Cancer occurrence in Ardabil: results of a population-based cancer registry from Iran

The provincial health authority reported a high mortality rate from upper GI cancer in the newly established Ardabil Province of northwest Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 4-year (1996-1999) period among the indigenous population of Ardabil Province, including subjects seeking care in the cities of Tabriz and Tehran. Diagnosis of cancer was based on histopathology in 71.4%, clinical or radiologic findings in 25% and death certificate in 3.6% of cases. A total of 3,455 cancers (mean age 57.1 +/- 17.3 years) was found during the study. Of these, 60% (2,072) were in males. ASRs for all cancers in males and females were 132.0 and 96.3, respectively. The top 5 cancers in males (excluding skin cancer) according to the calculated ASR were stomach (49.1) [corrected], esophagus (15.4), lung and bronchus (7.9), colon and rectum (7.9) and bladder (7.6); in females, these were stomach (25.42), esophagus (14.4), breast (7.6), colon and rectum (5. 9) and lung and bronchus (3.6). Compared to rates obtained 30 years ago, the incidence of upper GI cancer in this region has increased about 100%, and there is a striking increase in the incidence of gastric cancer with a decline in the esophageal cancer rate. ASRs for gastric cancer in Ardabil were 49.1 for males and 25.4 for females, while for esophageal cancer these were 15.4 and 14.4, respectively. The ASR for cervical cancer was the lowest (0.4) recorded in the world before. Gastric cancer alone constitutes one-third of all cancers in Ardabil, the ASR of which is the highest reported from Iran up to now and one of the highest in the world.     

Esophageal squamous cell carcinoma associated with gastric adenocarcinoma

Adenocarcinoma of the stomach occurred in six of 425 consecutive patients with esophageal squamous cell cancer. In two cases, the gastric cancer, which was recognized at 17 and 29 months, respectively, after the nonsurgical treatment of the esophageal tumor, was treated by surgical resection. In three cases, the tumors which were diagnosed simultaneously, were treated by surgery (one case) resection of the gastric tumor and nonsurgical therapy for the esophageal tumor (one case), and nonsurgical therapy for both tumors (one case). In one case, a gastric cancer was resected 6 years before diagnosis of an esophageal tumor and a second cancer in the gastric stump. A nonsurgical protocol was then adopted for both tumors. The association of these two cancers raises questions concerning their epidemiology, diagnosis, prognosis, and management. There is room for nonsurgical multimodality protocols and, in association with surgery, survival was prolonged for more than 1 year in five of six patients.     

Cancer in East Azerbaijan, Iran: Results of a Population-based Cancer Registry

Background and aims: Regardless of the fact that cancers of GI tract have been reported to be the most common fatal neoplasms in East Azerbaijan, there is a serious lack of population-based studies in this region. Methods: A comprehensive search was therefore undertaken to prospectively register all cases of cancer occurring in the province during March 2006-2007. Diagnosis of cancer was based on histopathology of primary lesions in 84.0% of cases, clinical investigation and ultrasound in 7.2%, only clinical investigation in 5.4%, and histology of metastasis in 2.9. Less than 1% were based on cytology and death certificates in one official year. Results: A total of 4,922 cancers (mean age 60.2 years) were diagnosed during this population-based study. Of these, 56.8% (2,114) were in males. ASRs for all cancers in males and females were 164.3 and 130.6 respectively. The top five sites for cancer in males (excluding skin cancer) according to the calculated ASR (world) were stomach (26.0), bladder (15.7), esophagus (12.4), colon and rectum (11.6) and blood (10.8); in females, they were breast (23.5), esophagus (11.7), stomach (11.6), colon and rectum (9.7) and nervous system (5.5). Conclusion: This first comprehensive report on cancer incidence in East Azerbaijan documents particularly high incidence rates for esophageal and gastric cancer across the sexes.     

