world cancer report - iarc

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applies to depressed, flat neoplastic lesions (type IIc) only when the diameter does not exceed 1 cm. Sporadic advanced colonic cancer is treated by segmental colectomy with a tendency to large resection. Adjuvant chemotherapy (5 FU-levamisole or 5 FUleucovorine) is recommended if lymph node invasion is confirmed and some advocate a similar indication in B2 (subserosal) tumours. Recently introduced cytotoxic drugs, such as irinotecan and REFERENCES 1. Troisi RJ, Freedman AN, Devesa SS (1999) Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite, and stage, 1975-1994. Cancer, 85: 1670-1676. 2. Tomatis L, Aitio A, Day NE, Heseltine E, Kaldor J, Miller AB, Parkin DM, Riboli E, eds (1990) Cancer: Causes, Occurrence and Control (IARC Scientific Publications, No. 100), Lyon, IARCPress. 3. Honda T, Kai I, Ohi G (1999) Fat and dietary fiber intake and colon cancer mortality: a chronological comparison between Japan and the United States. Nutr Cancer, 33: 95- 99. 4. Cohen AM, Minsky BD, Schilsky RL (1997) Cancers of the Colon. In: DeVita VTJ, Hellman,S, Rosenberg,SA eds, Cancer: Principles and Practice of Oncology, Philadelphia- New York, Lippincott-Raven, 1144-1197. 5. Clapper ML, Chang WC, Meropol NJ (2001) Chemoprevention of colorectal cancer. Curr Opin Oncol, 13: 307-313. 6. Hamilton SR and Aaltonen LA, eds (2000) World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System, Lyon, IARCPress. 7. Ilyas M, Straub J, Tomlinson IP, Bodmer WF (1999) Genetic pathways in colorectal and other cancers. Eur J Cancer, 35: 335-351. 8. Gryfe R, Swallow C, Bapat B, Redston M, Gallinger S, Couture J (1997) Molecular biology of colorectal cancer. Curr Probl Cancer, 21: 233-300. 202 Human cancers by organ site oxaliplatin, are beginning to become established in treatment regimes [15]. Advanced cancer located in the rectum is treated by neo-adjuvant radiotherapy if the tumour is either T3 (showing local invasion) or N+ (positive lymph nodes). Colorectal cancer is nowadays considered to be a chemosensitive tumour; in some patients, the occurrence of liver or pulmonary metastases does not exclude a curative management based upon combined resection and chemotherapy. The 9. Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst, 91: 916-932. 10. Fujiwara T, Stolker JM, Watanabe T, Rashid A, Longo P, Eshleman JR, Booker S, Lynch HT, Jass JR, Green JS, Kim H, Jen J, Vogelstein B, Hamilton SR (1998) Accumulated clonal genetic alterations in familial and sporadic colorectal carcinomas with widespread instability in microsatellite sequences. Am J Pathol, 153: 1063-1078. 11. Boland CR, Thibodeau SN, Hamilton SR, Sidransky D, Eshleman JR, Burt RW, Meltzer SJ, Rodriguez-Bigas MA, Fodde R, Ranzani GN, Srivastava S (1998) A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res, 58: 5248- 5257. 12. Gryfe R, Kim H, Hsieh ET, Aronson MD, Holowaty EJ, Bull SB, Redston M, Gallinger S (2000) Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med, 342: 69-77. 13. McLeod HL, Murray GI (1999) Tumour markers of prognosis in colorectal cancer. Br J Cancer, 79: 191-203. 14. Hegde P, Qi R, Gaspard R, Abernathy K, Dharap S, Earle-Hughes J, Gay C, Nwokekeh NU, Chen T, Saeed AI, Sharov V, Lee NH, Yeatman TJ, Quackenbush J (2001) Identification of tumor markers in models of human colorectal cancer using a 19,200-element complementary DNA microarray. Cancer Res, 61: 7792-7797. 15. Grothey A, Schmoll HJ (2001) New chemotherapy approaches in colorectal cancer. Curr Opin Oncol, 13: 275-286. aggressive management of operable patients is based on initial segmental liver or lung resection followed by first line chemotherapy. In inoperable patients, first and second line chemotherapy protocols are proposed and a delayed surgical resection may be considered in some cases. The five-year survival following detection and treatment of colorectal cancer is around 50% (Fig. 5.36). WEBSITES Johns Hopkins Hereditary Colorectal Cancer Website: http://www.hopkins coloncancer.org/subspecialties/ heredicolor_cancer/overview.htm APC gene mutation database: http://perso.curie.fr/Thierry.Soussi/APC.html
LIVER CANCER SUMMARY > About 560,000 new cases of liver cancer, usually hepatocellular carcinoma, occur annually, and contribute significantly to cancer mortality worldwide. More than 80% of cases occur in Asia and Africa and irrespective of etiology, the incidence rate is more than twice as high in men as in women. > In Africa and Asia, hepatocellular carcinoma is most frequently caused by hepatitis B virus infection; concomitant dietary exposure to aflatoxins multiplies the risk. In Japan, this cancer is predominantly caused by hepatitis C virus infection. > In Western countries, liver cirrhosis due to chronic alcohol abuse is the major etiological factor. > Hepatocellular carcinoma is almost always lethal, survival from time of diagnosis often being less than six months; only 10% of patients survive five years or more. Definition Hepatocellular carcinoma arises from hepatocytes and accounts for 80% of all primary cancers of the liver. Other tumour types include intrahepatic cholangiocarcinoma (tumours of that part of the bile duct epithelium located within the liver), hepatoblastoma (a malignant