EPIDEMIOLOGIJA RAKA JEDNJAKA, FAKTORI RIZIKA I MOGUĆNOSTI PREVENCIJE
Sažetak
Incidencija raka jednjaka i mortalitet izazvan rakom jednjaka u razvijenim zemljama porasli su u poslednje četiri decenije, za razliku od smanjene incidencije i mortaliteta kod drugih karcinoma. Rak jednjaka je osmi najčešći karcinom i šesti vodeći uzrok smrti od raka u svetu. U poslednje 3 decenije došlo je do promene vodećeg histološkog tipa karcinoma jednjaka, u razvijenim zemljama, sa skvamoznih ćelija jednjaka na adenokarcinom jednjaka. Faktori rizika dovode do pojave prekanceroznih stanja, skvamozne displazije, kao prekursora skvamoznog karcinoma jednjaka i Baretovog jednjaka, kao prekursora adenokarcinoma jednjaka. Duvan, alkohol, topli Mate napitak i kiselo povrće povezuju se sa povećanim rizikom od raka jednjaka, dok bi povećan unos voća i povrća mogao preventivno da utiče na rak jednjaka. Dokazi o uticaju relaksansa distalnog ezofagealnog sfinktera i antagonista histamin 2 receptora su kontradiktorni. Postoji inverzna povezanost infekcije Helicobacter pilori i Baretovog jednjaka i adenokarcinoma jednjaka. Imamo nisku sigurnost dokaza o uticaju infe-kcije humanim papiloma virusom i različitim hemijskim kancerogenima, kao što su policiklični aromatični ugljovodonici, N-nitrozo jedinjenja, acetaldehid i fumonizini na rak jednjaka. Brojni predisponirajući uslovi, kao što su gastroezofagealna refluksna bolest, Baretov jednjak, gojaznost, hijatalna hernija, ahalazija, tiloza i Plummer Vinsonov sindrom mogu povećati rizik od raka jednjaka. Primarna prevencija raka jednjaka sastoji se od promene načina života, koje obuhvataju prestanak pušenja, prestanak konzumiranja alkohola i povećan unos voća i povrća. Sekundarna prevencija sastoji se od hemoprevencije, skrininga i programa praćenja.
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