Gastrointestinal Malignancies: New Innovative Diagnostics And Treatment

New Innovative Diagnostics and Treatment

Qiang Cai, Bassel F El-Rayes, Jinghua Hao, David A Kooby, Jerome Carl Landry, Virginia Oliva Shaffer, Hong Xu

• Publisher: WSPC
• Year: 2015
• ISBN:
  9789814619028
• Topic: Ciencias biológicas
• Subtopic: Ciencias en general

Gastrointestinal Malignancies: New Innovative Diagnostics and Treatment summarizes new advantages in the diagnosis and treatment of gastrointestinal malignancies, thereby providing the most current and up-to-date knowledge on gastrointestinal malignancies to medical students, gastroenterologists, general surgeons, oncologic surgeons, and oncologists.

This book will feature the progresses made on treatment and diagnosis of gastrointestinal malignancies in the last ten years and provides the most current diagnostic and therapeutic modalities to the readers. The book will be an excellent reference tool for physicians and surgeons working in the field of gastrointestinal malignancies.

Editors of the book are experts from both the western and eastern parts of the world.

Gastrointestinal Malignancies: New Innovative Diagnostics and Treatment summarizes new advantages in the diagnosis and treatment of gastrointestinal malignancies, thereby providing the most current and up-to-date knowledge on gastrointestinal malignancies to medical students, gastroenterologists, general surgeons, oncologic surgeons, and oncologists.

This book will feature the progresses made on treatment and diagnosis of gastrointestinal malignancies in the last ten years and provides the most current diagnostic and therapeutic modalities to the readers. The book will be an excellent reference tool for physicians and surgeons working in the field of gastrointestinal malignancies.

Editors of the book are experts from both the western and eastern parts of the world.

Readership: Medical students, gastroenterologists, oncologists and oncologic surgeons and general surgeons.
Key Features:

• Each chapter contains “What is new” and “Take home message” sections
• New endoscopic therapy, such as endoscopic submucosal dissection, for earlier cancers will be included in the book
• Editors are experts from the western and eastern parts of the world

Chapter 1

The Descriptive Epidemiology
of Gastrointestinal Malignancies

Anthony Gamboa, Qi Lin, Peng Jin, Yifeng Zhou,
Qiang Liu, Jinghua Hao, Qiang Cai
and Roberd M. Bostick

What is New

•Esophageal adenocarcinoma and carcinoid tumor incidence rates continue to increase remarkably, while the rates for gastric cancer is declining worldwide, and that for colorectal cancer is declining in the United States.

•Liver cancer incidence continues to rise, though some predict that it will decline in the coming years as hepatitis B is addressed with vaccination and novel therapies for hepatitis C become available.

•Mortality trends for pancreatic cancer have shifted, with declining rates among African Americans and increasing rates among Caucasians, which is a reversal from a decade earlier.

Introduction

Examining the epidemiology of gastrointestinal malignancies reveals varying trends and evolving populations at risk. The most reliable data for determining incidence rates, mortality, and trends for various malignancies of the gastrointestinal system include those from large public data sets. Worldwide, the GLOBOCAN project of the World Health Organization (WHO) provides incidence and mortality data for many types of cancer. In the United States, the American Cancer Society annually collates data from the tumor registries of all 50 states and publishes incidence and mortality estimates for the various cancers. Finally, the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) collects more in-depth data from selected regions of the United States; these data are readily accessed and frequently utilized by researchers who elucidate trends and updated data on cancer epidemiology. Epidemiological trends are key for investigators who address evolving threats in gastrointestinal malignancies, and awareness of these trends allows clinicians to maximize the application of current diagnostic and therapeutic tools for patient care.

The most common types of gastrointestinal cancers are colorectal, pancreatic, liver, gastric, and esophageal cancers, and many other gastrointestinal malignancies are responsible for high mortality rates as well.

Esophageal Cancer

The epidemiology of esophageal cancer continues to evolve rapidly. The incidence of adenocarcinoma of the esophagus has risen dramatically over the last four decades, and its incidence is surpassing that of squamous cell carcinoma of the esophagus in many Western countries, corresponding to increases in obesity and gastroesophageal reflux disease (GERD).

The most common histologic types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Typically, data are reported separately for the two types because their incidence rates and trends vary substantially.