embryomal tumour of childhood) and angiosarcoma (arising from blood vessels) and are relatively rare. Epidemiology Liver cancer ranks third amongst the organ-specific causes of cancer-related deaths in men worldwide and accounts for almost 4% of all human cancers [1]. Globally, men are three times as likely as women to be afflicted; liver cancer is the fifth most common cancer among men < 3.3 < 5.6 Fig. 5.37 Global burden of liver cancer in men. Note the high incidence rates in some African and Asian regions. worldwide, but is the eighth in women. Liver cancer is a major health problem in developing countries where more than 80% of the world total (457,000 new annual cases) occur. The highest incidence rates are recorded in China (55% of the world total), Japan, South East Asia and sub-Saharan Africa (Fig. 5.37). In both high and low incidence areas, there is great variability in incidence among ethnic groups [2]. Age-specific rates of incidence show marked geographical variation (Fig. 5.38). In the Gambia, age-specific rates peak in the 45-55 years age range, whereas in Europe and the USA, high risk is associated with old age. Time trends in liver cancer are difficult to interpret due to changes in classification and variable inclusion of metastatic tumours [3]. However, the incidence of hepatocellular carcinoma in Japan, the UK, the USA and several Nordic countries has increased noticeably over the past two decades and has become progressively associated with younger age groups [4]. Mortality rates have increased in several < 9.0 < 15.0 Age-standardized incidence/100,000 population < 98.9 regions, including France. Some of these increases may be the result of improved detection. Etiology Experimental evidence in a variety of in vitro and animal models has demonstrated the carcinogenic effects of hepatitis B virus (HBV) on hepatocytes through both direct and indirect mechanisms [5]. HBV viral DNA has been found to integrate into hepatocyte DNA and may serve as an insertional mutagen. Viral replication in infected cells and the concurrent host immune response results in persistent inflammation that may eventually progress to cirrhosis and also may dispose toward carcinogenesis; this is the mechanism most commonly exhibited by hepatitis C virus (HCV) (Chronic infections, p56). Consistent epidemiological data have associated a significant risk of hepatocellular carcinoma with chronic HBV infection, which accordingly has been categorized as causing cancer in the context of IARC Monograph evaluations [6]. Prevalence of carriers in developing coun- Liver cancer 203
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WORLD HEALTH ORGANIZATION WHO OMS I
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WORLD CANCER REPORT Editors Bernard
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CONTENTS Foreword 9 1 The global bu
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The global burden of cancer Cancer
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Fig. 1.2 Incidence and mortality of
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Central and Southern Europe differ
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Incidence of cancer in South Centra
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from documentation of disease to a
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TOBACCO SUMMARY >In addition to lun
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Fig. 2.3 Smoking by children is inc
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Cancers positively Sex Standardized
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PHARMACOLOGICAL APPROACHES TO SMOKI
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level the dose—response relations
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lipoprotein-associated cholesterol,
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Agent Cancer site/cancer Main indus
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Industry, occupation Cancer site/ca
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to occupational exposures in develo
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Air pollutant WHO Air Quality Guide
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der cancer of the order of 50% is p
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AFLATOXIN B 1 HEPATITIS VIRUS (chro
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Fig. 2.30 Correlation between regio
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MEDICINAL DRUGS SUMMARY > Certain d
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Drug or drug combination Cancer IAR
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Agent or substance Cancer site/canc
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sources of electromagnetic fields [
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CHRONIC INFECTIONS SUMMARY > Infect
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Infection Subclinical Mutagenic fac
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TUMOURS ASSOCIATED WITH HIV/AIDS Ap
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DIET AND NUTRITION SUMMARY > Up to
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Fig. 2.54 The age-adjusted mortalit
