exudates and Esophageal-Neoplasms

Esophageal cancer is the sixth leading cause of cancer death worldwide with considerable geographical histological variation There is a paucity of data in esophageal cancer in demographics, histology, and survival among the multi-ethnic Malaysian population. This paper is a review of esophageal cancer epidemiology and survival among esophageal cancer patients from data collected by the Malaysian Upper Gastrointestinal Surgical Society.. This is a multicenter retrospective observational study of esophageal cancer patients from six upper gastrointestinal surgical centers in Malaysia between 2005 and 2019. Patient characteristics, histological type and stage were compared and survival analyzed.. There were 820 patients with esophageal cancer included, where 442 (53.9 %) cases had squamous cell carcinoma (SCC) and 378 (46.1 %) had adenocarcinomas (AC). Malays were the predominant ethnicity with AC (66.7 %) while Indians were the ethnic majority (74.6 %) with SCC. Majority of patients (56.8 %) presented as stage IV disease. Overall, the 1-, 3-, and 5-years' survival were 35.8 %, 13.8 % and 11.0 %, respectively. Surgical resection with curative intent yielded the best 5-year survival (29.4 %). Intervention in stage IV AC yielded superior survival when compared to SCC (median survival, 7.9 months vs 4.8 months; p, 0.018) Our series demonstrated an increase in AC to SCC over the last 15 years.. There was an ethnic preponderance seen between different histology in this region, not previously discussed. An increase in AC was observed over the last 15 years. Late diagnosis seen in most patients imparts poor prognosis as curative surgery affords the best outcome.

Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Humans; Malaysia; Multicenter Studies as Topic; Observational Studies as Topic

Esophagogastric junction (EGJ) adenocarcinoma has been on the increase in Western countries. However, in Asian countries, data on the incidence of EGJ adenocarcinoma are evidently lacking. In the present review, we focus on the current clinical situation of EGJ adenocarcinoma in three Asian countries: Japan, Hong Kong, and Malaysia. The incidence of EGJ adenocarcinoma has been reported to be gradually increasing in Malaysia and Japan, whereas it has stabilized in Hong Kong. However, the number of cases in these countries is comparatively low compared with Western countries. A reason for the reported difference in the incidence and time trend of EGJ adenocarcinoma among the three countries may be explained by two distinct etiologies: one arising from chronic gastritis similar to distal gastric cancer, and the other related to gastroesophageal reflux disease similar to esophageal adenocarcinoma including Barrett's adenocarcinoma. This review also shows that there are several concerns in clinical practice for EGJ adenocarcinoma. In Hong Kong and Malaysia, many EGJ adenocarcinomas have been detected at a stage not amenable to endoscopic resection. In Japan, histological curability criteria for endoscopic resection cases have not been established. We suggest that an international collaborative study using the same definition of EGJ adenocarcinoma may be helpful not only for clarifying the characteristics of these cancers but also for improving the clinical outcome of these patients.

Topics: Adenocarcinoma; Esophageal Neoplasms; Esophagogastric Junction; Hong Kong; Humans; Incidence; Japan; Malaysia

Esophageal cancer is one of the top leading causes of cancer-related deaths in Malaysia. To date, neither the prevalence nor incidence of esophageal cancer nationally have been recorded. Esophageal cancer remains a major and lethal health problem even if it is not common in Malaysia. The late presentation of esophageal cancer makes it a difficult and challenging medical problem. Therefore, more governmental and non-governmental organizations of Malaysia should emphasize primary and secondary prevention strategies.

