Epidemiology of Cancer of the Digestive Tract

The digestive organs are the most frequent site of cancer in the world, accounting for approximately 30% of all malignant tumors. This prominent position has been present for many decades in spite of marked shifts in the freq uency of cancer of specific organs. The most remarkable shift has been the decrease in gastric cancer rates occurring concomitantly with an increase in colon cancer rates in most 'western' industrialized societies. Important exceptions to this rule, as well as other epidemiologic evidence, indicate that the opposite trends for gastric and colon cancers are not inevitable consequences of each other. Although genetic­ ally determined precancerous syndromes are well recognized, it is generally agreed that environmental factors play an overriding role in digestive cancer causation. The most obvious environmental factors seem to be the result of what we eat, drink, or smoke. Although the nutritional component of the diet is of unquestionable importance, the nonnutrient elements in our diet have also proven to be influential causative factors. Several studies have focused on the microenvironment at the level of the mucosa or the digestive organs as a micro­ cosmos where forces promoting and inhibiting carcinogenesis are operating for a prolonged period of time. Their interaction eventually determines the presence or absence of a malignant tumor. Our understanding of such modulating forces, hopefully, will someday allow us to modify the microenvironment in a favorable way and attain the goal of cancer prevention. In recent years the field of cancer treatment has been burgeoning with ever expanding interest and commitments to research and therapy. Besides the large number of specialty journals and publications devoted to cancer related fields, nearly every general medical journal contains one or more articles related to cancer treatment and research. Another example of this expanding commitment and interest is reflected in the Internal Medicine subspecialty of Medical Oncology which, since its recognition as a subspecialty in 1973, has become the second most populated subspecialty, second only to cardiology. This burgeoning interest and commitment is obviously appropriate in view of the prevalence and incidence of the various cancers. These diseases constitute, after all, some of the most important and devastating problems of civilized man. It has been particularly gratifying to those involved with cancer research and therapy to observe the increasing interest in these diseases being translated into real improvements in patient care - improvements in length of survival, improvements in quality of survival, and improvements in palliative care. One need only look at Hodgkin's disease to observe the high rate of cure now routinely obtained whereas, in the past, many patients'disease continued to progress with fatal consequences. Some of these improvements came about through better staging techniques, and other improvements, as will be discussed in the chapter on Hodgkin's, came about from the application of early chemotherapy. Further research in Hodgkin's disease is still going on in order to improve results and decrease treatment related complications. Front Matter....Pages i-ix Epidemiology of Cancers of the Oral Cavity and Pharynx....Pages 1-19 Epidemiology of Esophageal Cancer: A Review....Pages 21-57 Epidemiology of Gastric Cancer....Pages 59-84 Epidemiology of Large Bowel Cancer....Pages 85-126 Epidemic Colon Cancer in Children and Adolescents?....Pages 127-146 Epidemiology of Gastrointestinal Lymphomas....Pages 147-159 Epidemiology of Primary Liver Cancer....Pages 161-195 Ethnogeographic Patterns in Gallbladder Cancer....Pages 197-226 Epidemiology of Cancer of the Gallbladder and Extra-Hepatic Biliary Passages....Pages 227-242 Epidemiology of Cancer of the Pancreas....Pages 243-259 Back Matter....Pages 261-264 Although the anthracycline antibiotics represent much of the present and future of cancer treatment, their actual use c stretches back barely two decades to the pioneering efforts of Aurelio Di Marco, who characterized the antitumor properties of daunomycin and adriamycin. Edited By K. Hellmann, P. Hilgard, S. Eccles. Includes Bibliographical References And Index.