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UNC School of Medicine | Institute for Global Health & Infectious Diseases

Esophageal Cancer

Endoscopic Screening for Esophageal Cancer precursor lesions in Malawi: a cross-sectional study

(PI, Shiraz Khan, Enrolling)

Esophageal cancer is the second commonest cancer in Malawi. Factors that lead to this tumor are not well understood. Lack of effective early screening methods contribute to advanced stage at diagnosis and therefore poor outcomes. We therefore designed a cross sectional study to be conducted at several district hospital in southern, central and northern Malawi recruiting 1000 participants with the objective of using an endoscopy-based screening program to assess prevalence of early esophageal lesions in a community of otherwise healthy individuals living in possible high-risk areas. Enrolled participants will undergo endoscopy for with staining with Lugols iodine to detect possible esophageal lesions with biopsy for identified lesions conducted for histological classification and diagnosis. Participants will also undergo a dental exam to assess oral health. Several biospecimen including mouthwash for oral microbiome studies will be collected. Objective is to assess community prevalence of SCC or pre-SCC lesions and oral health in a population of asymptomatic individuals in rural communities in Malawi. Specific objectives:

  • To evaluate the prevalence of esophageal dysplasia in a rural Malawian community
  • To determine the prevalence of dental fluorosis in a rural Malawian community
  • To assess the prevalence of other esophageal lesions in a rural Malawian community
  • To describe the digestive tract microbiome characteristics of a rural Malawian community
  • To evaluate the relationship between environmental risk factors and esophageal dysplasia
  • Weigh the possibility of developing biomarkers for esophageal dysplasia

HIV and other Risk Factors for Esophageal Squamous Cell Carcinoma in Malawi: A Case Control Study of Esophageal Squamous Cell Carcinoma in Lilongwe, Malawi

(PI, Dr.Bongani Kaimila, Dr. Tamiwe Tomoka, Data Analysis)

Esophageal cancer is the sixth leading cause of cancer worldwide, causing 400,000 deaths per year. Within Africa, there have been reports of high-incidence regions in southern Africa, central and eastern Africa. In Malawi, ESCC is the third commonest cancer nationwide behind Kaposi sarcoma and cervical carcinoma. Among cancers that are not classically HIV-related ESCC has the highest incidence in Malawi, yet very little is known about the epidemiology of this cancer in our setting. Due to continued uncertainty regarding causes of ESCC in Malawi, this case-control study examines the etiologies of ESCC at KCH and SGH. Based on prior work, we hypothesize the following etiologic contributors: HIV infection, polycyclic aromatic hydrocarbons (PAH) through exposure to indoor air pollution, biomass fuels, and dietary sources, fumonisin on maize and other dietary factors, such as dietary selenium deficiency, thermal injury from scalding hot beverages and tobacco and alcohol consumption. Objectives were 1)To identify risk factors for ESCC through a case-control study implemented at a national teaching hospital, specifically focused on exposure to HIV infection, PAH exposure, dietary factors including fumonisin and selenium, scalding hot beverages and foods, and tobacco and alcohol consumption. 2) To identify and characterize common somatic genetic and epigenetic alterations in ESCC tumors from Malawi and characterize germline genetic and epigenetic alterations associated with susceptibility to ESCC

Treatment Outcomes of Esophageal Cancer in Eastern Africa (TOEC-Eastern Africa)

(PI, Dr.Bongani Kaimila, Dr. Gita Mody, Data Analysis)

This is a prospective observational cohort design in which patients with esophageal cancer at KCH in Lilongwe, Malawi are being followed to collect key clinical and treatment-related data including Quality of Life (QOL) metrics and survival until death or loss to follow up, with key data pertaining to treatment to include chemotherapy, radiation therapy, chemo-radiotherapy, oesophageal stenting (esophageal stenting is a tube placing a tube in a patients esophagus (throat) to keep open a blocked area. The tube helps the patient to swallow solids and liquids), esophagectomy (surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part of another organ, usually the stomach) palliative care alone, as well as any combined or sequential therapies (refers to treatment with drug regimens administered one after another. Combination therapy refers to treatment with drug regimens concurrently administered). The study has been established as a collaborative effort within the African Esophageal Cancer Consortium (AfrECC) and aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania. Enrolment in Malawi commenced in June 2021 at Kamuzu Central Hospital and includes two sub-studies looking at esophageal stenting and ESCC imaging. The purpose of the proposed research is to prospectively evaluate outcomes related to existing treatment strategies for EC at participating sites within the African Esophageal Cancer Consortium (AfrECC).  Aim 1) To describe the types of treatments administered for all patients diagnosed with EC at participating AfrECC sites, including chemotherapeutic regimens, radiation therapy, chemo-radiotherapy, esophageal stenting, esophagectomy, and palliative care. Aim 2) To evaluate the effect of different EC treatment modalities on patients’ QOL during and after completion of treatment. Aim 3) To measure the effect of different treatment modalities on overall survival.

Nkhoma Hospital feasibility of endoscopic screening for Esophageal Squamous Cell Carcinoma (ESCC)

(PI, Dr. Gita Mody, Dr.Bongani Kaimila, Data Analysis)

UNC Project Malawi Cancer Program esophageal cancer and cancer clinic division lead Bongani Kaimila, MBBS, MSc, launched a cross-sectional study to determine the feasibility of endoscopic screening for Esophageal Squamous Cell Carcinoma (ESCC) precursor lesions in Malawi and the relationship with poor oral health. In Malawi, ESCC is the third commonest cancer nationwide. Among cancers that are not classically HIV-related, ESCC has the highest incidence in Malawi. Few data are available on precursor lesions of ESCC in Malawi, and there relationship to poor oral health. Objective is to assess community prevalence of SCC or pre-SCC lesions and oral health in a population of asymptomatic individuals in a rural community in central Malawi.