It could soon kill about 3,000 people. Can viral autopsies find them?

TORONTO — A surprisingly potent outbreak of a deadly form of lung cancer has been reported in Canada, with a toll that may approach 3,000.

The disease — called carcinoid syndrome — affects people with gastrointestinal issues such as constipation and gastrointestinal bleeding and is associated with several viruses including the herpes simplex virus and the HPV virus. These conditions prompt cancers of the colon and rectum, liver and other tissues, like lymph nodes.

The detection of these cancers comes from a viral “autopsy,” which involves patients being routinely tested for their viruses and having them sequenced.

The first reports of the disease emerged in Britain in 1983. For some reason, early detection of the disease was not widespread, as some hospitals were reluctant to diagnose the condition unless patients showed noticeable symptoms. The virus was first found in the United States in 1994.

But it wasn’t until 2009 that the United States began testing more and more people for the virus after more than 2,500 cases had been reported and cases were spreading rapidly. The California Department of Public Health then began requiring that all schoolchildren receive these screenings, and subsequent testing has shed light on other states, including California, which now requires that all blood donors undergo a single standard test for cancer of the cervix and cervixes.

Then came the Ontario cases.

Carcinoid syndrome results from a specific combination of viruses and other health problems, but the diseases are co-infected. A sufficient number of circulating viruses accompanies cancer of the upper GI tract to produce severe symptoms that are significant enough for the disease to be diagnosed in nearly half of patients.

In an interview, Dr. Erasmo Rebello, a scientist at the Hospital for Sick Children in Toronto, said the combination of viruses has been associated with larger cancerous tumors. “There are studies that have found up to 50 percent to 70 percent of cases of melanoma are correlated with virus infections,” he said.

Explaining why the outbreaks might persist for years, he said: “The disease can be recurrent in both the mouth and the throat but there also seems to be a problem in the glands that sit below the tongue and the two larynx tissues that sit above the voice box.”

The new cases are so dramatic that some doctors are speculating that the problem is related to the globalization of the herpes virus and its role in the spread of other viruses.

“The disease is susceptible to reemergence in populations with poor sanitation and a high susceptibility to sanitation problems,” said Eric Fornal, associate director of the Canadian Institutes of Health Research’s Centre for Cancer Research.

“It’s a complex problem,” he added. “Human immunodeficiency virus and herpes are endemic in the populations it has affected in the past. There also seems to be an association with the exposure of certain people with certain germs and poor respiratory care in certain regions.”

SOURCE: The New York Times

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