Abnormal Lesions and Drinking Alcohol Key Risk Factors for Epithelial Cell Cancer

Japanese researchers identify multiple precancerous lesions and alcohol consumption as risk factors for development of carcinoma in esophageal cancer survivors

Kyoto, Japan – Squamous cell carcinoma (SCC) is a cancer of epithelial cells such as the epidermis of the skin or lining of the lungs, digestive tract, or other parts of the body. Development of multiple SCCs in the esophagus and head and neck region is thought to occur through field characterization, in which large areas of cells predisposed to cancer develop into a tumor in response to a carcinogen. Alcohol consumption has been associated with this process. Cancer survivors who received curative treatment are at particular risk of developing multiple SCCs in the organs originally affected. Pre-tumorous SCC lesions (areas of abnormal tissue) known as Lugol-voiding lesions (LVLs) can be detected in a procedure that stains the gut lining, yet it has not been known whether more LVLs were associated with an increased risk of SCC. The relationship between lesion severity and genetic changes indicative of early esophageal cancer was also unknown, as was the effect of abstaining from smoking and alcohol consumption on SCC development.

Japanese researchers have now shown that the number of LVLs is indeed indicative of the risk of multiple SCCs in the esophagus and head and neck region in patients surviving esophageal cancer, and that alcohol abstinence reduces this risk. The study was reported in Gastroenterology .

The researchers studied 330 patients with early esophageal cancer, and found that those with more LVLs were considerably more likely to develop multiple SCCs in the esophagus and head and neck region. Many patients even carried a genetic mutation associated with tumor development in noncancerous parts of their esophagus lining, which may increase the likelihood of multiple SCC development.

“Alcohol abstinence significantly reduced development of SCC, particularly in patients with more LVLs”, coauthor Shinya Ohashi says. “This shows the importance of encouraging patients successfully treated for esophageal cancer to give up alcohol to lower their risk of developing multiple SCCs in the future.” Smoking abstinence seemed to have no effect on the SCC risk.

Early esophageal cancer survivors whose organs have been saved through endoscopic treatment are highly likely to be affected by field characterization, so they should be closely monitored. However, effective surveillance methods have not been available. “We showed that patients with many LVLs and/or who undergo facial flushing after drinking alcohol were more likely to develop multiple SCCs,” coauthor Tomonari Matsuda says. “The LVL grade is therefore a useful predictor of the risk of multiple SCCs in patients successfully treated for esophageal cancer. High-risk patients should receive endoscopic imaging to clarify this risk.”