Anaemia and Post-Cricoid Carcinoma

THE association between chronic anaemia and post-cricoid carcinoma has been recognised since the observations of Kelly (1919). Atrophy of the mucous membrane of the mouth and pharynx occurs in some cases of chronic anaemia and it is generally assumed that when malignant change in the buccopharyngeal epithelium supervenes it is because this atrophy is itself a pre-malignant condition (Ahlbom, 1936; Welin, 1953; Boyd, 1961). There is little direct evidence for this assumption and the present investigation shows that it is not entirely justified. A previous investigation of the mucous membrane of the mouth in anaemic subjects showed thinning of the epithelium in some cases, resulting primarily from atrophy of the rete pegs (Jacobs, 1960, 1961a). This thinning was more frequent and more severe in megaloblastic anaemia due to vitamin B12 deficiency than in iron deficiency anaemia, and in neither type ofanaemia was it related to the patient's haemoglobin concentration, serum iron level, serum vitamin B12 level, or the amount of stainable iron in the bone narrow. Occasional specimens in the iron deficient group showed the formation of mature keratin. The normal squamous epithelium of the mouth contains abundant glycogen but this was either deficient or totally lacking in the atrophic epithelia found in some cases of anaemia. An increased concentration of sulphydryl groups was also found in a few anaemic epithelia, especially in the superficial zone, and this was thought to denote a tendency to parakeratosis. The same specimens also contained an abnormal polysaccharide in the superficial layers of the epithelium. There were no histological features specific to the epithelium in iron deficiency. The present paper reviews 93 cases of post-cricoid carcinoma seen at St. Mary's and the Royal Marsden Hospitals, with particular reference to the presence of anaemia and to the histology of the epithelium adjacent to the growth. For purposes of comparison 118 cases of carcinoma occurring elsewhere in the hypopharynx are also reviewed. An attempt is made to compare epithelial histology in the mouth and post-cricoid region in anaemic patients.