New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology

Abstract

SummaryThe current ICD-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion. This study compares the epidemiological and clinical features of each subtype and subsite of adenocarcinomas of the oesophagus and stomach, to assess requirements for a new classification of these carcinomas. Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinomas identified throughout the period 1974-1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2.5 million. The incidence of adenocarcinomas of the lower oesophagus and cardia trebled in males, and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. Adenocarcinomas of the lower oesophagus and of the cardia were similar for median age at diagnosis, male to female ratio, percentage of patients who smoked and survival; both were significantly different from carcinomas of the subcardia in these respects. These data imply that adenocarcinomas of the lower oesophagus and cardia are the same disease. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a distinct subsite, to facilitate surveillance, management and research.

Socioeconomic status and risk of adenocarcinoma of the oesophagus and cancer of the gastric cardia in Scotland

“…It is also of interest to note that rates of oesophageal adenocarcinoma and gastric cardia cancer combined have, since the early 1980s, begun to exceed rates of other malignant neoplasms of the oesophagus in males, but not in females. This sex difference, which has also been seen in the Merseyside and Cheshire area (Dolan et al, 1999), is not completely consistent with a diagnostic or coding artefact, which might be expected to have a similar effect in both males and females. However, it must be acknowledged that subsite misclassification could, at least in part, explain the observed increase in incidence of gastric cardia cancer (Ekström et al, 1999;Levi et al, 1999).…”

“…The risks of cancers of the oesophagus (ICD-9 150) and stomach (151) have been correlated strongly with socioeconomic indicators, both in Scotland (Harris et al, 1998) and elsewhere (Faggiano et al, 1997). However, it has been argued that the existing international classification of oesophageal and stomach cancers is inadequate in the sense that it does not encourage distinction between cancers which may differ in aetiological terms (Dolan et al, 1999). The purpose of the present study is to provide a brief update of a previous analysis of temporal trends in the incidence of cancer of the oesophagus and stomach in Scotland (McKinney et al, 1995), focusing particularly on oesophageal adenocarcinoma and gastric cardia cancer, and to investigate the relationship of the last two with socioeconomic status.…”

Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999

“…8,13 These cancers have similar epidemiological, clinical and pathological features and may also have common aetiological factors. 14,15 Survival rates for cancer at the cardia are lower than those for cancer at non-cardia sites. 11 We have reported, separately, trends in the incidence of oesophageal and gastric cancer in England and Wales by subsite and morphology, 16 but were unable to examine mortality rates by subsite.…”

“…21 In a study using data from the Merseyside and Cheshire Cancer Registry, five of 25 cancers classified as being at the cardia had actually arisen in the lower oesophagus. 14 Patients with oesophageal or gastric cancer registered with the South West Cancer Intelligence Service from 1993 to 1999, who had died, had either gastric or oesophageal cancer as the primary cause of death (D. Bailey, personal communication 2002). Gastric cancer was the cause of death for only 3% of patients with oesophageal cancer, but oesophageal cancer was the cause of death for 16% of patients with gastric cancer.…”

Clinicopathological Time Trends of 2569 Gastric Carcinomas in Japan During the Past 20 Years

“…(Blot, Devesa et al 1991;Dolan, Sutton, et al, 1999) In addition, the age of onset has been dropping, and a remarkable shift has occurred in the histologic patterns of esophageal cancer among whites, as the incidence rates for squamous cell cancer have decreased while rates for adenocarcinoma have increased dramatically to surpass the rates for squamous cancer of the esophagus among males. The ANNALS OF Cancer Research and Therapy reasons for the upward trend in esophageal adenocarcinoma are not entirely clear but may be related in part to smoking habits, which appear to promote the development of reflux esophagitis and its evolution to Barrett's esophagus.…”