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GASTROESOPHAGEAL CANCER EPIDEMIOLOGY AND CLINICAL PRESENTATION Prof Eric Van Cutsem, MD, PhD University Hospitals Leuven Belgium
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
