The majority of cancer patients in eastern Golestan present first to the local general practitioners or to the medical and surgical specialists in the area, and only a small group of patients are first diagnosed in major cities outside the area. Before the study began, the investigators contacted all of the local medical practitioners and asked them to refer their patients with suspected GI tract cancers to the Atrak Clinic. From August 2001 to August 2003, 682 patients were referred to the Atrak Clinic. Based on the results of a recent cancer surveillance study and an ongoing cancer registration in Golestan Province, we have shown that approximately 70% of the incident cases of oesophageal cancer recorded in the eastern part of Golestan Province during the study period were referred to the Clinic (unpublished data), so the results of this report may be generalised to represent the experience of eastern Golestan Province.
All the 682 patients referred to the Atrak Clinic were suspected of having upper GI cancers. After signing an informed consent, the patients were interviewed by a physician using a structured questionnaire and underwent physical examination followed by oesophago-gastro-duodenal videoendoscopy. Intravenous Midazolam (5 mg) and 10% lidocaine spray to the pharynx were used as premedication. Local medical specialists, who had been given specific training, performed the endoscopies using Olympus GIF-XQ230 and Pentax EG-2900 video endoscopes. At least four biopsies were obtained from all of the tumours that were found during endoscopy and standard biopsies were taken from the antrum, the gastric body (lesser curvature), the cardia and the oesophagus in all patients. Two more biopsies were taken from columnar-lined distal oesophagus, if such tissue existed. The endoscopic data were entered on predesigned forms, and the location of the tumours was either captured and registered electronically (90% of the tumours), or precisely drawn on a specially designed form. An experienced endoscopist (R Malekzadeh) reviewed both the endoscopic reports and the captured images to confirm the exact site of the tumours. Biopsy specimens were oriented and spread on strips of filter paper and fixed immediately in 10% buffered formalin. The samples were sent to the DDRC, in Tehran, where they were embedded, sectioned and stained with haematoxylin and eosin and examined by experienced DDRC pathologists (M Sotoudeh and B Abedi).
The cancers were classified into four groups: oesophageal squamous cell carcinoma (ESCC), oesophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA) and gastric noncardia adenocarcinoma (GNCA). Adenocarcinomas of the stomach were classified as intestinal or diffuse type using Lauren's classification criteria (Lauren, 1965 ). Gastric cardia tumours were defined as adenocarcinoma with an estimated point of origin within 1 cm proximal or 3 cm distal of the oesophago-gastric junction.
The study was reviewed and approved by the Institutional Review Boards of the DDRC and the US National Cancer Institute.
All the 682 patients referred to the Atrak Clinic were suspected of having upper GI cancers. After signing an informed consent, the patients were interviewed by a physician using a structured questionnaire and underwent physical examination followed by oesophago-gastro-duodenal videoendoscopy. Intravenous Midazolam (5 mg) and 10% lidocaine spray to the pharynx were used as premedication. Local medical specialists, who had been given specific training, performed the endoscopies using Olympus GIF-XQ230 and Pentax EG-2900 video endoscopes. At least four biopsies were obtained from all of the tumours that were found during endoscopy and standard biopsies were taken from the antrum, the gastric body (lesser curvature), the cardia and the oesophagus in all patients. Two more biopsies were taken from columnar-lined distal oesophagus, if such tissue existed. The endoscopic data were entered on predesigned forms, and the location of the tumours was either captured and registered electronically (90% of the tumours), or precisely drawn on a specially designed form. An experienced endoscopist (R Malekzadeh) reviewed both the endoscopic reports and the captured images to confirm the exact site of the tumours. Biopsy specimens were oriented and spread on strips of filter paper and fixed immediately in 10% buffered formalin. The samples were sent to the DDRC, in Tehran, where they were embedded, sectioned and stained with haematoxylin and eosin and examined by experienced DDRC pathologists (M Sotoudeh and B Abedi).
The cancers were classified into four groups: oesophageal squamous cell carcinoma (ESCC), oesophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA) and gastric noncardia adenocarcinoma (GNCA). Adenocarcinomas of the stomach were classified as intestinal or diffuse type using Lauren's classification criteria (Lauren, 1965 ). Gastric cardia tumours were defined as adenocarcinoma with an estimated point of origin within 1 cm proximal or 3 cm distal of the oesophago-gastric junction.
The study was reviewed and approved by the Institutional Review Boards of the DDRC and the US National Cancer Institute.
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