Histologic types, staging, resectability, and smoking among Thai patients with lung cancer.

AIM: To examine the prevalence of cigarette smoking, histological types, staging at presentation and resectability among Thai patients with lung cancer. SETTING: A 500-bed referral cardiothoracic centre. METHOD: Prospective study with pre-defined outcome data, from January to December 1996. RESULTS: A total of 349 patients were histologically proved to have lung cancer. The mean age was 60 years (SD 12.5). There were 264 males and 85 females. 269 patients (77%) were smokers. Percentage of histopathologic types were 39 per cent adenocarcinoma, 30 per cent squamous cell carcinoma, 20 per cent undifferentiated cell carcinoma, and 11 per cent small cell carcinoma. The association with smoking is stronger in squamous cell carcinoma and small cell carcinoma and weaker in adenocarcinoma. Most patients (82%) were in advanced stages, stage 3B and 4.18 per cent of the patients were in stages eligible for surgery, i.e. stage 1, 2 and 3A. However, only 9.7 per cent of the patients were operable and 9.1 per cent were resectable. CONCLUSIONS: On reaching the diagnosis, most patients with lung cancer were in advanced stages of the disease, rendering a low resectability. The results emphasise the need for early diagnostic intervention in patients presenting with lung mass. Furthermore, preventive measures including a campaign against cigarette smoking, research into other possible aetiological factors should be more encouraged.

Oral submucous fibrosis. The South African experience.

A review of research related to oral submucous fibrosis (OSF) among South Africans of Indian descent shows a certain uniqueness compared to other countries. In South Africa the betel habit is more common among women, only 60% of chewers prefer the betel quid while the rest like the nut by itself, the majority of chewers prefer the baked (black) nut variety and a minority add tobacco to their chew. This pattern reflects in the distribution of OSF and the practice of the habit by OSF subjects. Compared to chewers without OSF, OSF subjects are younger and have shorter histories of chewing. Yet the profile of systemic diseases were similar among subjects with and without OSF. The habit as practised in South Africa also determines the pattern of oral squamous carcinomas. They are more common in women, with buccal mucosa cancers being the most frequent. The latter are commonly found in subjects not using any tobacco, indicating the carcinogenicity of the areca nut. It was also shown that oral cancer can develop in chewers without an intermediate precancerous OSF phase. A follow-up of OSF cases after cessation of the habit revealed that once present the disease is permanent. An analysis of cultured OSF fibroblasts demonstrated a permanent shift to larger cells theoretically capable of producing larger amounts of collagen. Thus the agents in the nut could be the initiators of the disease and its permanent character the result of a phenotypic alteration in cells from changes in gene expression.

Carcinoma espinocelular de língua: análise dos dados clínicos, sociodemográficos / Squamous cell carcinoma of oral tongue: analysis of clinical and social demographic features and prognostic factors

No presente estudo foram avaliados 895 casos de carcinoma espinocelular de língua (2/3 anteriores) tratados no Hospital A. C. Camargo no período de 1953 à 1990. Quanto aos dados clínicos, houve um predomínio do sexo masculino, raça branca e idade acima dos 50 anos. Apenas 9,2 por cento dos casos foram diagnosticados no estádio clínico I, sendo que o sexo feminino apresentou uma maior freqüência de disgnósticos neste estádio. O consumo de fumo foi encontrado em 86,0 por cento dos casos e 72,2 por cento dos pacientes consumiam bebidas alcoólicas. O período médio de duraçäo dos sintomas foi de até 6 meses. Apenas 2,2 por cento dos casos foram encaminhados ao Hospital por cirurgiöes-dentistas. A taxa de ocorrência de segunda neoplasia foi de 8,5 por cento. Na análise univariada da sobrevida global, encontrou-se um melhor prognóstico associado aos estádios iniciais, ausência de metástase regional, sexo feminino, näo fumantes ou alcoólatras e submetidos a tratamento cirúrgico. Houve uma melhora progressiva do prognóstico ao longo das décadas estudadas. Na análise multivariada, as variáveis relacionadas ao aumento do risco de óbito foram estadiamento T e N avançados, década de admissäo ao tratamento, consumo de álcool e idade acima de 60 anos. No grupo submetido a tratamento cirúrgico encontrou-se um aumento do risco de óbito no sexo feminino