Esophageal Cancer in the Sudan: Focus on the Screening for EBV and the Surgical Management

Esophageal cancer (EC) occurs commonly, particularly in Asia, and it is the sixth leading cause of cancer deaths worldwide [1]. Esophageal cancer classically happens in one of two forms, squamous cell carcinomas (SCCs) arising from the stratified squamous epithelial lining of the organ, and adenocarcinoma (AC) arising from columnar glandular cells that replace the squamous epithelium [2]. Sarcomas and small cell carcinomas usually constitute less than 1%-2% of all esophageal cancers [3]. The major risk factors for esophageal cancer include; gastro-esophageal reflux [4], tobacco smoking, alcohol drinking [5], viruses [6], susceptibility genes [7], low levels of intake of fruits and vegetables [8]. The relationship between viral infection and esophageal cancer was previously reported for several viruses including; high human Papillomavirus (HRHPV) particularly subtype 16, herpes simplex virus 1 (HSV1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). However, the mechanisms of the viral action in addition to geographic variation in infection rates of these viruses still need more efforts [9]. EBV is an oncogenic virus that has been described to be linked to Burkitt’s lymphoma, Hodgkin’s disease, breast cancer, gastric carcinoma, nasopharyngeal carcinoma and leiomyosarcoma [10]. However, whether EBV is associated to esophageal SCC still controversial: there are limited studies and their conclusions vary [11].