Ethanol and Carcinogenesis of the Alimentary Tract

Abstract

EPIDEMIOLOGYINICALLY, a link between alcoholism and certain great number of epidemiological studies has shown an association between excessive drinking of alcoholic beverages and cancer of the or~pharynx,I-~ the larynx,4. '&I5 and the In a series of .~t u d i e s , ' .~~-~~ heavy drinkers were found to have roughly a 10-fold increased risk of developing cancer of the mouth. Subjects who drink heavily often also smoke heavily. This later fact was first taken into account by Flamant et al., 25 who assessed both factors and reported that there was a "strong" association of alcohol intake with cancer of these sites that come most directly in contact with alcohol (tongue, hypopharynx, larynx, and esophagus). It was calculated that 76% of these cancers in males could be eliminated if exposure to alcohol and tobacco were a~o i d e d .~The risk of developing oral cancer for a heavy drinker who smokes was 6-15 times higher than for nondrinkers and nons m o k e r~.~,~ Also women who drink and smoke heavily develop cancer of the tongue and buccal cavity 15 years earlier than do women who abstain from both alcohol and toba~co.~ It appears that alcohol plays a more important role than smoking with respect to cancer of the esophagus, whereas smoking seems to be more strongly assoCiated with cancer of the mouth and pharynx.25 Recently, additional sites of cancer associated with alcohol were detected in the liver,4. 26-35 the pancreas,3639 the cardia of the stomach: ' the lungs,41. 42 and the rectum.4248 Hepatocellular carcinoma in alcoholics is commonly thought to occur in association with cirrhosis of the liver. Indeed, the incidence of cirrhosis in patients with hepatocellular carcinoma has been reported to vary between 16 and 80%,49 with most reports indicating a 55-80% association. Numerous etiologies have been proposed for carcinoma in alcoholic patients, especially in conjunction with a hyperregenerative state in cirrhosis. Both Brechot et aL50 and Ohnishi et al. 35 reported an increased incidence of liver cancer in hepatitis B surface antigen carriers due to heavy alcohol intake. However, as shown by Lieber et al.," cz. types of cancer has been observed for many years. A Tract alcoholism also stimulates the development of cancer in the noncirrhotic liver. Further evidence for the c a r c i nogenic role of alcohol in hepatocarcinogenesis may derive from case reports. Gottfried et al." reported a case of histologically proven hepatocellular carcinoma in an alcoholic. The tumor vanished spontaneously following abstention from alcohol. In addition, an unusual paired human accident demonstrated the cocarcinogenic role of alcohol in two chemical workers working with vinyl chloride. One worker consumed large quantities of alcohol in addition to his exposure to vinyl chloride and developed both angiosarcoma and hepatocellular cancer, while his colleague, a nondrinker, developed only angio~arcoma.~~ More recently, another target organ of alcohol with respect to carcinogenesis has been focused on, namely the rectum. First report...

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