Topics: Esophageal Neoplasms; Humans; Incidence; Malaysia; Prevalence; Risk Factors; Secondary Prevention

In the global phase 3 RAINBOW study, ramucirumab plus paclitaxel significantly improved overall survival compared with placebo plus paclitaxel in patients with advanced gastric or gastro-oesophageal junction (GEJ) adenocarcinoma. RAINBOW-Asia, a bridging study with similar design to RAINBOW, aimed to evaluate the efficacy and safety of ramucirumab plus paclitaxel for advanced gastric or GEJ adenocarcinoma in Asian, predominantly Chinese, patients.. RAINBOW-Asia was a randomised, double-blind, placebo-controlled, phase 3 trial done at 32 centres in China, Malaysia, the Philippines, and Thailand. Adult patients (≥18 years) with metastatic or locally advanced, unresectable gastric or GEJ adenocarcinoma who previously received fluoropyrimidine-platinum-based chemotherapy were randomly assigned with a centralised interactive web response system in a 2:1 ratio to receive ramucirumab 8 mg/kg or placebo intravenously on days 1 and 15 plus paclitaxel 80 mg/m. Between March 2, 2017, and June 30, 2020, 440 patients were randomly assigned to receive ramucirumab plus paclitaxel (n=294) or placebo plus paclitaxel (n=146). Median progression-free survival was 4·14 months (95% CI 3·71-4·30) in the ramucirumab plus paclitaxel group compared with 3·15 months (2·83-4·14) in the placebo plus paclitaxel group (hazard ratio [HR] 0·765, 95% CI 0·613-0·955, p=0·0184). Median overall survival was 8·71 months (95% CI 7·98-9·49) in the ramucirumab plus paclitaxel group and 7·92 months (6·31-9·10) in the placebo plus paclitaxel group (HR 0·963, 95% CI 0·771-1·203, p=0·7426). The most common grade 3 or worse treatment-emergent adverse events were decreased neutrophil count (159 [54%] of 293 patients in the ramucirumab plus paclitaxel group vs 56 [39%] of 145 in the placebo plus paclitaxel group), decreased white blood cell count (127 [43%] vs 42 [29%]), anaemia (46 [16%] vs 24 [17%]), hypertension (21 [7%] vs nine [6%]), and febrile neutropenia (18 [6%] vs one [<1%]).. These findings, along with the results from RAINBOW, support the use of ramucirumab plus paclitaxel as second-line therapy in a predominantly Chinese population with advanced gastric or GEJ adenocarcinoma.. Eli Lilly and Company, USA.. For the Chinese translation of the abstract see Supplementary Materials section.

Topics: Adenocarcinoma; Administration, Intravenous; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Case-Control Studies; China; Double-Blind Method; Esophageal Neoplasms; Esophagogastric Junction; Female; Humans; Malaysia; Male; Middle Aged; Paclitaxel; Philippines; Placebos; Progression-Free Survival; Ramucirumab; Safety; Stomach Neoplasms; Thailand; Treatment Outcome; Vascular Endothelial Growth Factor Receptor-2

With an age-standardized incidence rate of 2 per 100 000, esophageal cancer is not common among Malaysians, but they are nevertheless important due to its poor prognosis. The study is to clarify whether the human papillomavirus (HPV) is associated with esophageal cancer in Malaysians as there has been no report to date on this in Malaysians and other South East Asians.. Altogether 67 esophageal squamous cell carcinomas histologically diagnosed between 1 January 2004 and 31 December 2014 at the Department of Pathology, University of Malaya Medical Center, Malaysia were considered for HPV analysis using two commercially available methods, polymerase chain reaction with flow-through hybridization (21 HPV GenoArray Diagnostic Kit) and multiplex real-time polymerase chain reaction (Anyplex II HPV28 Detection). The DNA amplifiability of the formalin-fixed, paraffin-embedded tumor was checked by amplification of a 268 bp segment of the human β-globin gene (GH20/PC04) prior to HPV detection.. HPV detection was finally carried out in 51 patients. HPV16 was detected in the moderately differentiated, stage IV lower esophageal tumor of a 32-year-old Malaysian-born Chinese woman by both methods. Except for a predilection for Indians, the clinical characteristics of esophageal squamous cell carcinomas in this Malaysian cohort were generally similar to those of other populations.. It appears that HPV is rare and an unlikely oncovirus in esophageal squamous cell carcinomas of Malaysians.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cohort Studies; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Female; Humans; Malaysia; Male; Middle Aged; Papillomaviridae

