Alcohol consumption as a major risk factor in the development of early esophageal cancer in patients with head and neck cancer

Abstract

Objective To clarify the incidence of concomitant esophageal cancers in patients with head and neck cancer (HNC), and to investigate which risk factors are responsible for this association. Patients and Methods From 1994 to 2000, 134 patients with HNC underwent upper gastrointestinal endoscopy using the 0.8% Lugol stain method to detect esophageal cancer. A case-control study was designed to compare HNC patients with and without esophageal cancer. Logistic-regression analysis was used to obtain odds ratios of risk factors. Results Out of 134 patients with HNC, Lugol unstained area was detected in 42 patients. Biopsy specimens revealed squamous cell carcinoma in 17 (12.7%), dysplasia in 9 patients (6.6%), and normal in the others. Gastric carcinoma was also detected in 7 patients (5.2%). The estimated depth of cancer invasion was mucosa in 9 patients, submucosa in 5 patients, and proper muscle or deeper in 3 patients. In the results of statistical analysis, high alcohol consumption of more than 75 g per day increased the risk of esophageal cancer (odds ratio: 20.2, p<0.01). Intake of hard liquor showed a high odds ratio (whisky: 28.7, p<0.05, shochu: 12.7, p<0.05). The amount of cigarette smoking was not related to this association. Conclusion High incidence of esophageal cancer was found in the patients with HNC. A high alcohol consumption level, and in particular hard liquor, participated in the development of esophageal cancer in the patients with HNC. But cigarette smoking was not related to this association.