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cava involvement reduces five-year survival rates to 25-50%, whilst regional lymph node involvement or extracapsu- REFERENCES 1. Richie JP, Kantoff PW, Shapiro CL (1997) Renal cell carcinoma. In: Holland JF, Bast RC, Morton DL, Frei E, Kufe DW, Weichselbaum RR eds, Cancer Medicine, Williams and Wilkins. 2. Godley PA, Ataga KI (2000) Renal cell carcinoma. Curr Opin Oncol, 12: 260-264. 3. Ferlay J, Bray F, Parkin DM, Pisani P, eds (2001) Globocan 2000: Cancer Incidence and Mortality Worldwide (IARC Cancer Bases No. 5), Lyon, IARCPress. 4. McLaughlin JK, Blot WJ, Devesa SS, Fraumeni FJ (1996) Renal cancer. In: Schottenfeld D, Fraumeni, JFJ eds, Cancer Epidemiology and Prevention, New York, Oxford University Press, 1142-1155. 5. Chow WH, Devesa SS, Warren JL, Fraumeni JF, Jr. (1999) Rising incidence of renal cell cancer in the United States. JAMA, 281: 1628-1631. 6. Doll R (1996) Cancers weakly related to smoking. Br Med Bull, 52: 35-49. 7. Schmieder RE, Delles C, Messerli FH (2000) Diuretic therapy and the risk for renal cell carcinoma. J Nephrol, 13: 343-346. 8. Watkin N, Christmas TJ (1998) Renal Tumours. In: Morris D, Kearsley J, Williams C eds, Cancer: a comprehensive clinical guide, Harwood Academic Publishers. 9. Bernheim A, Vagner-Capodano A, Couturier J, et le Groupe Francais de Cytogenetique Oncologique (2000) De 264 Human cancers by organ site lar extension also indicates a much reduced rate of 15-50%. The presence of distant metastases or stage IV cancer la cytogénétique à la cytogénomie oncologique. Medecine/Sciences, 16: 528-539. 10. van den Berg, Dijkhuizen T (1999) Classification of renal cell cancer based on (cyto)genetic analysis. Contrib Nephrol, 128: 51-61. 11. Couch V, Lindor NM, Karnes PS, Michels VV (2000) von Hippel-Lindau disease. Mayo Clin Proc, 75: 265-272. 12. Hata J (1999) Wilms tumor and the WT1 gene. Contrib Nephrol, 128: 62-74. 13. Motzer RJ, Russo P (2000) Systemic therapy for renal cell carcinoma. J Urol, 163: 408-417. 14. Vogelzang NJ, Stadler WM (1998) Kidney cancer. Lancet, 352: 1691-1696. carries a very poor prognosis (5% fiveyear survival rate) [1]. WEBSITES NCI Kidney Cancer Homepage: http://www.cancer.gov/cancer_information/cancer_type/ kidney/ The Kidney Cancer Association (USA): http://www.nkca.org/
TUMOURS OF THE NERVOUS SYSTEM SUMMARY > Tumours of the nervous system account for less than 2% of all malignancies (about 175,000 cases per year worldwide); the incidence does not vary markedly between regions or populations. > Etiology is largely unknown; the only unequivocal cause is therapeutic irradiation, but occurrence in these circumstances is very rare. >The nervous system is frequently involved in inherited tumour syndromes, including neurofibromatosis (NF1/NF2 germline mutations), von Hippel-Lindau disease (VHL), tuberous sclerosis (TSC1/TSC2) and Li-Fraumeni syndrome (p53). > Glioblastomas are the most common brain tumours and mainly affect adults. These tumours are surgically incurable and largely resistant to radiation and chemotherapy; only 3% of patients survive more than 3 years. >Embryonal tumours, including cerebellar medulloblastomas, retinoblastomas and peripheral neuroblastoma, predominantly afflict children, ranking second after leukaemia as the most common types of paediatric cancer. Definition The majority of tumours of the central nervous system (CNS) are derived from glial cells (gliomas), the most malignant and frequent being glioblastoma. Malignant embryonal tumours typically manifest in children and occur in the central nervous system (medulloblastomas) and the sympathetic nervous system and adrenal gland (neuroblastomas). Tumours originating from the brain coverings (meningiomas) are usually benign. Epidemiology The age distribution of brain tumours is bimodal, with a peak incidence in children and a second larger peak in adults aged 45-70 [1]. In most developed countries, brain tumours are the 12 th most frequent cause of cancer-related mortality in men [2]. Geographical variation in incidence is less than for most other human neoplasms [2] (Fig. 5.149). However, incidence tends to be higher in more developed countries. In most North American and European countries, incidence rates for malignant tumours of the nervous system are 6-8 new cases per 100,000 population per year. Highest rates are observed in Sweden, Greece, Iceland and Croatia. In multiracial communities, both adults and children of African or Asian descent tend to be less frequently affected than whites. It has been reported that white Americans have a 3.5 times greater risk of glioblastoma and germ cell tumours than African Americans [1]. However, the lower incidence recorded for Singapore and Japan may be due to inadequate registration. < 6.6 < 7.8 < 9.1 < 10.2 < 11.6 Age-standardized incidence/100,000 population Fig 5.149 Incidence of cancers of the brain and nervous system in men, in