Marked epidemiological changes in upper gastrointestinal diseases and Helicobacter pylori infection have taken place in the Asian Pacific region. In particular, differences with respect to race in the multiracial Asian population in Malaysia have been important and interesting.. A time trend study of upper gastrointestinal disease and H. pylori infection in three time periods: 1989-1990, 1999-2000 and 2009-2010 spanning a period of 20 years was carried out.. Consecutive first time gastroscopies carried out on patients attending the University of Malaya Medical Center were studied. Diagnoses and H. pylori infection status were carefully recorded.. A steady decline in prevalence of duodenal ulcer (DU) and gastric ulcer (GU) from 21.1% to 9.5% to 5.0% and from 11.9% to 9.4% to 9.9% while an increase in erosive oesophagitis (EO) from 2.0% to 8.4% to 9.5% (chi-square for trend; P < 0.001) for the periods 1989-1990, 1999-200 and 2009-2010 were observed. The overall prevalence of H. pylori had also decreased from 51.7% to 30.3% to 11.1% for the same periods of time. The proportion of H. pylori positive ulcers had also decreased: DU (90.1%-69.8%-28.9%) and GU (86.6-56.8%-18.9%) (P < 0.001). This was observed in Malays, Chinese and Indians but the difference over time was most marked in Malays. There was a steady decline in the proportion of patients with gastric and oesophageal cancers.. Peptic ulcers have declined significantly over a 20-year period together with a decline in H. pylori infection. In contrast, a steady increase in erosive oesophagitis was observed. Gastric and oesophageal squamous cell cancers have declined to low levels.

Topics: Adult; Aged; Asian People; Carcinoma, Squamous Cell; Duodenal Ulcer; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Female; Gastrointestinal Diseases; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer; Population Surveillance; Stomach Ulcer; Time Factors

Tuberculosis remains an important cause of morbidity and mortality, especially in underdeveloped and developing nations. Manifestations could be nonspecific and may mimic many other conditions, including malignancies. Oesophageal involvement is surprisingly rare despite the high prevalence of pulmonary tuberculosis and the close proximity of these two structures. We report two cases of oesophageal tuberculosis; a 73-year-old man with simultaneous oesophageal, stomach and duodenal involvement, and a 45-year-old man with isolated oesophageal involvement. Underlying malignancies were initially suspected in both cases, but they were eventually diagnosed as tuberculosis.

Topics: Abdominal Pain; Aged; Diagnosis, Differential; Esophageal Diseases; Esophageal Neoplasms; Esophagoscopy; Gastroesophageal Reflux; Granuloma; Humans; Malaysia; Male; Middle Aged; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal

Esophageal cancer (ECA) is an important cancer in Malaysia. The aim of the study is to review the demographic data and clinical presentation of patients with ECA seen at the University of Malaya Medical Centre, Kuala Lumpur.. Patients with histologically proven ECA were recruited for the study. Patients' case notes, endoscopy and operating theater records were reviewed. All cases were histologically confirmed.. A total of 143 patients with ECA was diagnosed between 1998 and 2003. The mean age of the patients was 63.1 +/- 12.1 years with a male : female ratio of 1.8:1. Of these 50.3 percent were Indians, 32.9 percent, Chinese and 16.8 percent Malays. The overall hospital-based prevalence rates per 100 000 admissions according to races were: Malay; 23.5, Chinese; 57.4 and Indian; 134.1. The location of the tumors was: upper; 16 (11.2%) middle; 52 (36.4%) and lower; 75 (52.4%). The histological type of ECA were: squamous cell carcinomas; 113 (79.0%) and adenocarcinomas; 30 (21.0%). The ECA stage at diagnosis, was: II; 18 (12.6%), III; 23 (16.1%) and IV; 102 (71.3%). Only 24 (16.8%) patients underwent surgery and13 (9.1%) were considered curative. Overall 114 (79.7%) patients underwent palliative endoscopic stenting and six (4.2%) were given other palliative therapy including radiotherapy.. Squamous cell cancer was the predominant type. ECA presents late in our patients and only a minority of patients underwent curative surgery.

