Background: The incidence of malignant Esophageal-respiratory fistulas in Esophageal cancer patients is not so frequent. The fistula development in Esophageal cancer may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of Esophageal-respiratory fistula,one with Esophageal bronchial fistula and the other with Esophageal pleural fistula. Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an Esophageal growth of 8. 5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. Nine months after the start of treatment, the patient’, s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an Esophageal-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an Esophageal growth of 5. 5 cm in the middle esophagus. The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’, s dysphagia worsened,barium swallow showed Esophageal-bronchial fistula. The patient was managed symptomatically and later lost to follow-up. Conclusions: Fistula formation and subsequent abscess results in a poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes Esophageal-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, Esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.

Esophageal cancer is the second most common malignancy in Iranian men; it is the third in women. It is killing about 5800 Iranians each year. Squamous cell carcinoma (SCC) is presently the most common type of Esophageal cancer accounting for about 90% of all Esophageal cancers in Iran. Recent studies in Iran have shown that there is a gradual increase in the incidence of adenocarcinoma of the distal esophagus along with gastric cardia adenocarcinoma. Thirty-five years ago, the age-adjusted incidence rate (ASR) of SCC of esophagus in Gonbad city, Golestan province, Northeast of Iran (>100 per 105 people per year), was found to be one of the highest rates for any single cancer ever reported in the world. Recent studies have shown that the incidence of SCC in Gonbad has declined to less than half of what it was in the past. This decline in the incidence of Esophageal SCC is in parallel with improvement in socioeconomic status of people living in this region. According to the recent cancer registry data in Iran, there is still an obvious intra-country variability between the incidence of Esophageal cancer in South with an ASR of 3 for men and 2 for women in Kerman and 43 and 36, respectively, in northeastern province of Golestan. The reasons for this very high rate of SCC in northeastern Iran have been the subject of several studies during the last 35 years. According to the results of these studies, the suspected risk factors include low intake of fruits and vegetables, drinking hot tea, consumption of opium products and tobacco, H.pylori infection in stomach, using unhealthy drinking water from cistern and genetic susceptibility. The main suspected mutagens are polycyclic aromatic hydrocarbons (PAH) and N-Nitroso compounds. In order to embark on a primary and secondary prevention of this fatal cancer further prospective studies are presently going on in the northeastern Iran. Golestan cohort study of Esophageal cancer with enrollment of 50,000 subjects is now in its follow-up phase. We expect simple and feasible evidence based preventive strategies to be implemented in future from the results of these studies.

Background and aim: Non-melanoma skin cancers (NMSC) are one of the most prevalent malignancies of the human. Although the morality rate is not high for these cancers, they may cause high morbility for the patients. In addition to the skin type, factors such as sun exposure, head and neck radiotherapy, inappropriate use of sunscreen and cultural changes may increase the incidence of these cancers. The objective of this study was to determine NMSC in Isfahan.Materials and Methods: We used data of the cancer resistery center for performing this study and the incidence of NMSC per 100,000 populations was determined. Results: Overall 1681 cases were registered. The incidence of NMSC was calculated to be 10.67/100,000population. The most common site for BCC and SCC was middle face. Conclusion: NMSC incidence in Isfahan is lower than west countries although this incidence is 10.67/100,000in a year. It means that 5-6 thousand cases of NMSC occur in Iran each year. We can prevent its morbidity and mortality by early correct diagnosis.

Background: Esophageal cancer is the 7th most common cancer in Iran. The northern part of the country shows the highest incidence for this malignancy. In this study we present some epidemiological and clinicopathological characteristics of patients with Esophageal carcinoma in this region.Methods: In a cross sectional study, 238 Esophageal cancer patients were enrolled in a prospective study of neoadjuvant chemo-radiation treatment in a 4-year period (2006-2009). In an oncology clinic their epidemiologic characteristics and clinicopathological findings were registered in a preplanned file. Data consisted of age, sex, race, occupation, residential location, smoking, addiction history, signs and symptoms, blood biochemistry profile, imaging and endoscopic findings. The data were analyzed with the SPSS software. Results: The mean age of the patients was (55% female) 59 years. They were mostly Fars (63%) and Turkmen (13%). Seventy two percent were residents of rural area, 20% were smokers and 22.3% were opium addict and its analogues. Only 1.3% of patients consumed alcohol. The most common presenting symptom was dysphagia (93.7%), mainly grade III dysphagia (53%). Location of tumor in esophagus was in the middle third in 53.4% and lower segment in 44.5%. 65 % of the patients had an abnormal esophagogram. On endoscopic evaluation the most common types of tumors were polypoid, vegetative and fungoid, respectively. Mean tumor length was 5.7 cm. The most common histology type was squamus cell carcinoma (99.1%) which was moderately differentiated in 51.3% of these patients. No significant relationship was found between the grade of dysphagia with the macroscopic type and the pathologic grade of the tumor in this study. Conclusion: Squamous cell carcinoma comprised more than 99% of all Esophageal cancers in our patients and this histological type is the prominent type in the Northeast of Iran. Middle Esophageal segment is the major site for this type of cancer which unfortunately most patients present with grade III. Dysphasia reflects the advanced stage of the disease.

Metastasis of cancers to finger is a very rare finding. Herein, we report on an 80-year-old woman presented with a large painless ulceroproliferative lesion of her right thumb. The lesion was surgically excised. Pathological report revealed a papillary adenocarcinoma-a distant metastasis from the esophagus. The patient had an uneventful course and was discharged from the hospital