17. Epidemiology and prevention of liver-, pancreas- and gastric cancer
Gastric
- Epidemiology
- Was most common cancer in 1970s, but now much less common
- Perhaps due to decreased prevalence of H. pylori
- Male > female
- Strong geographical differences in incidence
- High incidence in Korea and Japan
- Declining incidence in Western countries
- Was most common cancer in 1970s, but now much less common
- Etiology
- Male gender
- Old age
- Diet
- Salt
- Smoked food
- Nitrites, nitrates
- Smoking
- Obesity
- Chronic gastritis
- H. pylori
- Prognosis
- 5 year survival: 15%
- Prevention
- Treat H. pylori
- Improve diet
- Stop smoking
- Treat gastritis
- Prevent obesity
Pancreas
- Epidemiology
- Rare but fatal cancer
- Male > female
- Age of onset: 60 – 80
- Accounts for only 3% of cancers in US
- Etiology
- Old age
- Men
- Blacks
- Smoking
- Obesity
- Chronic pancreatitis
- Cirrhosis
- Binge drinking
- Family history
- Prognosis
- 5 year survival: 5%
- Highest lethality of all cancers
- Prevention
- Avoid avoidable risk factors
Liver
- Epidemiology
- Male > female
- Age of onset in Western countries: 70 years
- Highest incidence in Asia, Africa
- Due to endemic HBV, HCV
- Etiology
- In developing countries
- HBV
- HCV
- Aflatoxin
- In developed countries
- HCV
- Promiscuity
- Chronic alcoholism
- Non-alcoholic fatty liver disease
- Low socioeconomic status
- In developing countries
- Prognosis
- 5-year survival < 50%
- Prevention
- Avoid alcohol
- Avoid obesity
- Safe sex
- Screening
- In high-risk patients (cirrhosis, chronic hepatitis)
- HBV, HCV serology
- AFP