Early Detection of Esophageal Cancer
Esophageal squamous cell carcinoma (ESCC) is a major cause of death in the central Asian
esophageal cancer belt and human papillomavirus (HPV) has been proposed as a potential
cause. While several HPV-associated cancers have been identified (e.g., cervical,
tonsillar), the role of HPV in esophageal carcinogenesis remains unclear. Estimates of the
prevalence of HPV in ESCC in Henan province, which lies in the central Asian esophageal
cancer belt and of which Linxian is a part, have varied from 0-78%. Contamination of
specimens may contribute to this variation, as may differences in HPV detection techniques.
With the imminent availability of an effective HPV vaccine, it is critical to determine if
HPV is or is not involved in ESCC in Linxian given the potential for cancer prevention
through use of the vaccine if HPV is involved.
The overall objective is to test the hypothesis that HPV is involved in the pathogenesis of
ESCC in Linxian, China. We will 1) determine the prevalence of HPV DNA in ESCC tumors and 2)
evaluate the activity of HPV in HPV DNA-positive cases.
This study will be conducted among adult patients with ESCC presenting for esophagectomy at
Yaocun Commune Hospital in Linxian, China.
This case series study will collect demographic and clinical data from medical records and
will use rigorous sterile procedures to obtain biologic specimens (blood, tumor, non-tumor)
from patients with ESCC. The presence of HPV DNA in tumor specimens will be evaluated using
PCR with L1, E6, and E7-based primers. The activity of HPV in HPV DNA-positive cases will be
assessed by immunohistochemistry for p16 (ink4a) over-expression, RT-PCR for E6/E7 mRNA
expression, and amplification of papillomavirus oncogene transcripts (APOT) for HPV
integration in tumor specimens. Non-tumor specimens will also be examined for the presence
of HPV DNA, and serum will be tested for HPV 16 and HPV 18 E6/E7 seropositivity as a marker
of HPV-associated cancer.
Sanford M Dawsey, M.D.
National Cancer Institute (NCI)
United States: Federal Government