world cancer report - iarc

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Fig. 5.52 Trends in incidence and mortality of testicular cancer in Norway, 1960-1990. Incidence has increased significantly while mortality has decreased, due to effective chemotherapy. decade older for testicular seminoma. Mortality has declined markedly since the introduction of cisplatin as the basis of chemotherapy in the mid-1970s. Etiology Generally relevant environmental causes of testicular cancer have not been established. There is an increased incidence of the disease in individuals with a history of an undescended testicle, testicular feminization and those with a family history of testicular cancer. In utero exposure to exogenous estrogens may increase the risk of testicular cancer as a result of increased incidence of cryptorchidism and dysgenesis. A history of maternal exposure to diethylstilbestrol has been associated with an increased relative risk of up to 5.3 [13]. Testicular cancer is more common in higher socioeconomic groups. Hormonal and genetic factors seem likely to play an important, but currently unclear, role as risk factors; other factors may include the influence of heat [14]. Detection Most patients with testicular germ cell tumours present with a painless swelling 212 Human cancers by organ site or a nodule in the testis. Other common presentations include back pain, (caused by retroperitoneal metastasis), haemoptysis (consequent upon pulmonary metastases) and gynecomastia (excessive development of male mammary glands). Diagnosis is based on physical examination, ultrasonography and biopsy. In patients with nonseminoma, serum tumour markers alpha-fetoprotein and/or human chorionic gonadotrophin are elevated in 80% of patients with disseminated disease and in 50% of patients with early stage disease. Patients with testicular seminoma may have modestly elevated levels of human chorionic gonadotrophin and of lactic dehydrogenase. There are no reliable screening tests for testicular cancer. Due to low incidence and a high cure rate, advocacy of testicular self-examination and the impact of selfassessment are controversial. Pathology and genetics About 90% of testicular malignancies arise from germ cells and these tumours are classified as seminoma (40%) (Fig. 5.53) or nonseminoma, which includes embryonal tumours (20-25%) (Fig. 5.54), Fig. 5.53 Histology of a seminoma with uniform cells resembling primitive germ cells, large vesicular nuclei and a glycogen-rich clear cytoplasm. Note the scattered lymphocytic infiltrates. Fig. 5.54 Embryonal carcinoma consisting of a pleiomorphic proliferation containing glandular structures. teratoma (25-30%) and choriocarcinoma (1%). Germ cell tumours can also arise from extra-gonadal primary sites. Ovarian germ cell tumours of young women share clinical features and treatment approaches with male germ cell tumours. All germ cell tumours are commonly associated with the presence of isochromosome 12p (an abnormal chromosome 12 with two identical short arms), a region which contains the gene for cyclin D2 [15]. The initiation of a germ cell tumour is associated with various aberrations in the normal developmental pathway of the germ cell (Fig. 5.55). Management Current management of germ cell tumours should yield average cure rates in excess of 95%, and even 80% of patients with metastatic disease respond to chemotherapy, radiotherapy and surgery (Fig. 5.56). However, survival in develop-
TUMOUR NORMAL Gastrula PGC 2n Imprint erasure Foetal gonad Fig. 5.55 Normal and neoplastic male germ cell development. The division of a precursor cell, the spermatocyte (4n), produces 4 sperm cells each with one set of chromosomes (1n). The fusion of egg and sperm to form the zygote doubles the number of chromosomes to the normal complement (2n). Aberrant development may produce a cell which has twice the normal chromosomal complement (4n). CIS = carcinoma in situ, GCT = germ cell tumour, PGC = primordial germ cell. ing countries is only 42% to 61%, an indication of limited access to appropriate therapy [13]. Seminoma Stage I disease, confined to the testis, is managed by post-operative radiotherapy to the retroperitoneal nodes which reduces risk of recurrence from about 20% to 2%. Patients who relapse either during surveillance or after radiation are reliably cured with chemotherapy or radiation at the time of relapse. Normal levels of alpha-fetoprotein, the presence of any human chorionic gonadotrophin or any lactic dehydrogenase are good prognostic factors. Patients with abdominal involve- BIRTH PUBERTY FERTILIZATION Apoptosis Postnatal gonad Mitosis Mitosis Mitosis Gonocyte 2n Spermatogonium 2n Spermatogonium 2n Spermatocyte 4n Recombination checkpoint Cyclin D2 p53 Aberrant chromatid exchange 12p Amplification (↑ Cyclin D2) Transformation Apoptosis rescue ment from seminoma should receive either radiation therapy (5 cm bulk disease). Nonseminoma Patients with local nonseminoma confined to the testis should be offered either aggressive surveillance or nerve-sparing retroperitoneal lymph node dissection. Surveillance requires monthly chest Xrays and assay of markers and two-monthly abdominal CT scans for one year. In the second year following diagnosis, chest Xray and assay of tumour markers should be carried out every six months and CT performed every three months. Good Sperm 1n Gamete imprinting Zygote 2n CIS 4n Maternal host Mitosis Mitosis Embryo 2n Apoptosis Embryonal imprinting Body plan Cell fate Differentiation GCT ±4n Apoptosis Aberrant Imprinting Cell fate Differentiation prognostic factors include low levels of alpha-fetoprotein (
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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
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prolonged use. Similar drugs, that
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aspirin and other non-steroidal ant
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SCREENING FOR BREAST CANCER SUMMARY
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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 and 198: LIVER CANCER SUMMARY > About 560,00
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: Management The dramatic division be
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
Page 249 and 250: Fig. 5.131 Primary melanoma with a
Page 251 and 252: THYROID CANCER SUMMARY > Cancer of
Page 253 and 254: Papillary carcinoma RET/PTC TRK BRA
Page 255 and 256: 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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