesophageal dilatation in mild cases to surgical intervention in the more severe cases. The mean length of stay in hospital was 36.5 days (3-60 days). Postoperative complications occurred in 3 patients in 3 patients and 2 patients died.