world cancer report - iarc

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tries is high (10-15%) and it can be estimated that two-thirds of liver cancer cases in developing countries are attributable to this virus [7]. HBV is particularly implicated in hepatocellular carcinoma in Africa and Asia, and HCV in Japan and the USA [4]. In developing countries, dietary ingestion of aflatoxins (produced by the mould Aspergillus flavus, which under hot and humid conditions contaminates stored grain), and specifically aflatoxin B1, is causally associated with development of hepatocellular carcinoma, and exposure to aflatoxins may be synergistic with HBV infection (Food contaminants, p43). In developed countries, principal known risk factors are smoking and chronic alcohol abuse. The major clinical hepatocellular carcinoma risk factor is cirrhosis; 70-90% of hepatocellular carcinomas develop in patients with macronodular cirrhosis. Iron overload caused by untreated haematochromatosis may provoke in some patient series a risk of death of as much as 45% from hepatocellular carcinoma [8]. Hepatocellular carcinoma may occur in 37% of patients with tyrosinaemia who survive to two years old and may occur in patients who have successfully undergone liver transplant. Other metabolic disorders which may carry an increased risk of hepatocellular carcinoma or other liver cancers include alpha-1-trypsin deficiency, hypercitrullinaemia and glycogen storage disease (Table 5.6). Hepatic cholangiocarcinoma is rare in most populations, the exception being in the population of Northern Thailand where it is associated with chronic infection by the liver fluke Opisthorchis viverrini, which is contracted through consumption of infected raw fish. Detection Screening programmes by ultrasound examination with or without pre-selection on the basis of raised levels of alpha-fetoprotein have not proved effective in reducing mortality. Recent observations indicate that free DNA originating from tumour cells is detectable in the plasma of liver cancer patients at an early stage. Detection of relevant genetic changes in the plasma (such as p53 mutation at codon 249 in the inhabitants of high incidence areas and aberrant methylation of CDKN2A in most parts of the world) may soon become useful aids in screening tests for hepatocellular carcinoma. The availability of simple, genetic tests would be an important contribution to screening programmes. Fig. 5.38 Age-specific incidence of liver cancer in men; rates are higher in young men in areas where viral hepatitis is endemic. 204 Human cancers by organ site Risk factors and predisposing conditions Hepatocellular carcinoma Chronic infection with hepatitis B virus Infection with hepatitis C virus Chronic liver cirrhosis Untreated haemochromatosis Tyrosinaemia Alcohol abuse Aflatoxins Long-term use of oral contraceptives High dose anabolic steroids Agents causing peroxisome proliferation Cholangiocarcinoma Liver fluke (Opisthorchis viverrini and Clonorchis sinensis) infection (esp. certain areas of China and South East Asia) Hepatolithiasis Thorotrast (no-longer used X-ray contrast medium) Inflammatory bowel disease Nitrosamines Angiosarcoma Vinyl chloride (polymer industry) Table 5.6 Risk factors and predisposing conditions for liver cancer. Common symptoms of hepatocellular carcinoma are abdominal pain, weight loss, fatigue, abdominal swelling and anorexia. Most patients, particularly in sub-Saharan Africa, present with hepatomegaly; other common signs are ascites and jaundice. Hepatocellular carcinoma which infiltrates a cirrhotic liver often compromises the already impaired hepatic function and thus causes death before becoming very large, as is the case in most Japanese and American patients [8]. Intrahepatic cholangiocarcinoma is characterized by general malaise, mild abdominal pain and weight loss, and by jaundice and cholangitis at later stages [9]. The majority of cases can be diagnosed by computed tomography (CT) (Fig. 5.40) and ultrasonography. A definitive diagnosis may depend on histological analysis via fine needle biopsy. Endoscopic retrograde, transhepatic or magnetic resonance cholangiography can identify the level of biliary obstruction in the case of intrahepatic cholangiocarcinoma.
Fig. 5.39 A woman in the Gambia preparing food which is potentially contaminated by aflatoxin. The combination of aflatoxin ingestion and chronic hepatitis B poses a high risk of hepatocellular carcinoma (Chronic infections, p56). Pathology and genetics Hepatocellular carcinoma is a malignant epithelial tumour derived from hepatocytes, and thus resembles normal liver both structurally and cytologically. Small early-stage hepatocellular carcinomas (
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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
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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 and 196: ane protein involved in cell adhesi
Page 197: LIVER CANCER SUMMARY > About 560,00
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
Page 247 and 248: 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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