Worldwide, the number of incident esophageal cancer cases was approximately 482,000 in 2008; there were 3–4 times more cases among males than among females;¹ and the age-standardized esophageal cancer incidence rate is 7.0 per 100,000 population, making esophageal cancer the sixth most common malignancy among men and the ninth most common among women worldwide. The annual number of deaths from esophageal cancer is approximately 406,000, or 5.8 per 100,000 population worldwide. It is the fifth most common cause of cancer-related deaths among men, eighth most common among women, and the sixth most common overall worldwide. Approximately 83% of individuals diagnosed with esophageal cancer and 86% of those who die from the disease are in developing countries.²

In the United States, the lifetime risk of an individual being diagnosed with esophageal cancer is less than 1%.³ The American Cancer Society estimates that 18,170 new cases of esophageal cancer will be diagnosed in 2014. Among these, 14,660 are expected to be in men and 3,510 in women. There will be an estimated 15,450 deaths from esophageal cancer in 2014, 12,450 in men and 3,000 in women. Among men in the United States, esophageal cancer will be the seventh leading cause of death from cancer. Using data from SEER, during 2003–2009, at diagnosis, approximately 22% of new cases had localized disease, 30% had regional spread, 36% had distant metastasis, and the remainder did not have staging information available. During the same time, the five-year relative survival rates for esophageal cancer were 39% for those with localized cancer at diagnosis, 21% for those with regional nodal spread, and 4% for those with distant metastasis. Over the last several decades, the esophageal cancer relative survival rates have improved. During 1975–1977, the overall five-year relative survival rate in the United States was 5%; during 1987–1989 it was 9%; and during 2003–2009, 19%. There is no difference in survival between adenocarcinoma and squamous cell carcinoma in this data.⁴

There are important differences in the epidemiology of esophageal cancer by histologic type, geographic location, and race. Squamous cell carcinoma is more common worldwide than adenocarcinoma of the esophagus; however, the incidence of adenocarcinoma has surpassed that of squamous cell carcinoma in the United States, the United Kingdom, Australia, France, and some other Western European countries.⁵ In the United States, the incidence of esophageal adenocarcinoma increased from 0.4 to 2.58 per 100,000 between 1975 and 2009.⁶ The incidence increased 463% from 1975 to 2004 among white males and 335% among women, despite a declining rate of squamous cell carcinoma.⁷ Similar trends are reported in Western Europe. These rate changes correspond to changes in rates of obesity and GERD, which can cause Barrett’s esophagus. More than 90% of squamous cell carcinoma cases in the United States are attributed to alcohol and tobacco use. Declining rates of tobacco use may explain the decline in squamous cell carcinoma.⁸

The respective overall five-year relative survival rate among white and black patients in the United States diagnosed with esophageal cancer is 17% and 11%; for those with localized cancers, they are 41% and 20%; for those with regional spread, 21% and 15%; and for those with distant metastasis, 4% and 3%. The incidence of squamous cell carcinoma is higher among Blacks.^4,9

Education has been inversely associated with esophageal cancer mortality rates. Among white males 25 to 64 years old, the mortality rate per 100,000 in 2007 was 7.92 among those with less than 12 years education compared to 2.93 among those with more than 16 years education. The mortality rates have also been increasing at a faster pace among those with less education; from 1993 to 2007, mortality annually increased 2.99% among those with less than 12 years education and 0.6% among those with more than 16 years education. In black males, mortality annually increased by 2.47% among those with less than 12 years education but decreased by 1.63% per year among those with more than 16 years education. These findings may be related to less or delayed access to medical care. They may also be related to different rates of smoking, alcohol consumption, and obesity between groups with different levels of education.¹⁰

In southern Africa, the incidence rate of esophageal cancer is more than 20 times higher than in northern, middle and western Africa. A particularly high incidence is found in the “Asian belt” or “esophageal cancer belt,” which includes Turkey, northern Iran, central Asian republics, and northern and central China. The annual incidence in this region is more than 100/100,000, and of these cases, 90% are squamous cell carcinoma.¹ Risk factors contributing to these high rates are poorly understood but may include drinking beverages at high temperatures, tobacco, and chewing Betel and Areca nut.^11,12 There are wide variations in the incidence within these regions that remain unexplained. In China, the highest rates are found in the north-central provinces Shanxi and Henan. In central Asia, Turkmenistan and Kazakhstan have higher rates than their neighbors, and in within Iran, dry regions east of the Caspian Sea have a much higher incidence than the nearby humid regions to the west.⁹ In Taiwan, the incidence rate of squamous cell carcinoma continues to rise while that for adenocarcinoma remains unchanged.¹³

Known risk factors for esophageal adenocarcinoma include higher body mass index, history of smoking, gastroesophageal reflux disease, and low fruit and vegetable consumption. Factors that contribute the development of esophageal squamous cell carcinoma include history of smoking, alcohol use, and low fruit and vegetable consumption.⁸

Gastric Cancer

Gastric cancer incidence continues to decline in most parts of the world, but cancers in the gastric cardia are increasing, as are noncardia gastric cancers among 25–39-year-olds in the United States.

