Why is There a Change in Patterns of GE Cancer?
Recent decades have seen a worrying trend in incidence rates of distal oesophageal and proximal gastric cancers. Fuelled by radical changes in lifestyle, diet, physical activity and environmental exposures, as well as an ageing population and host genetic
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Abstract
Recent decades have seen a worrying trend in incidence rates of distal oesophageal and proximal gastric cancers. Fuelled by radical changes in lifestyle, diet, physical activity and environmental exposures, as well as an ageing population and host genetic predisposition, the incidence of oesophageal adenocarcinoma (OAC) is on the rise in Western populations. While overall incidence of gastric cancers is declining, the ageing of society means that an increase in absolute numbers is expected over coming years. Both cancers tend to present at an advanced stage, hence prognosis remains poor despite increasingly effective screening and treatment strategies. The development of gastric and oesophageal malignancies is influenced by myriad factors, not least geographical, racial and socioeconomic differences in addition to lifestyle choices. The multidimensional nature of these risk factors requires a holistic
P. Thiagarajan Department of Emergency Medicine, Balmoral Building, Leicester Royal Infirmary, Leicester, LE1 5WW United Kingdom J. A. Jankowski Digestive Disease Centre, Level 4, Windsor Building, Royal Infirmary, Leicester, LE1 5WW United Kingdom J. A. Jankowski (&) Department of Oncology, University of Oxford, Oxford, OX3 7DQ United Kingdom e-mail: [email protected] J. A. Jankowski Centre for Digestive Diseases, Queen Mary University of London, London, E1 7AT United Kingdom
F. Otto and M. P. Lutz (eds.), Early Gastrointestinal Cancers, Recent Results in Cancer Research 196, DOI: 10.1007/978-3-642-31629-6_8, Ó Springer-Verlag Berlin Heidelberg 2012
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understanding of their net influence in the development of malignancy. This review explores the evidence base for established and putative risk factors in the development of gastric and oesophageal cancers. It is hoped that with a clear understanding of important risk factors, a multidisciplinary approach including effective primary prevention, regular screening of high-risk groups and continued research into the molecular biology of gastrointestinal carcinogenesis may facilitate a reduction in incidence rates, as well as early detection and optimal management of upper gastrointestinal malignancies.
Contents 1 2
Introduction........................................................................................................................ An Ageing Population....................................................................................................... 2.1 Factors Leading to Improved Life Expectancy .................................................... 2.2 Implications of an Ageing Population on Management of Upper GI Cancers ... 3 Colonisation with Helicobacter Pylori.............................................................................. 3.1 Mechanisms of Oncogenesis.................................................................................. 3.2 H. pylori Eradication and Decline in Prevalence ................................................. 3.3 Association Between H. pylori and
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