Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites

Abstract

Summary Data in a regional cancer registry covering a population of 5 million and with an efficiency of registration of over 95% have been used to examine incidence trends in oesophageal and gastric carcinoma. In the West Midlands Region of the UK, during the period 1962 to 1981 the age standardised incidence of gastric carcinoma decreased by 20%. However, an analysis by both histological type and detailed site reveals that while the incidence of distal lesions is diminishing, the incidence of adenocarcinoma of the oesophagus and cardia is increasing. The proximal and distal lesions also exhibit marked differences in social class distribution and sex ratio. The results strongly suggest that the aetiological factors involved for cardia and adjoining sites are different from those for pyloric antrum.The morbidity and mortality rates of gastric carcinoma have been decreasing in the West Midlands Region of England as they have generally throughout the world. However, mortality rates usually refer to all histological types and all sites combined, and there have been a number of reports (Yang & Davis, 1988;Moller & Moller Jensen, 1988;Antonioli & Cady, 1984;Storm, 1983) (Waterhouse, 1974). As part of a comprehensive epidemiological and clinical study of the data in the registry (Fielding et al., 1989), trends in both histological and site distribution were examined for the period 1957-1981. Registration was known to be incomplete during the earliest years and, for this reason, the results given here are restricted to the period [1962][1963][1964][1965][1966][1967][1968][1969][1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981] except, for reasons given later, in the analysis by type of first symptom. As part of the original study the data had already been subjected to intensive validity checks and assessments which are described in the monographs on oesophageal and stomach cancer (Matthews et al., 1987;Fielding et al., 1989) of endoscopies. Endoscopy here includes both rigid oesophagoscopy and the flexible tubes which became prevalent in the early 1970s, since the two types cannot be distinguished in the Registry code used. The effect of the rise in patients undergoing endoscopy was examined within each sub-site, these are likely to be underestimates because not all investigations will have been routinely reported to the Registry. The size of this error is not known but is unlikely to have changed substantially over the study period.Another factor used to assess the validity of the changes in sub-site incidence was the type of first symptom, although this was only available for the period 1957-76. Cardia patients have a very much higher rate of dysphagia than others and an increase in dysphagia rate would, therefore, imply an increase in lesions involving the cardia. However, since the number of all recorded symptoms had increased, a standardised rate based on the all symptoms rate in 1972-76 was calculated for each 5-year period.Other factors examined were mean age, sex ratio and social class. Th...

Epidemiological features of gastric and oesophageal cancers in Slovakia

“…of oesophageal cancer, which are only now increasing in men. It is of interest, therefore, to examine whether this increase is primarily due to an increasing frequency of adenocarcinomas and whether a similar increase is occurring in the cardia, as has been reported from the United States (Wang et al, 1986;Yang & Davis, 1988) and countries of western Europe (Levi & La Vecchia, 1991;Powell & McConkey, 1990 Nevertheless, it is clear that there has been no simultaneous increase in tumours of the gastric cardia and adenocarcinoma of the oesophagus. Instead, the increase in oesophageal carcinoma seems likely to have been due to an increase in the frequency of squamous cell carcinomas.…”

“…Despite widespread decreases in the occurrence of stomach cancer, tumours around the gastric cardia have been noted to be increasing in frequency in the United States and Europe (Powell & McConkey, 1990;Blot et al, 1991). At the same time the incidence of adenocarcinoma of the oesophagus has been increasing (Blot et al, 1991;Levi & La Vecchia, 1991;Powell & McConkey, 1990), even in populations where squamous cell carcinomas of the oesophagus are becoming less frequent (Zheng et al, 1992).…”

Epstein‐Barr virus in gastric carcinoma is associated with location in the cardia and with a diffuse histology: A study in one area of Chile

“…22 Simultaneously, several authors have reported an increasing incidence of GC at cardia. 23,24 In this country, Csendes et al 25 also reported an increase in the proportional frequency of cardia lesions over a 30-year period (26.8% in 1958 to 42.3% in 1990), in parallel with a decreased frequency of antrum lesions. In addition, they found an increased frequency of diffuse histological type lesions in the same series.…”

Socioeconomic status and risk of adenocarcinoma of the oesophagus and cancer of the gastric cardia in Scotland

“…Analysis of population-based cancer registration data for the West Midlands Region of the UK showed that a higher proportion of male cases of adenocarcinoma of the oesophagus and gastric cardia were classified as higher social class (based on occupation) compared both to other sites of gastric cancer, and to all sites of cancer combined (Powell and McConkey, 1990). Conversely, in the same comparison, a lower than expected proportion of cases of adenocarcinoma of the oesophagus and gastric cardia were classified as lower social class.…”