Malignant and pre-malignant oesophageal pathology in a South African teaching hospital

Abstract

Introduction: South Africa (SA) has one of the highest global incidences of   squamous cell carcinoma of the oesophagus (SCC). A decreasing incidence of  oesophageal SCC in SA has been suggested. The study aimed to assess whether the incidence of  these malignant histopathological subtypes has changed in this setting.
Methods: A retrospective review of histopathological reports on pre-malignant and malignant oesophageal lesions over three time periods (TP), namely: 2003–4 (TP1), 2008–9 (TP2) and 2013–14 (TP3) was carried out at Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Results: A total of 1341 specimen reports were retrieved. TP1-3 consisted of 514 (39.3%), 320 (24.5%) and 474 (36.2%) patients respectively. Six hundred and forty-nine patients were male (48.3%), 642 were female (47.8%) and 50 were not specified. i.e. a sex ratio of 1.01:1. The mean age was 60.8 (± 11.8). There were 1197 Black patients (91.5%), 66 Asian (5.1%), 25 White (1.9%), 9 mixed  ancestry (0.7%), and 11 of unknown race (0.8%). SCC was the most common cancer 1098 (89.1%) followed by adenocarcinoma (AC) 69 (5.6%). The ratio of SCC to AC remained fairly consistent over the total time period.  Seventy-four  oesophageal resections were performed with a yearly average resection rate of only 5.6%.
Conclusions: SCC is still the most prevalent oesophageal cancer (OC) without an increase in the ratio of AC to SCC. The   diagnosis of squamous cell dysplasia is concordant with previously cited rates. Barrett’s oesophagitis remains uncommon. Resection rates for OC are low but similar to other South African referring centers.

Keywords: Oesophageal cancer, squamous cell cancer, South Africa, pre-malignant oesophageal lesions, oesophageal resection, adenocarcinoma

Abbreviations: SA – South Africa; SCC – Oesophageal squamous cell cancer; OC – Oesophageal cancer; BO – Barrett’s oesophagitis; TP1 – Time period 1; TP2 – Time period 2; TP3 – Time period 3; IALCH - Inkosi Albert Luthuli Central Hospital; KZN – KwaZulu-Natal; AJCC - American Joint Committee on Cancer ; UICC - International Union Against Cancer ; TNM - Tumor Node Metastasis