gastroesophageal cancer epidemiology and … · gastroesophageal cancer epidemiology and clinical...
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GASTROESOPHAGEAL CANCER EPIDEMIOLOGY AND CLINICAL PRESENTATION
Prof Eric Van Cutsem, MD, PhD
University Hospitals Leuven
Belgium
Leuven city hall and University
Leuven: capital of beer AnheuserBusch-InBev
Some important AB-Inbev brands are Stella Artois, Beck’s, Jupiler, Budweiser, Leffe, Labatt, Hoegaerden, Bass and Corona.
Outline
• Incidence and Mortality in US
• Global Incidence and Mortality
• Incidence and Mortality in Europe
• Analytical Epidemiology: Etiology
Courtesy A Cervantes for some slides
Gastric Cancer – Epidemiology
❑ * Declining in incidence
✓ * 4th commonest cancer globally
✓ * 934,000 new cases per year
✓ * 2nd most common cause of death (700,000) globally
✓ * 2/3 of cases in Asia
✓ * 42% of cases in China
✓ * Early gastric cancer – 5 year survival >90%
Ten leading cancer types for the estimated new cases in USA by sex in 2015.
Siegel RL et al. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65; 5-29
Ten leading cancer types for the estimated deaths in USA by sex in 2015.
Siegel RL et al. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65; 5-29
Siegel RL et al. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65; 5-29
Trends in death rates for selected types of cancer in males in USA.
Siegel RL et al. CA Cancer J Clin 2015; 65; 5-29
Stage distribution of esophageal cancer from 2004-2010 In USA by race.
All races
White
black
Siegel RL et al. Cancer Statistics, 2015. CA Cancer J Clin 2015; 65; 5-29
5 Year relative survival of esophageal cancer by race and stage at diagnosis from 2004-2010 In USA.
All races
White
black
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Estimated Number of New Cancer Cases in 21 World Areas, 2012. *Region estimates do not sum to the worldwide estimate due to calculation method. Source: GLOBOCAN 2012.
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Estimated new cancer cases and deaths worldwide
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Estimated new cancer cases and deaths worldwide in developed countries
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Estimated new cancer cases and deaths worldwide in developing countries
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Gastric cancer incidence rate by sex and world area
Plummer M, et al. Int J Cancer 2015; 136:487-490
New cancer cases attributable to infection in 2008
Torre LA et al. Global Cancer Statistics, 2012. CA Cancer J Clin 2015; 65; 87-108.
Esophageal cancer incidence rate by sex and world area
De Angelis R et al. Lancet Oncol 2014; 15:23-34.
Age-specific 5-year relative survival gastric cancer diagnosed in 2000-2007. The EUROCARE-5
De Angelis R et al. Lancet Oncol 2014; 15:23-34.
Age-standardized 5-year relative survival for gastric cancer followed up in 1999-2007. The EUROCARE-5
De Angelis R et al. Lancet Oncol 2014; 15:23-34.
European mean age-standardized 5-year relative survival for adult cancer patients diagnosed in 2000-2007. The EUROCARE-5
Castro C et al. Ann Oncol 2014; 25; 283-290.
Trends in incidence rate in men for esophageal cancer in Europe: rising incidence of adenocarcinoma.
SCC ADENO
Risk factors
• Male > Female (2:1) • Smoking • Nutrition • GERD - obesity • H. pylori infection • Atrofic gastritis • Partial gastrectomy • Genetic predisposition
(e.g. HNPCC, FAP, hereditary diffuse gastric cancer, Peutz Jeghers)
Waddel T et al. 2014
Turati F et al. Ann Oncol 2013; 24; 609-617.
Gastro-esophageal cancer and Body Mass index
FACTS ON GASTRIC CANCER EPIDEMIOLOGY-1
• Incidence of gastric cancer is decreasing in developed countries
• Incidence and mortality remains high in developing countries
• However it is still a severe global health issue
• Males:Females 2:1
• Wide variation in incidence accross countries
• Highest incidence in East Asia (Korea, Japan, Mongolia and China), Central and Eastern Europe and South America
• Lowest incicence in North America, Nothern Europe and Africa
FACTS ON GASTRIC CANCER EPIDEMIOLOGY-2
• Regional variations reflect differences in dietary patterns, food storage and availability of fresh products
• Prevalence of Helicobacter pylori infection
• Chronic infection of H. Pylori accounts for 90% of cases of non cardia gastric cancer
• Declining incidence may be due to: – Increase availability of fresh fruits and vegetables – Decreased reliance in salt preserved food
– Decreased incidence of H. pylori infection
– Decreased smoking in western countries
Ford AC, et al. Br Med J 2014; 348; g3174.
FACTS ON GASTRIC CANCER EPIDEMIOLOGY-3
• Increased Incidence and Mortality of upper third gastric cancer plus junctional and lower third adenocarcinoma of the esophagus – In USA and Europe and in countries where the incidence of non cardia
gastric cancer is low
– Predominant in males with high BMI and tobacco users
Etiology of Gastro-esophageal Junction Adenocarcinoma
Esophageal Gastric Adenocarcinoma Adenocarcinoma
❖ H.pylori protective + H.pylori – infection leading cause
❖ Obesity + Obesity ± ❖ Barrett’s esophagus + Barrett’s esophagus - ❖ Smoking + Smoking + ❖ Alcohol + Alcohol +
Siewert Classification for GE Junction Adenocarcinoma
5-year Survival by Stage at Diagnosis 95% 77% 50% 5%
I II III IV
50
10
20
30
40
0
%Stage of Gastric Cancer at Diagnosis
Majority of gastric cancers present at late stage
Clinical Presentation of Gastric Cancer
➢ Clinical presentation depends on stage of disease at diagnosis
➢ Early gastric cancer – asymptomatic or incidental GI symptoms epigastric pain, bloating, indigestion
➢ Advanced gastric cancer – Nausea / vomiting, hematemesis/malena, weight loss, gastric outlet obstruction, peritoneal effusion