Esophageal/Gastric Cancer Screening in High-risk Populations in Henan Province,China

Objective: To summarize the endoscopic screening findings in high-risk population of esophageal and gastriccarcinoma and analyze influential factors related to screening. Methods: In seven selected cities and counties withhigh incidences of esophageal carcinoma, people at age of 40-69 were set as the target population. Those withgastroscopy contradictions were excluded, and all who were voluntary and willing to comply with the medicalrequirements were subjected to endoscopic screening and histological examination for esophageal, gastric cardiaand gastric carcinoma in accordance with national technical manual for early detection and treatment of cancer.Results: In three years, 36,154 people were screened, and 16,847 (46.60%) cases were found to have precancerouslesions. A total of 875 cases were found to have cancers (2.42%), and among them 739 cases had early stagewith an early diagnosis rate is 84.5%. Some 715 patients underwent prompt treatment and the success rate was81.8%. Conclusions: In a high-risk population of esophageal and gastric carcinoma, it is feasible to implementearly detection and treatment by endoscopic screening. Screening can identify potential invasive carcinoma,early stage carcinoma and precancerous lesions, improving efficacy through early detection and treatment. Theexploratory analysis of related influential factors will help broad implementation of early detection and treatmentfor esophageal and gastric carcinoma.     

Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer

BACKGROUND: The aim of this study was to determine by radioisotope use whether the sentinel lymph node concept is applicable to esophagogastric cancers. In addition, we examined radioactivities of hot nodes and compared them with the sensitivity of a gamma probe. METHODS: The subjects were 44 patients, 23 with esophageal cancer and 21 with gastric cancer. The day before surgery, patients underwent endoscopic submucosal injection of 184 MBq of Tc-99m tin colloids into sites surrounding the tumor. Radioisotope activities of lymph nodes dissected at surgery were measured with a well-typed gamma detector and each lymph node was categorized as a hot or cold node. Histopathology of the lymph nodes was examined by hematoxylin and eosin staining. Radioisotope activities and histopathological results were compared to determine whether radioisotope flow reflects lymphatic flow to regional lymph nodes. The sensitivity of a gamma probe was measured in a laboratory study and the relation between the radioisotope activities of hot nodes and the detection sensitivity of the gamma probe was examined. RESULTS: Histopathological examination revealed lymph node metastasis in 18 of the 44 patients. In 15 of these 18 patients, metastatic foci were recognized in at least one hot node. Subsequent analysis was performed on the 36 patients in whom tumor invasion was confined to the muscle layer and in whom endoscopic clippings had not been applied. Lymph node metastases were observed in 12 of these 36 patients. In these 12 patients, at least one hot node was positive for metastasis. The laboratory study revealed that the gamma probe was able to detect radioisotope activities of >/=0.02 micro Ci. Thirty-two of 63 (51%) esophageal cancer hot nodes and 16 of 86 (19%) gastric cancer hot nodes showed radioisotope activities below the detection sensitivity of the gamma probe. CONCLUSION: The sentinel lymph node concept is applicable to patients with esophageal and gastric cancers; however, further studies are necessary to identify hot nodes accurately using gamma probes.     

Incidence,Survival and Prevalence of Esophageal and Gastric Cancer in Linzhou City from 2003 to 2009

This study describes recent trends in incidence, survival and prevalence of subgroups of esophageal and gastriccancer in Linzhou city between 2003 and 2009. Data of esophageal and gastric cancer for the period of interestwere extracted from the Linzhou Cancer Registry. Using information on tumor morphology or anatomical site,data were divided into six groups; esophageal squamous cell carcinoma, esophageal adenocarcinoma, otherand unspecified types of esophageal cancer, and cardia, non-cardia, and unspecified anatomical site of stomachcancer. Incidence, survival and prevalence rates for each of the six cancer groups were calculated. The majorityof esophageal cancers were squamous cell carcinomas (82%). Cardiac cancer was the major gastric cancer group(64%). The incidence of esophageal squamous cell carcinoma and gastric cardiac cancer increased between 2003and 2009. Both esophageal and gastric cancer had a higher incidence in males compared with females. Overallsurvival was poor in all sub-groups with 1 year survival ranging from 45.9 to 65.6% and 5 year survival rangingfrom 14.7 to 30.5%. Prevalence of esophageal squamous cell carcinoma and gastric cardiac cancer was high(accounting for 80% overall). An increased focus on prevention and early diagnosis, especially in esophagealsquamous cell carcinoma and gastric cardiac cancer, is required.     