Topics: Academic Medical Centers; Adenocarcinoma; Aged; Asian People; Carcinoma, Squamous Cell; Delayed Diagnosis; Esophageal Neoplasms; Female; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Prevalence; Retrospective Studies; Risk Factors; Smoking

Dramatic changes in the prevalence and pattern of gastrointestinal disease has taken place in Asia in recent years.. To compare the prevalence of duodenal (DU) and gastric ulcers (GU), erosive oesophagitis (EO), gastric cancer (GCA) and oesophageal cancer (OCA) and Helicobacter pylori infection over a 10-year interval of time in a multiracial South-East Asian population.. Endoscopy records of first time gastroscopy in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia were reviewed for 1989/1990 and 1999/2000.. In the period of 1989-1990, 3252 records and in 1999-2000, 4615 records were analysed. Both DU (21.1-9.5%) and GU (11.9-9.4%) had decreased significantly (P < 0.001). EO had increased significantly from 2.0% to 8.4% (P < 0.001). Both GCA and OCA had declined in the 10-year interval. Helicobacter pylori prevalence had decreased from 51.7% to 30.3% (P < 0.001).The decrease in DU and GU was seen in all racial groups. The increase in EO was most marked in Indians and the decrease in GCA in Chinese. The proportion of H. pylori-associated DU and GU had also decreased with time.. Peptic ulcers and H. pylori infection had declined over a 10-year period of time and showed an opposing time trend with EO, which had increased dramatically. Both GCA and OCA had declined in prevalence.

Topics: Asian People; Esophageal Neoplasms; Esophagitis, Peptic; Female; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Male; Peptic Ulcer; Prevalence; Stomach Neoplasms

To describe the incidence trends in esophageal squamous cell carcinoma (SCC) and adenocarcinoma among the three major ethnic groups in Singapore from 1968 to 2002.. Esophageal cancer cases in Singapore citizens and permanent residents obtained from the Singapore Cancer Registry and population data derived from the national census were used to calculate the incidence rates from 1968 to 2002.. The age-standardized incidence rates (ASRs) for SCC decreased progressively from 8.31 to 3.85 per 100,000 men (p = 0.017) and from 3.43 to 0.81 per 100,000 women (p = 0.027). The rates fell for all three ethnic groups. The ASR for adenocarcinoma rose from 0 to 0.54 per 100,000 men and from 0.03 to 0.13 per 100,000 women, although these time trends did not achieve statistical significance. The frequency of regular smoking in the population decreased from 23% in 1966/1977 to 12.6% in 2004. The percentage of obesity in adults rose from 4.3% in 1982-1985 to 6.9% in 2004. The frequency of esophagitis in Singapore based on endoscopic findings increased from 3.9% in 1992 to 9.8% in 2001.. The decline in the incidence of SCC is likely to be associated with the known decrease in the frequency of smoking among Singaporeans. In contrast, there appears to be a trend toward an increase in the incidence of adenocarcinoma in Singapore, although the absolute incidence remains relatively low. This may be due to the associated rise in the frequency of reflux esophagitis and obesity in Singapore.

Topics: Adenocarcinoma; Adult; Carcinoma, Squamous Cell; China; Esophageal Neoplasms; Female; Humans; Incidence; India; Linear Models; Malaysia; Male; Middle Aged; Registries; Risk Factors; Sex Factors; Singapore

Topics: Adult; Aged; Diagnosis, Differential; Duodenitis; Dyspepsia; Endoscopy; Esophageal Neoplasms; Female; Gastritis; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer; Stomach Neoplasms

Topics: Adolescent; Adult; Aged; Analgesia; Analgesics; Esophageal Neoplasms; Esophageal Stenosis; Hospitals, University; Humans; Intermittent Positive-Pressure Ventilation; Malaysia; Middle Aged; Pain, Postoperative

Topics: Adolescent; Adult; Aged; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophageal Stenosis; Esophagoplasty; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Mouth Neoplasms; Pharyngeal Neoplasms; Surgical Procedures, Operative