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OVERWEIGHT, OBESITY AND PHYSICAL AC
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IMMUNOSUPPRESSION SUMMARY >Persiste
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Fig. 2.64 Cancer following immunosu
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Syndrome Gene Location Cancer site/
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viduals, confirmation of a gene def
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REPRODUCTIVE FACTORS AND HORMONES S
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PHYTO-ESTROGENS AND CANCER PEVENTIO
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Indicator Number of oral contracept
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Mechanisms of tumour development Th
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The stages in tumorigenesis have be
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PRECURSOR LESIONS IN CHEMOPREVENTIO
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CARCINOGEN ACTIVATION AND DNA REPAI
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adducts, a few weeks or months for
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I Reactive oxygen species Methylati
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which remove the mismatched bases,
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Common human oncogenes Many common
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product of the RB1 gene (pRb) and a
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ates a molecular bridge between p53
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potential cancer genes altered thro
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One of the earliest genes to be ide
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Regulation of the cell cycle and co
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CELL-CELL COMMUNICATION SUMMARY > C
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Connexin genes and tumour suppressi
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APOPTOSIS SUMMARY > The term apopto
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Caspase-8 Caspase-3 c-FLIP Procaspa
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ways. Several options are under inv
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INVASION AND METASTASIS SUMMARY > T
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laminin, entactin and also heparan
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Target Example of agent Comments Ad
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organs, and to respond to local gro
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TOBACCO CONTROL SUMMARY > Tobacco-i
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Region Deaths due to % of total dea
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ipated, is primarily attributable t
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smoke. This may be achieved in part
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there is no evidence for the effica
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industries, processes and occupatio
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stoves arises in rural areas of dev
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Climbing plants on trellis at end r
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HEPATITIS B VACCINATION SUMMARY > P
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Fig. 4.17 Chronic active HBV-associ
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HUMAN PAPILLOMAVIRUS VACCINATION SU
Page 145 and 146: Vaccine Site of trial Number of pat
Page 147 and 148: prolonged use. Similar drugs, that
Page 149 and 150: aspirin and other non-steroidal ant
Page 151 and 152: SCREENING FOR BREAST CANCER SUMMARY
Page 153 and 154: Fig. 4.35 Cumulative mortality from
Page 155 and 156: SCREENING FOR PROSTATE CANCER SUMMA
Page 157 and 158: Fig. 4.39 Poster designed for an an
Page 159 and 160: is around 10% for cancer (out of ev
Page 161 and 162: 45 with one positive rehydrated FOB
Page 163 and 164: eing based on (i) time trends in th
Page 165 and 166: Fig. 4.48 Women at a clinic in Indi
Page 167 and 168: SCREENING FOR ORAL CANCER SUMMARY >
Page 169 and 170: India will provide useful informati
Page 171 and 172: cer incidence following cure of inf
Page 173 and 174: 100 50 25 10 5 2.5 1 Japan Males Fe
Page 175 and 176: Human cancers by organ site Maligna
Page 177 and 178: tobacco smoking: age at start, aver
Page 179 and 180: diagnosis is usually confirmed by h
Page 181 and 182: is frequent and survival rates are
Page 183 and 184: Fig. 5.14 Physician reading digital
Page 185 and 186: Markers of prognosis in breast canc
Page 187 and 188: cer in the contralateral breast (Ch
Page 189 and 190: 100 50 25 10 5 2.5 1 Japan Chile Po
Page 191 and 192: depends on staging. Small intramuco
Page 193 and 194: Fig. 5.30 A diet rich in fresh frui
Page 195: ane protein involved in cell adhesi
Page 199 and 200: Fig. 5.39 A woman in the Gambia pre
Page 201 and 202: REFERENCES 1. Ferlay J, Bray F, Par
Page 203 and 204: Certain Possible Uncertain Age Andr
Page 205 and 206: Management The dramatic division be
Page 207 and 208: TUMOUR NORMAL Gastrula PGC 2n Impri
Page 209 and 210: CANCERS OF THE FEMALE REPRODUCTIVE
