world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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100<br />
50<br />
25<br />
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2.5<br />
1<br />
Japan Chile Poland Denmark<br />
50<br />
Males Males<br />
Females<br />
100<br />
Fig. 5.24 The mortality from stomach <strong>cancer</strong> is decreasing <strong>world</strong>wide, including in countries with a high<br />
disease burden. D.M. Parkin et al. (2001) Eur J Cancer, 37 Suppl. 8: S4-66.<br />
monotonous diets which are rich in starchy<br />
food pose an increased risk, probably<br />
because they are deficient in the protective<br />
dietary constituents. Many studies<br />
suggest a small increase in risk (about<br />
two-fold) in smokers, but alcohol does not<br />
affect risk, other than at the gastric cardia.<br />
Conditions which cause an excessive rate<br />
of cell proliferation in the gastric epithelium,<br />
thus increasing the chance of fixation<br />
of replication errors induced by dietary and<br />
endogenous carcinogens, include Helicobacter<br />
pylori infection (Chronic infections,<br />
p56), gastric ulcer, atrophic gastritis and<br />
autoimmune gastritis associated with pernicious<br />
anaemia. Gastritis is associated<br />
with increased production of oxidants and<br />
reactive nitrogen intermediates, including<br />
nitric oxide. There is increased expression<br />
of the inducible isoform of nitric oxide synthase<br />
in gastritis. Gastritis and atrophy<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
Females<br />
Males<br />
Females<br />
Males<br />
Females<br />
19601970198019902000 19601970198019902000 19601970198019902000 19601970198019902000<br />
100<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
A B<br />
1<br />
100<br />
50<br />
alter gastric acid secretion, elevating gastric<br />
pH, changing the gastric flora and<br />
allowing anaerobic bacteria to colonize the<br />
stomach.<br />
25<br />
Detection<br />
Early stomach <strong>cancer</strong> is an adenocarcinoma<br />
limited to the mucosa, or the mucosa<br />
and submucosa. It often does not cause<br />
symptoms, although up to 50% of patients<br />
may have non-specific gastrointestinal<br />
complaints, such as dyspepsia. This often<br />
delays the diagnosis of stomach <strong>cancer</strong>.<br />
Approximately 80% of Western patients<br />
with stomach <strong>cancer</strong> present to the physician<br />
with advanced tumours, symptoms of<br />
which may include nausea, weight loss,<br />
back pain, epigastric pain, gastrointestinal<br />
bleeding or perforation [3]. Endoscopy and<br />
biopsy is considered to be the most sensitive<br />
and specific diagnostic test for stom-<br />
Fig. 5.26 (A) Endoscopy showing advanced gastric carcinoma in an 80-year-old male patient (ulcerated<br />
tumour without definite limits, infiltrating into the surrounding stomach wall). (B) Corresponding gross<br />
feature of the resected stomach with advanced <strong>cancer</strong> located in the lesser curvature of the angulus.<br />
10<br />
5<br />
2.5<br />
1<br />
ach <strong>cancer</strong>. Endoscopic detection of early<br />
lesions may be improved with dyeendoscopy<br />
using indigo carmine, congored,<br />
truigine or methylene blue. Diagnosis<br />
may also be obtained by double-contrast<br />
barium X-ray. Screening for early disease<br />
by X-ray (photofluoroscopy), followed by<br />
gastroscopy and biopsy of suspicious findings,<br />
has been widely used in Japan since<br />
the 1960s. It is a costly approach to prevention,<br />
and the results have been controversial.<br />
Serum pepsinogen screening is a<br />
new and potentially useful method for<br />
detection of stomach <strong>cancer</strong> [4].<br />
Tumour staging prior to treatment decision<br />
involves percutaneous ultrasound or computed<br />
tomography to detect liver metastases<br />
and distant lymph node metastases<br />
and laparoscopy (with or without laparoscopic<br />
ultrasound) to seek evidence for<br />
peritoneal spread or serosal involvement.<br />
Pathology and genetics<br />
Chronic atrophic gastritis, in particular H.<br />
pylori-associated chronic active gastritis,<br />
Fig. 5.25 Severe atrophic gastritis with intestinal<br />
metaplasia, a risk factor for gastric carcinoma.<br />
Fig. 5.27 Invasive gastric carcinoma: a well-differentiated<br />
trabecular invasive tubular adenocarcinoma.<br />
Stomach <strong>cancer</strong><br />
195