OESOPHAGEAL CANCER EARLY DETECTION

KENYA NATIONAL CANCER SCREENING GUIDELINES I 71

OESOPHAGEAL CANCER EARLY DETECTION

Introduction

Oesophageal cancer is the 7th most common cancer and 6th most frequent cause of

cancer mortality in the world, with estimates of 572, 034 new cases and 508,585 deaths

in 2018 (GLOBOCAN, 2018). In Kenya it is one of the top cancers in both men and wom-

en. With an incidence of 4,380 cases, it is the second most common in males and third

in females. Worryingly, the mortality rate and the incidence rates are almost equal at

18.4% (GLOBOCAN, 2018). In addition, the cancer has been reported to be on the rise

and in particular hot spots in the country. The main variant of oesophageal cancer seen

in Kenya is oesophageal squamous cell carcinoma unlike in the Europe and A

Currently, international screening guidelines for oesophageal cancer do not exist. How- ever, due to the high disease burden in Kenya, there is a need provide guidance on how to improve early detection of the cancer. This can lead to better treatment outcomes, better prognosis and will be a more cost-effective approach as compared to the current status whereby late diagnosis is most common.

RISK FACTORS

Non-modifiable risk factors

• Increasing age

• Family history of oesophageal cancer

Modifiable risk factors

• Overweight and obesity

• Alcohol consumption

• Tobacco use

• Carbon exposure from firewood and other sources

72 1 KENYA NATIONAL CANCER SCREENING GUIDELINES

RATIONALE FOR EARLY DETECTION

The most recent data from GLOBOCAN shows an increase in mortality from oesophageal

cancer in Kenya (GLOBOCAN, 2018). Many patients present late, at a point when curative

treatment cannot be offered. Early detection provides a chance to catch precancerous

lesions or dysplasia and early disease which can lead to less morbidity, better chances of

successful treatment and lower treatment costs.

Current international recommendations do not support population wide screening.

However, in high-risk populations in Asia and in Africa, it seems feasible to do targeted

screening in these populations as has been done in China (Codipilly, 2018; Chen 2016,

Roshandel, 2014). A study done in Kenya showed the feasibility of this and also provided

initial estimates of dysplasia rates (Mwachiro, 2016).

GOALS OF SCREENING

Early detection makes it possible to detect precancerous lesions and early cancer

lesions.

APPROACHES TO SCREENING

1. Identifying individuals in areas of high-risk/ incidence for oesophageal

cancer

2. Recommending screening tests that can be done for detection

3. Providing facilities that can carry out the screening tests

SCREENING TESTS

1. White Light Endoscopy:

a. Advantages: Can be done in any endoscopy unit.

b. Disadvantage: Misses out on precursor lesions. Has a cost

attached to it and needs sedation as well as trained

endoscopists.

2. Lugol’s chromoendoscopy

a. Advantages: Shows precursor lesions. Lugol’s iodine is cheap.

b. Disadvantages: Endoscopists need additional training. Allergic

reaction to iodine can occur. Needs sedation and endoscopy.

3. Narrow band Imaging endoscopy

a. Advantages: Shows precursor lesions

b. Disadvantages: Needs special endoscopy equipment.

Endoscopists need additional training and also sedation risks.

Possible future screening test:

1. Breath test- still in research phase

2. Cytosponge screening test

3. Blood markers- to check for autoantibodies and methylated DNA

markers

SCREENING RECOMMENDATIONS:

1. Individuals with first degree relatives with biopsy proven oesophageal cancer

should have screening endoscopy 10 years prior to index age of diagnosis of

the first degree relative or at age 40 whichever is earlier

2. Asymptomatic individuals living in high risk areas should get a one-time

screening endoscopy at age 40 years.

3. Patients treated for head and neck cancer squamous cell carcinoma should be

screened annually for ten years.

4. Patients who have had caustic acid ingestion should be screened 10years

from the injury via endoscopy.

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REFERENCES:

GLOBOCAN 2018 data

Codipilly DC, Qin Y, Dawsey SM, Kisiel J, Topazian M, Ahlquist D, Iyer PG. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc. 2018

Sep;88(3):413-426. doi: 10.1016/j.gie.2018.04.2352. Epub 2018 Apr 27. Review. PMID:

29709526

Mwachiro MM, Burgert SL, Lando J, Chepkwony R, Bett C, Bosire C, Abnet CC, Githan- ga J, Waweru W, Giffen CA, Murphy G, White RE, Topazian MD, Dawsey SM. Esophageal Squamous Dysplasia is Common in Asymptomatic Kenyans: A Prospective, Communi- ty-Based, Cross-Sectional Study. Am J Gastroenterol. 2016 Apr;111(4):500-7. doi: 10.1038/ ajg.2016.26. Epub 2016 Feb 23. PMID: 26902228

Chen Q, Yu L, Hao C et al. Effectiveness evaluation of organized screening for esophageal cancer: a case-control study in Linzhou city, China. Sci Rep 2016;6:35707

Roshandel G, Khoshnia M, Sotoudeh M et al. Endoscopic screening for precancerous le- sions of the esophagus in a high risk area in Northern Iran. Arch Iran Med 2014;17:246-52

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