False statements about carcinoma esophagus are all of the following except: March 2007

Ans. A: Most common in lower third There are a number of risk factors for esophageal cancer: Age-Most patients are over 60. Gender-It is more common in men. Heredity-It is more likely in people who have close relatives with cancer. Tobacco smoking and heavy alcohol use increase the risk. Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition, while all other risk factors predispose more for squamous cell carcinoma). Human papillomavirus (HPV) Paicular dietary substances, such as nitrosamine. Plummer-Vinson syndrome (anemia and esophageal webbing) Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles). Radiation therapy for other conditions in the mediastinum. Celiac disease predisposes towards squamous cell carcinoma. Carcinoma may develop at the achalasia segment due to persistent retention esophagitis as a result of fermentation of food residues. The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 inches long) is commonly divided into three pas for purposes of determining the location. Adenocarcinomas tend to occur distally and squamous cell carcinomas proximally, but the converse may also be the case. Worldwide squamous cell carcinoma is most common whereas adenocarcinomas predominates in the west. Squamous cell carcinomas are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption. Adenocarcinomas are often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. Endoscopy is the first line investigation for most patients.