171,623 research outputs found
Two distinct aetiologies of cardia cancer, evidence from premorbid serological markers of gastric atrophy and Helicobacter pylori status
No full textBackground: Non-cardia gastric adenocarcinoma is positively associated with Helicobacter pylori infection
and atrophic gastritis. The role of H pylori infection and atrophic gastritis in cardia cancer is unclear.
Aim: To compare cardia versus non-cardia cancer with respect to the premorbid state of the stomach.
Methods: Nested case–control study. To each of 129 non-cardia and 44 cardia cancers, three controls were
matched. Serum collected a median of 11.9 years before the diagnosis of cancer was tested for anti-H pylori
antibodies, pepsinogen I:II and gastrin.
Results: Non-cardia cancer was positively associated with H pylori (OR 4.75, 95% CI 2.56 to 8.81) and
gastric atrophy (pepsinogen I:II ,2.5; OR 4.47, 95% CI 2.71 to 7.37). The diffuse and intestinal histological
subtypes of non-cardia cancer were of similar proportions and both showed a positive association with
H pylori and atrophy. Cardia cancer was negatively associated with H pylori (OR 0.27, 95% CI 0.12 to
0.59), but H pylori-positive cardia cancer showed an association with gastric atrophy (OR 3.33, 95% CI 1.06
to 10.5). The predominant histological subtype of cardia cancer was intestinal and was not associated with
gastric atrophy compared with the diffuse subtype ((OR 0.72, 95% CI 0.19 to 2.79) vs (OR 3.46, 95% CI 0.32
to 37.5)). Cardia cancer in patients with atrophy had an intestinal: diffuse ratio (1:1) similar to non-cardia
cancer (1.9:1), whereas cardia cancers in patients without atrophy were predominantly intestinal (7:1).
Conclusion: These findings indicate two aetiologies of cardia cancer, one associated with H pylori atrophic
gastritis, resembling non-cardia cancer, and the other associated with non-atrophic gastric mucosa,
resembling oesophageal adenocarcinoma. Serological markers of gastric atrophy may provide the key to
determining gastric versus oesophageal origin of cardia cancer
Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gatric cardia cancer.
No full text<b>INTRODUCTION</b>
Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux
disease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the
aetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association
between adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic
gastritis and GORD symptoms.
<b>METHODS</b>
138 patients with upper GI adenocarcinoma and age and sex matched controls were studied.
Serum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles.
History of GORD symptoms, smoking and H.pylori infection was incorporated in logistic regression
analysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal
adenocarcinoma.
<b>RESULTS</b>
Non-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of
these cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD
symptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively
associated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 – 8.67)] and with frequent
GORD symptoms [OR, 95% CI: 10.08 (2.29 – 44.36)] though the latter was only apparent in the nonatrophic
subgroup and in the intestinal subtype. The association of cardia cancer with atrophy was
stronger for the diffuse versus intestinal subtype and this was the converse of the association
observed with non-cardia cancer.
<b>CONCLUSION</b>
These findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic
gastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to
GORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD
symptoms and histological subtype may distinguish between gastric versus oesophageal origin of
cardia cancer
Incidence and survival of oesophageal and gastric cancer in England between 1998 and 2007, a population-based study.
No full textBACKGROUND: Major changes in the incidence of oesophageal and gastric cancers have been reported internationally. This study describes recent trends in incidence and survival of subgroups of oesophageal and gastric cancer in England between 1998 and 2007 and considers the implications for cancer services and policy. METHODS: Data on 133,804 English patients diagnosed with oesophageal and gastric cancer between 1998 and 2007 were extracted from the National Cancer Data Repository. Using information on anatomical site and tumour morphology, data were divided into six groups; upper and middle oesophagus, lower oesophagus, oesophagus with an unspecified anatomical site, cardia, non-cardia stomach, and stomach with an unspecified anatomical site. Age-standardised incidence rates (per 100,000 European standard population) were calculated for each group by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan-Meier method. RESULTS: The majority of oesophageal cancers were in the lower third of the oesophagus (58%). Stomach with an unspecified anatomical site was the largest gastric cancer group (53%). The incidence of lower oesophageal cancer increased between 1998 and 2002 and remained stable thereafter. The incidence of cancer of the cardia, non-cardia stomach, and stomach with an unspecified anatomical site declined over the 10 year period. Both lower oesophageal and cardia cancers had a much higher incidence in males compared with females (M:F 4:1). The incidence was also higher in the most deprived quintiles for all six cancer groups. Survival was poor in all sub-groups with 1 year survival ranging from 14.8-40.8% and 5 year survival ranging from 3.7-15.6%. CONCLUSIONS: An increased focus on prevention and early diagnosis, especially in deprived areas and in males, is required to improve outcomes for these cancers. Improved recording of tumour site, stage and morphology and the evaluation of focused early diagnosis programmes are also needed. The poor long-term survival reinforces the need for early detection and multidisciplinary care
Gastric Cancer in Ardabil, Iran - a Review and Update on Cancer Registry Data
No full textThe incidence rate of gastric cancer in western countries has shown a remarkable decline in recent years
while it is still the most common cancer among men in Iran. Ardabil, a North Western province, was found to
have the highest rate of GC in Iran and one of the highest gastric cardia cancer rates in the world. We used the
most recent data from Ardabil cancer registry to update on the incidence and mortality of GC and performed
an extensive search of the English and Persian literature in Pub Med, Embase and all 5 Persian web-based
databases, respectively, to summarize all possible risk factors for GC in Ardabil. The age-standardized incidence
rate of gastric cancer was 51.8 (95% CI: 47.8-55.8) in men and 24.9 (95% CI: 21.5-27.2) in women per 100,000.
Age-standardized mortality rates for gastric cancer in this population were 32.2 (95% CI: 29.1-35.3) and 16.3
(95% CI: 13.9-18.6). The gastric cardia sub-site was the most common location (32.7%) in Ardabil. According
to our review H.pylori infection, gastroesphageal reflux symptoms, tobacco smoking, and high intakes of salt,
red meat and dairy products increase the risk of GC while diets with a high content of allium vegetables and
fruits, especially citrus fruits, and consumption of fresh fish, were significantly protective against GC. We
conclude that Ardabil has the highest rate of GC in Iran and one the highest rates of gastric cardia cancer in
the world, with no evidence of decline in incidence since 2000. In addition to H.pylori infection, the epidemic
of gastroesphageal reflux disease and several dietary factors may be responsible for the very high incidence of
gastric cardia cancer in Ardabil
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