Endoscopic mucosal resection for esophageal cancer

Lymph node metastasis or microvascular permeation is rare among esophageal cancer which remains within the epithelium or the lamina propria mucosae. Endoscopic mucosal resection (EMR) is recommended for them as a radical treatment. Radical esophagectomy had been indicated for esophageal cancer reaching to the muscularis mucosae for their incidence of lymph node metastasis (10%). Recently, number of m3 or sm1 cancer cases treated by EMR has been increased, for some clinical trial succeeded to show that there is no significant difference between the prognosis of patient treated by EMR and by surgery. Thirty one patients (14%) have been lost among 219 patients who underwent EMR (mucosal cancer: 196 and submucosal cancer: 23). Four cases (13% of all patients lost after EMR) died of esophageal cancer, (one case with m3 cancer was lost by lymph node metastasis, one with sm2 cancer by liver metastasis, and two patients who refused surgical treatment by local recurrence after EMR), nineteen by other diseases than esophageal cancer and eight by cancer at other organs (lung: 3, hypoharynx: 2, mesopharynx: 1, stomach: 1, ureter: 1). Three of them were found concomitantly and 5 metachronously. Local recurrence was found in 8.3% of all patients treated by EMR. All patients with recurrence had received piecemeal resection. Sixty seven percents of all lesion of local recurrence was detected by endoscopic surveillance within one year after EMR. All recurred lesions were treated by EMR and pathological studies on resected specimens revealed that all recurred lesions were mucosal cancer. Metachronous esophageal cancer was found in 11% of all EMR cases. Sixty five percent of all metachronous cancer were detected in one to three years after EMR. Metachronous esophageal cancer after EMR was frequently found among cases with esophageal mucosa which has many small unstained areas. Malignant lesions were found in 33 cases (15%) of all patients treated by EMR synchronously and 37 (17%) metachronously. The stomach and the head and neck are most frequent site of associated cancers.     

食管及贲门癌术后并发症再手术治疗（附17例分析）

目的：分析对食管及贲门癌术后几种常见并发症施再手术治疗的临床意义。方法：对１７例食管及贲让癌术后发生吻合口瘘、乳糜胸、胃穿孔等并发症的患者进行再次开胸分别施行吻合口重建,胸导管结扎及胃穿也修补术,并对再手术治疗的治愈率,死亡率进行统计分析。结果：经再手术治疗的１７例中因乳糜胸行胸导管结扎术７例,治愈４例,死亡３例。因吻合口瘘行吻理建术５例。治愈３例,死亡１例,１例自动出院;因胸内胃穿孔行胃穿孔修补     

Esophageal Cancer in the Intermediate Stage

When we consider the prognosis of esophageal carcinoma, we cometo the conclusion that the less the invasion of the disease,the better the prognosis can be. It is quite reasonable that the prognosis of early cancer isthe most favorable. However, a relatively good prognosis wasalso found for the patients with a, cancer, in which the slightestinvasion into the adventitia had been detected, the incidenceof 5-yr survivors being 31.2%. Approximately 35% of these patientswhose cancers were resected by us were shown to have the diseasein this stage. Since there have not been many patients withearly carcinoma treated so far, we should initially aim at thedetection and treatment of the cancers in which the invasionis limited to the submucosa (sm) and the proprial muscular layer(mp), and those in which invasion reaches just to the adventitia(a, cases). However, if there has been any histological evidenceof lymph node metastasis, intravascular invasion or skip metastasisin such cases, the patients are most likely to die within 1or 2 yr after the operation because of recurrence. When thepatients show such findings postoperatively, they must be giventhe most effective systemic treatment.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.     

hMAM mRNA在乳腺癌组织中的表达

目的：探讨乳腺组织特异性基因ｈＭＡＭ ｍＲＮＡ作为检测乳腺癌微小转移指标的可能性。方法：采用ＲＴ－ＰＣＲ方法,检测ｈＭＡＭ ｍＲＮＡ在乳腺癌组织和相应癌旁正常乳腺组织４４例及胃癌、大肠癌、食管癌、肺癌、卵巢癌组织各５例中的表达。分析ｈＭＡＭｍＲＮＡ表达与乳腺癌临床病理特点之间的关系。实验结果进行统计学处理。结果：４４例乳腺癌组织和相应癌旁组织中均表达ｈＭＡＭ ｍＲＮＡ,其中有５６．８２％（２５／４     

Clinicopathologic Studies of Gastric Cancer with Metastasis to the Liver--Based on the Cases Detected at Initial Surgery

A total of 3,010 patients with gastric cancer were operatedon in our surgical department during the 13-year period from1968 to 1980. Out of these, 204 patients with liver metastasisdetected at the initial surgery were studied. The incidence was 6.8%. The primary lesion was resected in 104of the 204 cases. Male patients comprised about 75% and 60-to 69-year-old patients constituted about 45%. In relation tothe site of the primary lesion, cancer invading to all areasof the stomach comprised 44% of the nonresected group, whilecancer located in the lower portion was more frequent than thatin the upper portion in the resected group. The resected stomachwas analyzed histopatholo-gically. Most of the cancers belongedto Borrmann gross types II and III. Histologically, papillaryand well- or moderately differentiated tubular adeno-carcinomasconstituted 65% and medullary type 61.5%. Concerning the prognosis,median survival in the resected group was two to three monthslonger than in the nonresected group. When chemotherapy wasperformed, survival was prolonged a further two to three months.     

