John Thaw was one of my favourite actors. Although famous for many of his TV roles, I particularly liked his gruff but kindly portrayal of Inspector Morse and especially his on-screen mentoring of Sgt Lewis, played by Kevin Whately, writes Dr Muiris Houston.
He died in February from cancer of the oesophagus, aged 60. I'm not sure whether John Thaw was a smoker or a drinker, but if he was, then he had two of the risk factors for oesophageal cancer. The tumour is more common in males and older people and is also associated with being overweight and having chronic heartburn.
The oesophagus - or gullet - is a hollow tube that carries food and liquid from the throat to the stomach. It can be affected by two separate forms of cancer. Squamous cell carcinoma is associated with smoking and drinking alcohol. Adenocarcinoma is associated with acid reflux, which is a common condition caused by hiatus hernia and the excessive production of acid in the stomach. It seems that the ongoing scarring of the gullet by repeated surges of acid from the stomach may set off cancer changes in the cells of some people.
The incidence of this type of cancer is rising, particularly among women, and constitutes more than 60 per cent of oesophageal cancers diagnosed in the Republic, compared with 40 per cent in many other European countries.
Tom Walsh is a consultant surgeon at James Connolly Memorial Hospital, Blanchardstown, Co Dublin, who specialises in the treatment of oesophageal cancer. He has just returned from a European oesophageal cancer conference in Barcelona where he says; "statistics presented showed that in Ireland, women account for approximately 40 per cent of sufferers, compared with 10 per cent in France and 20 per cent in most other European countries. This is an alarming statistic and, while the cause remains unknown, it does point toward the Celtic gene and possibly the high percentage of reflux sufferers in this country."
The most recent report from the National Cancer Registry (NCR) shows there was, on average, 289 cases of oesophageal cancer each year in the period 1994 to 1998. Although this represents only 1.5 per cent of all cancers, the statistics confirm that the incidence of cancer of the oesophagus is on the rise.
The NCR, along with its counterpart in Northern Ireland, is about to start a large-scale study into why oesophageal cancer rates are on the increase.
Last year, Lucilla Hyland, a business woman in her early 40s, died from the disease. The time from diagnosis to her death was only 18 weeks. Her first symptom was difficulty swallowing - called dysphagia by doctors. In an effort to fund more research into cancer of the oesophagus, a group of her friends set up the Oesophageal Cancer Research Fund (OCRF) in conjunction with Walsh.
Last Saturday, the group organised the first annual Lollipop Day with the aim of increasing awareness of the disease and to encourage people to visit the doctor at the first sign of difficulty swallowing, especially if accompanied by weight loss. According to Walsh, "one of the major issues surrounding the disease is that patients often do not understand the potential significance of their symptoms, and present late, often too late".
Research suggests that only 20 per cent of people with oesophageal cancer are alive one year after diagnosis. Better awareness should help to improved the outcome figures. But more research is needed into why the disease is on the increase, why it is becoming more common in women and also to discover the exact link between acid reflux and the increasingly common adenocarcinoma form of the tumour.
For more information visit the website: www.lollipop.com
Dr Muiris Houston can be contacted at mhouston@irish-times.ie. Messages can be left for him at 01-6707711, ext. 8511. He regrets he cannot reply to individual medical queries