Europe. Generally, incidence rates are higher for men; in particular, malignant brain tumours occur more frequently in males while the benign meningiomas occur predominantly in females. During the past decade, the incidence of glioblastomas in the elderly has increased by 1-2% per year but to some extent this may be due to the introduction of high-resolution neuroimaging. The brain is also a frequent site of metastases, with carcinomas of the breast and lung as most frequent primary tumours. Etiology With the exception of brain tumours associated with inherited cancer syndromes and the very rare cases caused by therapeutic irradiation, no causative environmental or lifestyle factors have been unequivocally identified. Radiation-induced meningiomas may follow low-dose irradiation for tinea capitis (a fungal infection of the scalp) and high-dose irradiation for primary brain tumours [3]. Children who received prophylactic CNS irradiation for acute lymphoblastic leukaemia seem to have an increased risk of developing malignant gliomas. Tumours of the nervous system 265
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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
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SCREENING FOR PROSTATE CANCER SUMMA
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Fig. 4.39 Poster designed for an an
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is around 10% for cancer (out of ev
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45 with one positive rehydrated FOB
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eing based on (i) time trends in th
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Fig. 4.48 Women at a clinic in Indi
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SCREENING FOR ORAL CANCER SUMMARY >
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India will provide useful informati
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cer incidence following cure of inf
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100 50 25 10 5 2.5 1 Japan Males Fe
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Human cancers by organ site Maligna
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tobacco smoking: age at start, aver
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diagnosis is usually confirmed by h
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is frequent and survival rates are
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Fig. 5.14 Physician reading digital
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Markers of prognosis in breast canc
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cer in the contralateral breast (Ch
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100 50 25 10 5 2.5 1 Japan Chile Po
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depends on staging. Small intramuco
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Fig. 5.30 A diet rich in fresh frui
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ane protein involved in cell adhesi
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LIVER CANCER SUMMARY > About 560,00
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Fig. 5.39 A woman in the Gambia pre
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REFERENCES 1. Ferlay J, Bray F, Par
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Certain Possible Uncertain Age Andr
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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
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
Page 257: Stage Clear cell carcinoma Papillar
Page 261 and 262: ing the optic tract, brain stem and
Page 263 and 264: mut = mutant p53 wt = wildtype p53
Page 265 and 266: SURGICAL ONCOLOGY SUMMARY > Surgica
Page 267 and 268: Year Radical mastectomy (%) Modifie
Page 269 and 270: TELEMEDICINE The prospects for tele
Page 271 and 272: Equipment Energy 50% depth dose App
Page 273 and 274: CANCER EDUCATION IN MEDICAL COURSES
Page 275 and 276: Fig. 6.10 Crystals of cisplatin: mo
Page 277 and 278: Responsiveness Cancer (in decreasin
Page 279 and 280: Most of the world’s most common c
Page 281 and 282: treatment of cancer. The problems l
Page 283 and 284: duction. It is clear that tumour ce
Page 285 and 286: REHABILITATION SUMMARY > Rehabilita
Page 287 and 288: cer and its associated disability.
Page 289 and 290: REFERENCES 1. Garden FH, Gillis TA
Page 291 and 292: Cancer pain relief varies and in so
Page 293 and 294: EMERGING ISSUES IN PALLIATIVE CARE
Page 295 and 296: Cancer control The negative impact
Page 297 and 298: priority to cancer control activiti
Page 299 and 300: Prevention of cancer Every country
Page 301 and 302: - Assessing the magnitude of the ca
Page 303 and 304: high-risk women. Further details on
Page 305 and 306: ecords departments are either rudim
Page 307 and 308: 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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