A case of triple cancer--gastric, esophageal and hepatocellular carcinoma

A case of triple cancer involving a tubular adenocarcinoma of the stomach, a squamous cell carcinoma of the esophagus, and hepatocellular carcinoma of the live is reported. These three cancers had been diagnosed while the patient was alive and later were confirmed by autopsy. The esophageal cancer and hepatocellular carcinoma were found almost simultaneously, 6 years after surgery for the gastric cancer. Although many cases of triple cancer have been reported, a triple cancer of this combination is very rare (0.3% of all cases of triple cancer), our case being the fifth such case in Japan.     

胸腹腔镜和开放手术对食管癌的安全性评估及远期疗效比较

目的 评估胸腔镜腹腔镜和开放手术治疗食管癌的安全性及远期疗效.方法 选取134例食管癌患者进行回顾性分析,其中49例使用胸腹腔镜联合食管癌切除根治术,其余85例采用传统的开放性手术.评估2组患者的手术指标、术后并发症以及远期疗效.结果 手术过程中开放组3例死亡,腔镜组未出现死亡.2组在术后住院时间及胸管留置时间上无明显差异;腔镜组手术中出血量明显少于开放手术组;2组术后并发症的发生率差异无统计学意义.腔镜组术后5年生存率明显高于开放手术组.结论 微创食管癌手术在手术出血、术后恢复以及远期疗效上有着很明显的优势.     

管状胃法在食管癌和贲门癌根治术中的应用效果研究

目的研究管状胃法在食管癌和贲门癌根治术中的应用效果。方法选取2011年1月至2012年12月接受手术治疗的食管癌与贲门癌患者62例,按照食管重建方法分为观察组(31例)和对照组(31例)。两组患者一般资料比较,差异无统计学意义(P>0.05),观察组患者采取管状胃法治疗,对照组患者采取全胃缝缩治疗。结果两组患者手术成功率均为93.5%(P>0.05)。观察组和对照组患者手术后感染率分别为0和19.4%(P<0.05)。观察组和对照组患者手术后死亡率分别为0和12.9%(P>0.05),两组患者其他各项观察指标比较,差异无统计学意义(P>0.05)。结论食管癌和贲门癌采用管状胃法根治术,效果显著,值得在临床上推广应用。     

Preoperative and adjuvant therapies for upper gastrointestinal cancers

Survival of esophageal, gastrointestinal junction and gastric cancers is poor given that they frequently present with locally advanced or metastatic disease. The incidence of gastrointestinal junction adenocarcinoma is increasing whereas that of squamous cell carcinoma of the esophagus is decreasing. The accuracy of staging has improved with newer diagnostic techniques, including positron emission tomography, endoscopic ultrasound and laparoscopy, and this should be integrated in prospective Phase III clinical trials evaluating neoadjuvant and adjuvant therapies for some esophageal and all gastric carcinomas. For esophageal cancer (except for one trial by Walsh and colleagues), four randomized Phase III trials comparing preoperative chemoradiation followed by surgery versus surgery alone have not shown a survival benefit. Neither have the trials, where preoperative chemoradiation followed by surgery, is compared with definitive chemoradiation. Nevertheless, it is commonly practiced in the USA and has become a preferred combined modality approach. Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more than Stage IA). The UK-MAGIC trial results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, probably has an impact on the treatment practice of these cancers in Europe and Asia. Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer (pathologic complete response of 20-30%) need to be further evaluated in a Phase III setting and compared with postoperative chemoradiation. Active ongoing research will help us clarify the role of preoperative and adjuvant therapies in esophageal and gastric cancers. The role of molecular profiling is evolving and will help us differentiate the responders from the nonresponders.     

