Stomach Cancer
In gastric cancer there has been a shift from the more endemic gastric cancer, associated with the high risk countries, to an cardioesophageal junction lesion which is occurring in the United States quite frequently. And we don’t really know what the etiology of that is. The endemic form of gastric cancer are two different types of gastric cancer now that are of importance. One is the endemic form which is associated with intestinal metaplasia of the stomach, with chronic gastritis, with H. pylori infection. And the other is the proximal, poorly differentiated generally, adenocarcinoma of the cardioesophageal junction which is actually increasing in incidence. But the endemic form has gone down very significantly over the last 50 years in the United States. It looks like it clearly is related to the environment. It’s clearly related to what we put in our mouths. In the early part of this century there was no widespread use of refrigeration. Fresh fruits, fresh vegetables were not eaten very much. Things like sauerkraut, things like preserved and salted vegetables were eaten. Fresh meat was not eaten. Then in the 1920’s there was the introduction of refrigerated railroad cars and actually gastric cancer began to fall about 10-15 years after, in the early 1930’s is when it began to take its real dip. And it’s very clear that when you don’t eat highly salted meats, you don’t eat a lot of meats that are preserved with nitrites, you have a lower incidence of gastric cancers. So that’s probably the reason for the fall in the endemic form.
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There has been a rapid increase in incidence of gastric cancer between 1975 and 1990 in the rate per thousand of – it’s gone up about four times – of adenocarcinoma of the distal esophagus, proximal stomach in white males. This is really a very rapidly increasing tumor. It’s said that only melanoma is increasing more frequently than this tumor. And we really don’t have a good clue as to why that is. It’s most common in Caucasian men, typically between the ages of 40-70, and people who are obese, who have a history of gastroesophageal reflux disease and people who smoke cigarettes and drink some alcohol. It’s interesting that if the endemic form of gastric cancer is associated with intestinal metaplasia of the stomach – in other words, small intestinal epithelium in the stomach – this of course, which is associated with Barrett’s esophagus, is gastric metaplasia of the distal esophagus. So as a general rule, it’s not good to have the wrong mucosa in the wrong organ it appears.
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