Gastric adenocarcinoma is the most common form of cancer of the stomach, and herein it will be referred to as “gastric cancer.” Gastric cancer is the fourth most common type of malignancy in the world after lung, breast, and colorectal cancer, accounting for 8% of all new cases (989,600 diagnoses) and 9.7% of all cancer-related deaths (738,000 deaths). It is the third most common cause of cancer death among men and fifth among women. The incidence is twice as high among males than females, and over 70% of cases occur in developing countries.^1,2,14

Across the world, gastric cancer incidence varies considerably. The incidence among Korean males is 62/100,000 and among Guatemalan women 26/100,000, compared to less than 1/100,000 in Botswana. Incidence is highest in Korea, Japan, China, Brazil, much of South America, Eastern Europe, and Portugal and lowest in North America, India, and much of Africa.

In the United States, the American Cancer Society estimates that 22,220 new cases will be diagnosed in 2014, and that 13,730 will be males and 8,490 females. It is estimated that 10,990 deaths will occur in 2014, 6,720 among males and 4,270 among females. Over the last several decades in the United States, gastric cancer relative survival rates have improved. Between 1975–1977, the overall five-year relative survival rate in the United States was 15%; between 1987–1989 it was 20%, and between 2003–2009, 29%. Five-year survival rates are similar in Blacks (29%) and Whites (28%).⁴ In SEER, 25% of cases are localized, 30% have regional nodal spread, 34% have distant metastasis at diagnosis, and 11% are unstaged. The five-year relative survival is 63.2% among those with localized tumors, 28.4% among those with regional nodal spread, and 3.9% among cases with distant metastasis.^15,16

Incidence rates among immigrants tend to be similar to those in the country to which they move rather than to those in their country of origin, especially as successive generations are born in their adopted country. Environmental factors are therefore thought to play a large role in the incidence rates. However, gastric cancer incidence among Japanese-born immigrants to the United States is three to six times higher than that among United States-born whites. Among Chinese male immigrants, the rate is the same as among United States-born white males, but among Chinese female immigrants, the rate is twice as high as among United States-born white females. These findings suggest that early environmental factors may play an important role in gastric carcinogenesis.¹⁷

In most parts of the world, gastric cancer incidence has decreased. In 1975, it was the leading cause of cancer worldwide.¹ The incidence rate has declined by more than 80% over the last 50 years in North America and many parts of Europe.¹⁴ The relative risk in the United Kingdom declined throughout the 20th century.¹⁸ More recently, rates have declined in China, Japan, Korea, and in parts of South America.¹⁴

The declining incidence worldwide is attributed to multiple factors. The introduction and widespread use of refrigerators may hav...

Table of contents

• Cover
• Half Title
• Title
• Copyright Page
• Contents
• Preface
• Editors’ Biography
• List of Authors
• Chapter 1 The Descriptive Epidemiology of Gastrointestinal Malignancies
• Chapter 2 Biomarkers and the Quest for Personalized Cancer Care
• Chapter 3 Prevention of Gastrointestinal Malignancy
• Chapter 4 Imaging in Gastrointestinal Malignancies
• Chapter 5 Nutritional Supports for Patients with Gastrointestinal Malignancies
• Chapter 6 Palliative Care for Patients with Advanced Gastrointestinal Malignancies
• Chapter 7 Endoscopic Diagnosis and Treatment of Esophageal Malignancies
• Chapter 8 Multimodality Management of Esophageal Malignancies beyond Endoscopy
• Chapter 9 Endoscopic Diagnosis and Treatment of Gastric Malignancies
• Chapter 10 Management of Gastric and Gastroesophageal Junction Adenocarcinoma beyond Endoscopy
• Chapter 11 Endoscopic Diagnosis and Treatment of Colorectal Malignancies
• Chapter 12 Multimodality Management of Colorectal Malignancies Beyond Endoscopy
• Chapter 13 Multimodality Management of Oligometastatic Colorectal Cancer
• Chapter 14 Diagnosis and Staging of Pancreatic Malignancies
• Chapter 15 Borderline Resectable Adenocarcinoma of the Pancreas
• Chapter 16 Treatment of Advanced Pancreatic Cancer
• Chapter 17 Diagnosis of Hepatobiliary Malignancies
• Chapter 18 Non-Surgical Management of Hepatobiliary Malignancies
• Chapter 19 Surgical Treatment of Hepatobiliary Malignancies and Liver Transplantation
• Chapter 20 Image-Guided Therapy of Liver Malignancy
• Chapter 21 Rare Gastrointestinal Malignancies
• Chapter 22 The Essentials of the Gastrointestinal and Pancreaticobiliary Malignancies Pathology
• Chapter 23 Proton Therapy: A New Dawn for Gastrointestinal Cancer Treatment
• Chapter 24 Radiotherapy for Rectal Cancer
• Chapter 25 Radiotheraphy for Pancreatic Cancer
• Index