Gastrointestinal cancer includes tumors of the proximal and distal stomach which are explored by upper GI endoscopy, using a flexible endoscope. It includes also tumors of the large bowel (colon and rectum), explored with flexible endoscopes by a complete colonoscopy or by a simple sigmoidoscopy. In 2008 the number of incident cases occurring in the World is estimated at 988 602 for gastric cancer and at 1 235 108 for colorectal cancer. A trigger role is played by Helicobacter pylori infection in gastric cancer, and by Diet, Nutrition and physical activity, in colorectal cancer. Gastric cancer is more frequent in developing countries of Asia and Latin America; colorectal cancer is more frequent in more developed countries of North America and Europe. For both tumors, endoscopic diagnosis is based on a 2 steps analysis, with detection followed by charaterization and prediction of histology, before decision of endoscopic resection. Techniques of endoscopic resection include polypectomy with a ligating snare, and modalities of resection called EMR and ESD. Endoscopic diagnosis with eventual treatment is the final step of all screening strategies, either in organized mass screening under the control of Health Authorities, or in Opportunistic screening in individual cases. In mass screening, endoscopy is performed only in persons with a positive filter test. In opportunistic screening endoscopy is a primary procedure. In secondary prevention of cancer, the early treatment of the tumor has a positive impact on survival and mortality. In the colorectum the treatment of premalignant adenomatous polyps has an impact on the reduction of incidence and could be considered as a primary prevention.
Hoey, J., C. Montvernay and R. Lambert (Centre d;Eplddmiologie, Faculté de medecine Rockefeller, 69008 Lyon, France). Wine and tobacco: risk factors for gastric cancer in France. Am J Epidemiol 1981;113:668–74. Cross-sectional studies in France have shown strong regional correlations between death rates from alcohol related diseases and death rates from gastric cancer. The present study involved 40 cases of newly diagnosed adenocarcinoma of the stomach and 168 control subjects with one of four other gastrointestinal diagnoses selected from the same hospital service during the same time period, 1978–1980. On the basis of a standard nutritional Interview alcohol and particularly red wine were seen to be significant risk factors for this cancer (relative risks of 6.9 with 95% confidence limits (CL) of 3.3–14.3 for alcohol and 6.3 with CL 3.1–12.7 for wine). Smoking of one or more cigarettes per day was associated with a relative risk for gastric cancer of 4.8 with CL of 1.6–14.8. The presence of both risk factors was associated with a relative risk of 9.3 with 95% CL of 4.6–19.0. Possible confounding by age, smoking, and eating lettuce (a reported protective factor for gastric cancer in other studies) did not explain these results. The relative risks were consistently found and remained significant when each diagnostic group of control subjects was analyzed separately. These results suggest that alcohol, and particularly red wine, may be important risk factors for adenocarcinoma of the stomach in France. in addition, cigarette smoking, a risk factor in Itself, when coupled with alcohol appears markedly to increase the risk.
It is the object of this note to describe certain ameboid phenomena observed in the cells of rat and mouse sarcomas when cultivatedin vitro, and to suggest that these phenomena probably play an important part in the infiltrative and metastatic growth of tumors. We have employed in this study Burrows'1modification of Harrison's2technic, as applied by us3to rats and mice. Since rat and mouse sarcomas do not differ essentially from one another in their behavior when cultivatedin vitro, we shall confine our description, for the sake of clearness, to the various changes observed in the cells of a mouse sarcoma growing in mouse plasma. The edges of a freshly implanted piece of tissue, examined under the microscope, are sharply defined and free from projecting cells. The tissue itself looks compact and homogeneous. Twelve hours later the edges of the tissue are beset with
In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.
