Date of Award

Winter 1-3-2019

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Karthik S Udupa

Abstract

Background: Esophageal cancer (EC) stands the 6th most frequent cause of death due to cancer worldwide.It is mainly classified into mainly Esophageal squamous cell carcinoma (ESCC) and Esophageal adenocarcinoma (EAC). The incidence extends from Eastern to Central Asia. Although there are advances in the management and treatment of EC patients, the generaloutcome is very poor. It is mainly because of the diagnosis during its advanced stages and due to the absence of early clinical symptoms. Therefore, it is an important health challenge .A clear picture regarding the risk factors and other patient demographics may help to improve the management of the condition.Need for the study: EC is often of sudden onset and poor prognosis. It is often detected at advanced disease stageleading to poor treatment outcome and high morbidity and mortality. An improved understanding of the epidemiology, socio-demographics and the risk factors could aid timely diagnosis and management by endoscopic methods or other less invasive methods or procedures resulting in improved treatment outcomes. Methodology: The study is a single centered retrospective study conducted in Kasturba Hospital (KH), Manipal. Duration was 9 months (August 2018 to April 2019). Study group consisted of patients admitted during the months of January 1 2012 till April 11 2018. Pediatric population was excluded from the study. Sources of study include patient medical records and hospital database for discharge summary. Results: A total of 443 patient medical records were reviewed retrospectively. Occupation and low socio-economic status have an important association with EC. We have found that among patients, majority belonged to two categories, Agriculturists and Homemakers. Although the women populations were non-smokers they might have been largely exposed to passive smoking, smoke and fume exposure as they use cow-dung, firewood, coal etc. as fuels for cooking. Alcohol intake and smoking are established risk factors for the development of EC. Most of the patients presented with the symptoms of dysphagia, weight loss and Cough. Most common symptoms affecting the quality of life among patients with EC were found to be dysphagia and eating disorders. These patients had multiple co-morbidities among which most had Hypertension, Diabetes Mellitus Type 2 (T2DM) and Asthma. Hyperglycemia is said to promote cancer cell growth. In this study we found that most of the patients were diagnosed with ESCC and studies conducted in Karnataka suggests that ESCC is the most frequently occurring cancer. Conclusion: In the study, we reviewed a total of 443 patient medical records and observed the influence of Age, Gender, Body Mass Index (BMI), Social Habits, and Occupation in EC patients in particular regions of Karnataka. The risk factors were assessed individually to determine the effect of each in the development of EC in which we found that age, BMI, smoking, alcohol, tobacco chewing had a significant effect on EC. We also studied the effects of Hemoglobin (Hb), White Blood Cells (WBC), Erythrocyte Sedimentation Rate (ESR), Glycosylated Hemoglobin (Hba1c), and Fasting Blood Glucose (FBS) in EC patients. It was found that the most common type of EC was ESCC and that it was present mostly in the middle and lower thirds of the esophagus.

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