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DOI: 10.1055/s-2002-35311
Endoscopic Tumor Diagnosis and Treatment
Publication History
Publication Date:
13 November 2002 (online)
Epidemiology and Screening
There are many risk factors for carcinogenesis, including cigarette smoking, alcohol, coffee drinking. However, it is difficult to investigate the extent to which such factors are significantly responsible for the development of cancer. Kaneko et al. investigated whether daily consumption of alcohol and/or cigarette smoking is related to an initial esophageal carcinoma lesion [1]. Video endoscopy with Lugol staining was carried out in 1257 consecutive patients - 641 with daily consumption of alcohol and/or cigarettes, representing a high-risk population, and 616 patients alcohol or cigarette consumption, representing a low-risk population. The rate of low-grade dysplasia (LGD) in the high-risk population was 1.7 % (11/641), compared with 1.8 % (11/616) in the low-risk population (P = 0.925); for high-grade dysplasia (HGD), the figures were 2.0 % (13/641) vs. 0.3 % (2/616) (P < 0.0001). The rates of alcohol drinking and/or cigarette smoking in patients with LGD, HGD, and invasive carcinoma were 50 % (11/22), 87 % (13/15), and 90 % (63/70), respectively. The authors concluded that daily consumption of alcohol and/or cigarettes is not significantly related to the initiation of carcinogenesis in the esophagus, but they suggest that such consumption may act as a promoter for progression from LGD to HGD.
Chang et al. also reported on the clinical, endoscopic, and pathological features in 53 patients with superficial esophageal cancer [2]. Forty-two of the patients reported alcohol consumption, 40 were smokers, one had corrosive esophagitis, and one had Barrett’s esophagus. Associated malignancies included head and neck cancer (n = 3), gastric cancer (n = 7), and bladder cancer (n = 1). At the time of diagnosis, 29 of the patients (54.7 %) had esophageal symptoms, whereas 24 patients (45.3 %) presented with nonspecific symptoms or were detected during routine check-up. The endoscopic findings showed that the superficial type of lesion was most frequent (35.8 %), and the lesions were most commonly located in the mid-esophagus (64.2 %). Forty-five patients (84.9 %) underwent surgical resection, and eight (15.1 %) received endoscopic resection. Thirty-five patients (66 %) showed submucosal involvement, 12 patients (22.6 %) intramucosal involvement, and six patients (11.3 %) had lesions limited to the epithelium. There were lymph-node metastases from intramucosal cancers in two patients (11 %), whereas eight (22.9 %) of those with submucosal cancer had lymph-node metastases.
There also appear to be risk factors for gastric cancer such as Helicobacter pylori infection, salt consumption, nitrosourea, and genetic factors. Ng et al. reported an increased frequency of premalignant gastric lesions in first-degree relatives of gastric cancer patients [3]. A total of 65 first-degree relatives of 25 index cancer patients and 95 control individuals were studied. Gastric cancer relatives had similar H. pylori infection rates to those of the control patients (56.8 % vs. 61.5 %, P = 0.08). The active and chronic inflammation scores on the Sydney system were also comparable. However, intestinal metaplasia and dysplasia were significantly more frequent in relatives than in controls (intestinal dysplasia 41.5 % vs. 15.8 %, P = 0.001; dysplasia: 9.8 % vs. 0 %, P = 0.003).
Gastric intestinal metaplasia is commonly found in first-degree relatives of gastric cancer patients. Factors in addition to H. pylori infection are likely to contribute to the development of premalignant gastric lesions in family members. Gastric intestinal metaplasia is generally considered to be a precursor lesion in the development of intestinal-type adenocarcinoma. Shen et al. concluded that aberrant expression of monoclonal antibody (mAb) Das-1 reactive antigen of the colonic phenotype in both precancerous lesions (intestinal metaplasia) and gastric adenocarcinoma may be clinically significant for early detection or possible endoscopic surveillance [4].
The early detection of stomach cancer, mainly thanks to mass screening (usually using radiography) has led to better survival rates in Japan. Dan et al. conducted a cost-effectiveness analysis to identify population subgroups who might benefit from a mass endoscopic screening program in Singapore [5]. The study was carried out in the male population in Singapore at intermediate risk for stomach cancer, comparing a group receiving mass screening and a group without. Screening of the Singapore male population over the age of 50 (340 000 patients) using endoscopy every 2 years resulted in the prevention of 4272 additional stomach cancer deaths. The cost of averting one cancer death was equivalent to US$ 129 800, and the cost benefit of the screening program was US$ 12 810 per quality-adjusted life year saved. The authors concluded that screening for gastric cancer in a moderate to high-risk population subgroup is potentially cost-effective.
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M. Kida, M.D.
Dept. of Medicine · Kitasato University East Hospital
2-1-1 Asamizodai, Sagamihara · Kanagawa 228-8520 · Japan
Fax: + 81-427-49-8690
Email: m-kida@kitasato-u.ac.jp