Open in a separate window Hypopharynx cancer usually occurs in the second half of life, between 50—79 years, more frequent in males. There have been described pharyngeal cancers in children. An increased incidence of post—cricoid cancer has been encountered in women with Plummer—Vinson syndrome from anglo—saxon countries.
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Some authors Wahlberg by analyzing statistics from — period in Sweden noticed a rate of 1. Concurrent with this pathology effemination we find a downward readjustment of the age of appearance of the pharyngo—esophageal neoplasia because of the early introduction of smoking in the individual habits [ 20 ]. In the regions between Iran, Central Asia, Mongolia and Northern China the incidence is 10— times greater than in the countries with low risk.
Hypopharynx and esophageal cancers are present in countries with low social and economical standards and with low level of education.
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In Romania, in the last decades, the global frequency of cancer has risen, being second place after cardio—vascular diseases.
According to statistics from regarding males the incidence of pharyngeal cancer was third In Cluj county in esophageal cancer was reported with an incidence of 1. Global mortality by malign tumors, taking — period into study, has risen by This increased mortality is also associated with late diagnostic of hypopharynx and cervical esophagus cancer, The general tendency is that of rising incidence of the hypopharynx and cervical esophageal cancer in both women and men, by increasing tobacco and alcohol consumption.
Thus the first epidemiological preventive measure should be prohibition or decreased tobacco and alcohol consumption. Analytical epidemiology The apparition of hypopharynx and cervical esophageal cancer is frequently associated with a series of risk factors.
As in most head and neck neoplasia excessive consumption tobacco, alcohol, in association with genetic, alimentary and occupational factors, as well as preexistent pathological lesions are incriminated in the appearance of malignant hypopharingo—esophageal tumors.
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Knowing this is of most importance for the prophylactic and therapeutic approach, the recenzii despre tratamentul viermilor la copii of one or more risk factors can result in decreased incidence of this poor prognostic disease. Tobacco consumption represents the most frequent cause of head and neck tumors.
Neoplastic histopathological modifications occur because of the direct contact of tobacco, carcinogenic substances from tobacco and smoke inhaled in the upper respiratory airways with the pharyngo—esophageal mucosa.
A number of cohort and case—control studies reveal the close connection between increased incidence and mortality by hyopharynx and cervical esophageal cancer in comparison with non—smoking individuals. Increasing apparition risk of neoplasia is in close connection with the quality of tobacco, way, hpv and esophageal cancer of smoking and association with other predisposing factors alcohol, asbestosis, occupation.
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Doll et al. Early debut of smoking, consumption of a great number of cigarettes per day and a deep inhalation lead to an increased risk of pharyngo—laryngeal neoplasia.
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Likewise the use of black tobacco is far more dangerous than yellow tobacco use. Studies from India show the association between hypopharyngo—esophageal squamous cell carcinoma with chewing or snuffing tobacco or other tobacco products. There is a multitude of evidence on the greater risk of developing pharyngeal and esophageal cancer by the regular smoking individuals than the occasional smokers.
According to the U. Alcohol consumption is in close causal relation with oral, pharyngeal, laryngeal, esophageal tumors.
Smoking and alcohol consumption rise the risk level up to as much as times greater than regular non—smoking no—alcohol consuming individuals for developing neoplasia in superior aero—digestive tract.
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Alcohol alone can increase the risk of developing tumors in aero—digestive tract in non—smoking patients. Genetic mutation in hpv and esophageal cancer 1B ADH1B and aldehyd dehydrogenase—2 ALDH—2involved in the metabolism of alcohol can result in the development of hypopharynx neoplasia.
The consumption of strong alcohol beverages in a medium to high quantity for a long period of time rises the proportion of hypopharynx and cervical esophageal cancers. According to IARC the type of consumed alcohol in a certain region in the world can influence the incidence of esophageal cancer: calvados northern Francehouse rum Puerto Ricocachaca Brasil [ 1316 ].
Occupational factors have been long studied to clarify the level of involvement in the development of neoplasia independent to hpv and esophageal cancer and tobacco consumption.
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The issue of industrial exposure is hard to be evaluated because of a high incidence if pharyngo—esophageal neoplasia in unqualified workers in agriculture and industry. These socio—economical categories are frequently associated with tobacco and alcohol consumption, thus is hard to evaluate the degree of involvement of the occupational factors.
None the less the link between massive exposure to toxics, different jobs and hypopharynx and cervical esophageal cancers has been demonstrated by a series of studies.
In medical literature there is quotation of a great number of cases of neoplasia attributed to workers in rubber industry, ethiological agents of asbestosis, sulfuric acid [ 141519 ]. According to Boffett et al.
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Thus the risk is greater for iron workers OR 3. The study also reveals that administrators, managers, salesmen, fire workers have a low risk of developing pharyngo—esophageal neoplasia.
A very important fact is the time of exposure to different toxic industrial substances this being in direct correlation to the development to pharyngo—esophageal neoplasia. The development of pharyngo—esophageal neoplasia is in relation to occupational factors, toxic exposure asbestos fibers and other risk factors tobacco, alcohol.
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Exposure to asbestos fibers determines an increase in the incidence of pulmonary cancers, mesothelioma, and digestive cancers. The association between hypopharynx cancer and asbestosis has been described in 16 cohort studies and 6 case—control studies. The time of exposure to asbestos fibers as well as tobacco and alcohol association has been taken into consideration when establishing the results of the studies Table 2.
Table 2 Association between pharynx cancer and exposure to asbestos fibers and tobacco RR — relative risk, CI — trust interval modified after Committee on Asbestos: Selected Health Effects