Esophageal cancer subtypes and survival rates at the VA Caribbean Healthcare System: a 10-year experience.
BACKGROUND
The incidence of the two main subtypes of esophageal cancer has changed in Western countries in the past two decades, where an increasing trend is observed for adenocarcinoma. Up to date, there are no recent published data regarding esophageal cancer subtypes in Puerto Rico or its relationship with social habits.


METHODS
A total of 169 records from our patients with esophageal cancer for a 10 year period were reviewed. All of them were men, and the overall mean age at diagnosis was 69 years.


RESULTS
Two thirds (66%) of the patients had squamous cell carcinoma (SCC), with 47% located at the upper third, 40% in the middle third and 13% in the distal third of the esophagus. Thirty four percent of the patients had a diagnosis of adenocarcinoma, mostly found in the distal third of the esophagus (71%), outnumbering those cases of squamous cell carcinoma found in the same area. There was a significant statistical difference in the location of adenocarcinomas (p = 0.0001). The most common presenting symptom at the moment of diagnosis was dysphagia accompanied by associated weight loss. Most of the patients were both smokers and alcohol drinkers at some moment during their lifetimes. The overall survival rate once the patients were diagnosed was 1.1 years. The survival rate for those with SCC was 1.1 years and for those with adenocarcinomas was 8 months. Most of the patients who received chemotherapy and radiotherapy had a diagnosis of squamous cell carcinoma, while those who had surgery were mostly adenocarcinoma cases. At the time of diagnosis, about half of the patients with either type of cancer had metastatic disease. According to the data collected, only 10 out of the 169 patients remained alive at the time of this record review, most of them with squamous cell carcinoma and after receiving chemotherapy and radiotherapy. Regarding treatment with a proton pump inhibitor, H2 blocker or both, 66.3% of the patients with squamous cell carcinoma received those therapies, in contrast to only 33.7% of patients with adenocarcinoma.


CONCLUSIONS
There is an increasing trend for the frequency of adenocarcinoma compared to squamous cell carcinoma, which is comparable to the observed worldwide trend.
González Ortiz
Dilka I
DI
Department of Gastroenterology, VA Caribbean Healthcare System San Juan, Puerto Rico. dilkai@hotmail.com
Toro
Doris H
DH
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D004363:Drug Utilization; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy / Q000706:statistics & numerical data; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011647:Puerto Rico / Q000453:epidemiology; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate
D000970:Antineoplastic Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors