GI MALIGNANCIES – INDIA SCENARIO

SHANKAR ZANWAR

ESOPHAGUS

• Epidemiology - • Study by Dr Jijo Cherian, Dr Jayanti – 2007, J Gastro – Liver dis, trends in ca

esophagus

• Retrospective study 994 ca esophagus pts – 1989-2004

• Most common squamous cell ca – 912 -92%

• Adenocarcinoma – 82 patients – 8%

• Squamous cell carcinoma

• No significant difference in presenting symptoms, over study period

• There was decrease in number of patients detected as SCC below age 40

• No significant changes in trends of gender distribution

• Overall – 2.16:1 – M:F

• Upper – 1.73

• Middle – 2.08

• Lower – 2.35

• Adenocarcinoma

• 65 – EGJ malignancy

• 17 distal third

• None in the upper or middle third

• Over the study years no time trends seen in terms of frequency and gender(M:F – 3.6:1) was seen

• Significant increase in the number of pts detected ca. below age 40 in last 4 years of study

RISK FACTORS FOR CA.ESOPHAGUS

• Study by Dr Chitra and Dr Jayanti V, 2007 ISG journal

• 90 consecutive patients studied

• Study by Sanjay Katiyar, Khuroo et al – Cancer 2005

• HPV infection

• High in NE region – 44% of ca esophagus biopsies very less in Delhi region

• Mutation in p53• High in Delhi – 30.6% compared to NE and Kashmir

CLINICO-PATHOLOGICAL PROFILE

• Study from Kashmir, Nazir Khan - 2004

• 680 patients studied

• Presentation

• MC dysphagia to solids – 90%

• Loss of appetite – 80%

• Generalized weakness – 70%

• Weight loss – 50%

• Retro sternal pain – 40%

• Vomiting regurgitation – 20%

• Development of trachea-esophageal fistula grave prognosis – 2.6%(n=16), all died within 6 month.

STOMACH

• Highest prevalence seen in NE –Mizoram

• Accounting 30% of all cancers there - Tuibur - tobacco smoke water and meizol – local cigarette high in carcinogens – ICMR 2004

• Second commonest location is south India >4X that of north.Keechilat Pavithran, IJGCA journal 2002

• Site –

• MC body of stomach 40.7%

• Pylorus – 35%

• Cardia – 25%

• Nearly 95% are adenocarcinoma.

• Intestinal type is more common diffuse type as compared to west.

• More than 90% are diagnosed at advanced stage, >70% at surgery have serosal infiltration.

Keechilat Pavithran, IJGCA journal 2002

• Risk factors• H pylori – Prevalence varies from – 56-89%

• South India – pickled foods – OR 1.8 (CI 1.2 -3.2) independent risk factor – Dr. Sumathi, 2009 SMJ

• NE – Kalakhar – particular variety banana skin used in curries – 8X increased risk

• Salted tea use in Kashmir

• GSTM -1 mutations a/w OR – 1.98, Malik et alRajesh Dixit, Ind Jour Oncol 2011

• Male : female – 2.6: 1

• Age

• <30years - <10%

• 30-60 years ~50%, rest >60yr

• Treatment and survival

• Extensive LN dissection as in Japan is not practiced in India

• Curative surgery done in only – 20%

• 5 year over all survival – 5-18%Keechilat Pavithran, IJGCA journal 2002

HEPATOCELLULAR CARCINOMA

INCIDENCE

• About 70-97% seen in cirrhotics as globally

• Etiological distribution –

• HBV – 36.6%

• HCV – 27.8%

• Dual – 6%

• Others – 29.4%

• Long term cohort study – annual risk of HCC

• HBV – 2.2%, depends also on HbeAg, DNA status

• HCV – 3.8%

• Alcohol – 1.7%Shashi Paul, IJG 2007

CLINICAL PRESENTATION

R Kumar, S K Sarin QJM, oxford 2008

INASL consensus, Puri recommendation 2014

• Age adjusted rate of HCC

• Men 0.7-7.5, female 0.2-2.2 per 1lakh

• Male : female 4:1

• Mortality – 6.8/1lakh for men and 5.1/1lakh for women

• Incidence in cirrhotics – 1.6% per year

• Screening – Six monthly screening by EXPERIENCED personnel

• No additive role of alfa- fetoprotein in screening

GALL BLADDER

• This is 5th commonest GI cancer

• Incidence in registries – 1.01 in M to -2.3 in F /lakh

• Study by Nissar Hussain – Calcutta 2012

• n=198, M – 25.3%, F- 75.5%

K Mohandas, IJG 1999

GB CA. INDIA DISMAL PICTURE – BATRA, JGH 2005

• Study 634 patients, over 1 years

• Gall stones present in 54%

• Surgery – 46%, endotherapy – 19%

• 30 day mortality – 10%

• Median survival – 33.5m after simple cholecystectomy, 12m after radical surgey

• Debulking and palliative bypass surgery survival – 1-3months

CA PANCREAS• Incidence of ca pancreas is amongst the lowest in Indians

• Mean incidence 1.1 to 1.8 per lakh

• No regional variation unlike GBC

• Location wise distribution in Tata• Head – 84%, body 4%, tail 7%, non specified – 5%

Mohandas IJG, 1999

• Risk factors for ca pancreas• Tropical pancreatitis – commonest in Kerala

Chari, Madanagopal, Pitchumani, Pancreas 1994

• Cancer develops mainly in body, but studies from else where no correlation with tropical pancreatitis

MALIGNANT BILIARY OBSTRUCTIONN=110 of obstructive jaundice, Meerut

S Verma, Internet Journal of Tropical medicine 2010

• There is no study on epidemiological profile of cholangiocarcinoma from India.

COLORECTAL• Annual incidence rates, 4.4 per lakh

• Ranks 8th in cancers in male

• Presentation is a decade earlier than west - ICMR

• Highest incidence from – Trivandrum,

• Study from Kochi – 220 pts. By Peedikayil, IJG 2009

Peedikayil – 2009Mohandas, IJG 2009

THANK YOU