Esophageal Dysplasia in High Risk Group and Significance of Agnor in Esophageal Dysplasia.

Gomathi, S (2007) Esophageal Dysplasia in High Risk Group and Significance of Agnor in Esophageal Dysplasia. Masters thesis, Stanley Medical College, Chennai.


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Esophageal Cancer Is The Sixth Most Common Fatal Cancer In The World. The Five Year Survival Rate Is Among The Lowest For All Cases (14%)1 , The Main Reason Being Cancer Of The Esophagus Becomes Symptomatic At An Advanced Phase With A Late Diagnosis, When The Tumor Is Already Incurable. Most Of These Cases Come To Clinical Attention After They Have Spread Beyond The Esophagus And Become Inoperable. The Only Way To Prevent This Is By Early Detection Of Esophageal Malignancies. For This ,The Susceptible Population Should Be Subjected To Some Type Of Screening Programme To Identify Any Precancerous Conditions. Squamous Dysplasia And Squamous Cell Carcinoma In Situ Are The Two Major Categories Which Are Thought To Be Precursor Lesions Of Frank Esophageal Malignancy. All Grades Of Squamous Dysplasia And Carcinoma In Situ Are Associated With A Significantly Increased Risk Of Developing Esophageal Squamous Cell Carcinoma. Increasing Grades Of Dysplasia Are Associated With Dramatically Increased Risk. If These Dysplastic Lesions Can Be Identified In The High Risk Population, This Dreadful Condition Can Be Dealt With More Effectively. There Is Well Documented Epidemiologic Studies Linking Tobacco And Alcohol Use With The Development Of Esophageal Cancer. Alcohol Was Estimated To Be Causally Associated With Approximately 80% Of Esophageal Cancers And The Relative Risk Increases With The Amount Of Alcohol Consumed. Likewise, The Risk Associated With Tobacco Use Appears To Increase With The Number Of Cigarettes Smoked Per Day, Duration Of Smoking And Tar Content. Ex-Smokers Have Reduced Risk Compared To Current Smokers. A Synergistic Effect For The Combined Habit Of Alcohol Use And Smoking Or Tobacco Chewing Has Been Reported. It Is Likely That These Agents May Also Have A Causal Role In Dysplasia Of Esophagus. By Studying This High Risk Group For The Development Of Dysplasia, A Causal Association Can Be Established, Which Can Be Used As A Basis For Devising Effective Screening Protocols To Pick Up Cases At An Early Stage. Once Dysplasia Is Documented, It Can Be Classified As Mild, Moderate Or Severe Based On The Extent To Which The Immature Cells Replace The Normal Epithelium. Mild Dysplasia Might Be Reevaluated Periodically Or Treated By Chemoprevention. Moderate Dysplasia May Be Followed More Closely Or Treated By Focal Endoscopic Therapy. Severe Dysplasia And Carcinoma In Situ Should Be Treated By Endoscopic Mucosal Resection Which Is A Therapeutic Method Based On The Principle Of Strip Biopsy For Resection Of Flat Lesions Of Gastro Intestinal Tract Which Helps To Prevent These Lesions From Progressing To Inoperable Stage. With Changing Social Habits, More And More People Are Becoming Habituated To The Use Of Alcohol And Tobacco, Which Makes This Kind Of Screening Programme All The More Mandatory. Hence An Attempt Has Been Made Here To Establish A Causal Association Between These Risk Factors And Development Of Dysplasia. The High Risk Group Has Been Defined As Individuals With Habits Like Alcohol Consumption, Smoking, Tobacco Chewing And Intake Of Hot Beverages Like Coffee And Tea Either Alone Or In Combination Who Are More Prone To Develop Dysplasia. Esophageal Biopsies Of Asymptomatic Individuals Who Belong To High Risk Group Are Examined For The Presence Of Dysplasia, Comparing The Findings With Age Matched Subjects Without The Risk Factors. Correlation Of Duration Of Risk Factors And The Occurrence Of Dysplasia Is Also Evaluated. Further The Significance Of Agnor Study In Dysplasia Of The Esophagus Is Also Evaluated. Various Studies In Different Organs Have Proved That Agnor Numbers Are Increased In Malignant Cells Compared To Corresponding Benign Or Normal Cells. Moreover Interphase Agnor Numbers Are Closely Related To The Proliferative Activity Of Cells. The Agnor Numbers In Quiescent Cells Is Generally Low While In Proliferating Cells Such As Cancer Cells, A High Agnor Number Is Present. Agnor Staining And Counting Of Agnor Numbers Is Done To Determine Any Increase In Agnor Numbers In Dysplastic Esophagus Compared To Normal Esophagus, Thereby Evaluating The Degree Of Proliferative Activity In Dysplastic Cells. Dysplastic Cases Are Further Subdivided Into Mild, Moderate And Severe And The Variation In Agnor Numbers Is Also Analysed, Which Could Help In Determining The Prognostic Significance Of These Lesions. It Is An Attempt To Find Out The Presence Of Dysplasia In Asymptomatic Individuals Belonging To The High Risk Group And Evaluate The Significance Of The Role Of Risk Factors In Causation, Which Can Be Used For Prevention Research And Also For Early Detection Of Cases By Specific Protocols In Susceptible Population Thereby Reducing The Morbidity And Mortality Associated With This Dreadful Disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Esophageal Dysplasia; High Risk Group; Significance Agnor; Esophageal Dysplasia.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 23 Jun 2017 11:35
Last Modified: 23 Jun 2017 11:35

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