Comparison of Two Diverse Populations, British Columbia, Canada, and Ardabil, Iran, Indicates Several Variables Associated with Gastric and Esophageal Cancer Survival

Background

Geographic variation and temporal trends in the epidemiology of esophageal and gastric cancers vary according to both tumor morphology and organ subsite. This study compares 1-year survival of gastric and esophageal cancers between two distinct populations: British Columbia (BC), Canada, and Ardabil, Iran.

Methods

Data for invasive primary esophageal and gastric cancer patients were obtained from the population-based cancer registries for BC and Ardabil. The relative survival rate was calculated using WHO Statistical Information System (WHOSIS) life-tables for each country. Chi-square and Fisher??s exact tests were used to compare survival differences between BC and Ardabil. T-tests, chi-square tests, and Fisher??s exact test were used to compare patient characteristics and tumor factors between the populations.

Results

The overall 1-year age-standardized relative survivals for gastric cancer were 48% and 21% in BC and Ardabil, respectively (p?p?Conclusion Findings of this study point to differences in disease characteristics and patient factors, not solely differences in healthcare systems, as being responsible for the survival difference in these populations.     

Preoperative and adjuvant therapies for upper gastrointestinal cancers

Survival of esophageal, gastrointestinal junction and gastric cancers is poor given that they frequently present with locally advanced or metastatic disease. The incidence of gastrointestinal junction adenocarcinoma is increasing whereas that of squamous cell carcinoma of the esophagus is decreasing. The accuracy of staging has improved with newer diagnostic techniques, including positron emission tomography, endoscopic ultrasound and laparoscopy, and this should be integrated in prospective Phase III clinical trials evaluating neoadjuvant and adjuvant therapies for some esophageal and all gastric carcinomas. For esophageal cancer (except for one trial by Walsh and colleagues), four randomized Phase III trials comparing preoperative chemoradiation followed by surgery versus surgery alone have not shown a survival benefit. Neither have the trials, where preoperative chemoradiation followed by surgery, is compared with definitive chemoradiation. Nevertheless, it is commonly practiced in the USA and has become a preferred combined modality approach. Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more than Stage IA). The UK–MAGIC trial results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, probably has an impact on the treatment practice of these cancers in Europe and Asia. Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer (pathologic complete response of 20–30%) need to be further evaluated in a Phase III setting and compared with postoperative chemoradiation. Active ongoing research will help us clarify the role of preoperative and adjuvant therapies in esophageal and gastric cancers. The role of molecular profiling is evolving and will help us differentiate the responders from the nonresponders.     

Aneuploidy of tumor cells in cases of gastric cancer with esophageal invasion: Another indicator of poor prognosis

The prognosis of patients with gastric cancer with esophageal invasion is extremely poor. To evaluate factors related to this poor prognosis, we analyzed 200 patients with gastric cancer located in the upper third of the stomach. These patients underwent gastrectomy and were divided into two groups in terms of the presence (E[+] group; n=62) or absence (E[-] group; n=138) of histological evidence of esophageal invasion. Even when apparently curative surgery was performed, the 5-year survival rate of patients with E[+] gastric cancer (45.8%) was significantly lower than of patients with E[-] gastric cancer (71.6%). In the E[+] group, the 5-year survival rate of patients who had tumors with infiltrative growth and DNA aneuploidy was only 10.0%. These patients had a high frequency of peritoneal metastasis at operation (5/16; 31.3%); even when apparently curative operations were performed, 50% of these patients died from peritoneal metastatic recurrence within 2 years after surgery. Gastric adenocarcinoma with esophageal invasion accompanied by infiltrative growth and DNA aneuploidy had a high potential for peritoneal metastasis. This combination is associated with the most pessimistic prognosis for patients with gastric cancer with esophageal invasion. © 1995 Wiley-Liss, Inc.     

Combined modality therapy of localized gastric and esophageal cancers

Gastric and esophageal cancers continue to be a significant health problem. The incidence of proximal gastric and distal esophageal cancers has been increasing, especially in white men. Gastric and esophageal cancers have high rates of locoregional and distant failure, resulting in poor overall survival. Therefore, patients with gastric and esophageal cancer may benefit from combined modality therapy. Adjuvant chemoradiation has been shown to improve survival in gastric and gastroesophageal cancers in a phase III trial. In esophageal cancer, most randomized trials have not shown a survival benefit for preoperative chemotherapy or chemoradiation, although these approaches are widely used. This article reviews the role of staging, surgery, and adjuvant and preoperative therapies in the management of localized gastric and esophageal cancers.