Page 211 and 212: Fig. 5.62 Five-year relative surviv
Page 213 and 214: Inheritance of high-penetrance gene
Page 215 and 216: invasive malignant. Malignant germ
Page 217 and 218: OESOPHAGEAL CANCER SUMMARY >Cancer
Page 219 and 220: Fig. 5.76 A radiographic view of an
Page 221 and 222: with a stent; laser recannulation,
Page 223 and 224: Fig. 5.82 Risk of bladder cancer am
Page 225 and 226: Partial cystectomy is appropriate f
Page 227 and 228: poorly known since hypopharyngeal c
Page 229 and 230: Fig. 5.92 Oral leukoplakia with mil
Page 231 and 232: LYMPHOMA SUMMARY > Malignant lympho
Page 233 and 234: T Fig. 5.101 Nuclear magnetic reson
Page 235 and 236: Fig. 5.106 Five-year relative survi
Page 237 and 238: Fig. 5.109 The immediate aftermath
Page 239 and 240: A B Fig. 5.113 Acute myeloid leukae
Page 241 and 242: Fig. 5.118 Five-year relative survi
Page 243 and 244: Fig. 5.120 Age-specific incidence a
Page 245 and 246: Hereditary condition Mode of inheri
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MELANOMA SUMMARY > Approximately 13
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Fig. 5.131 Primary melanoma with a
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THYROID CANCER SUMMARY > Cancer of
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Papillary carcinoma RET/PTC TRK BRA
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KIDNEY CANCER SUMMARY > Cancer of t
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Stage Clear cell carcinoma Papillar
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TUMOURS OF THE NERVOUS SYSTEM SUMMA
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ing the optic tract, brain stem and
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mut = mutant p53 wt = wildtype p53
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SURGICAL ONCOLOGY SUMMARY > Surgica
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Year Radical mastectomy (%) Modifie
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TELEMEDICINE The prospects for tele
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Equipment Energy 50% depth dose App
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CANCER EDUCATION IN MEDICAL COURSES
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Fig. 6.10 Crystals of cisplatin: mo
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Responsiveness Cancer (in decreasin
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Most of the world’s most common c
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treatment of cancer. The problems l
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duction. It is clear that tumour ce
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REHABILITATION SUMMARY > Rehabilita
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cer and its associated disability.
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REFERENCES 1. Garden FH, Gillis TA
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Cancer pain relief varies and in so
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EMERGING ISSUES IN PALLIATIVE CARE
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Cancer control The negative impact
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priority to cancer control activiti
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Prevention of cancer Every country
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- Assessing the magnitude of the ca
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high-risk women. Further details on
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ecords departments are either rudim
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THE INTERNATIONAL AGENCY FOR RESEAR
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in the capitals/urban areas of four
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in the overall cancer strategy. WHO
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68% 1955 1975 1995 2025 32% 40% by
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Fig. 7.15 A grandfather at work in
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Fig. 7.17 Main causes of death in d
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Contributors and Reviewers Sources
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Dr Vera Luiz da Costa e Silva Tobac
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Georgia Moore Centers for Disease C
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REVIEWERS Dr Sandra E. Brooks 405 W
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2.53 T. Norat and E. Riboli, IARC 2
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Gastroenterology, 118(2 Suppl 1): S
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5.106 & 5.107 IARC/SEER/Osaka Cance
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4.17 R. Lambert, IARC/Adapted from
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Brain cancer, see nervous system tu
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Fibroblast growth factor (FGF), 117
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Microarray, 240 Micronutrients, 65,
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S Saccharin, 64, 85 Salicin, 153 Sa
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