Jump in esophageal and stomach cancers prompts study

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Jump in esophageal and stomach cancers prompts study

Two types of gastrointestinal cancers have risen dramatically in the past 20 years. A new national study is shedding light on what is contributing to this dramatic rise, while providing information people can use to prevent these types of cancers, which can be deadly.

These two types of cancers, called esophageal adenocarcinoma (EAC) and gastric cardia carcinoma (GCC), both occur near the esophagus, the tube that brings food from the mouth to the stomach. The first type is generally found in the lower third of the esophagus, which brings food from the mouth to the stomach, while the other occurs where the stomach joins the esophagus. What is even more startling is the incidence of EAC has increased 350 percent at a time when other types of stomach cancer have fallen dramatically.

This jump prompted the National Cancer Institute to begin the largest-ever multicentered study that would provide answers about what might be contributing to the increase in these specific cancers. Three major medical centers, including Yale, ran the study. Results of this study are now coming in.

Dietary links found
According to Dr. Susan T. Mayne of the Yale University School of Medicine, researchers found several culprits linked to the risk of EAC and GCC. The role of a diet high in animal products in causing these and related cancers was highlighted in the report, published in the October issue of Cancer Epidemiology, Biomarkers & Prevention.

To investigate a link between these cancers and diet, researchers interviewed more than 1,000 patients and nearly 700 healthy people in three regions, including Connecticut, New Jersey and Washington. Included were people who were newly diagnosed with EAC and GCC (two cancers that were increasing), as well as those that had the types that were declining (esophageal squamous cell carcinoma, ESCC, or noncardia gastric adenocarcinoma, NGA). They also interviewed nearly 700 healthy people for their control group, which helps isolate those factors that contribute to cancer.

In-person interviews were conducted for 80 percent of the participants, who provided information about their dietary patterns over the past three to five years. Computer analysis was performed to compare nutrient intake with the incidence of the various types of cancers.

Factors linked to cancer
The researchers found:

• The vast majority of the participants with adenocarcinoma of the esophagus (EAC) were male (83.3 %) and white (99.3 %).

• Diets high in dietary cholesterol, animal protein and vitamin B12 were associated with a higher risk of all four types of cancers.

• Nitrites in foods were associated only with an increased risk of NGA. Supplemental vitamin C intake for six months or more had a protective effect against this type of cancer.

• In contrast, fiber, beta carotene, folate and vitamins C and B6—found in plant foods—were associated with a lower risk of all four cancers.

• Dietary fiber was one of the strongest factors associated with lowered incidence of GCC and EAC.

• Total fat intake and intake of saturated fat each doubled the risk of EAC the investigators found. Saturated fat also raised the risk of GCC and ESCC.

• A high starch diet was associated with an increase in the two types of stomach cancers (NGA and GCC).

• Salt intake did not have a significant association with any of the types of cancers, once nitrite was considered.

Eliminating other factors important\

Past reports from this and other studies of gastric and esophageal cancers have shown that gastroesophageal reflux disease (GERD) is a significant risk factor for esophageal adenocarcinoma. To ensure these results would not be influenced by symptoms of GERD, the researchers were careful to do additional analyses to eliminate from the analysis anyone who had symptoms of reflux disease. Also considered were tobacco and alcohol use and obesity.

Source

Nutrient Intake and Risk of Subtypes of Esophageal and Gastric Cancer¹

Susan T. Mayne², Harvey A. Risch, Robert Dubrow, Wong-Ho Chow, Marilie D. Gammon, Thomas L. Vaughan, Diana C. Farrow, Janet B. Schoenberg, Janet L. Stanford, Habibul Ahsan, A. Brian West, Heidi Rotterdam, William J. Blot and Joseph F. Fraumeni, Jr.

Yale University School of Medicine, Department of Epidemiology and Public Health, New Haven, Connecticut [S. T. M., H. A. R., R. D.]; National Cancer Institute, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland [W-H. C., J. F. F.]; University of North Carolina School of Public Health, Department of Epidemiology, Chapel Hill, North Carolina [M. D. G.]; Fred Hutchinson Cancer Research Center, Program in Epidemiology, and University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington [T. L. V., D. C. F., J. L. S.]; New Jersey Department of Health and Senior Services, Cancer Epidemiology Services, Trenton, New Jersey [J. B. S.]; Division of Epidemiology [H. A.] and Department of Pathology [H. R.], Columbia University, New York, New York; New York University Medical Center, Department of Pathology, New York, New York [A. B. W.]; and International Epidemiology Institute, Rockville, Maryland [W. J. B.]

Incidence rates for adenocarcinoma of the esophagus and gastric cardia have been rising rapidly. We examined nutrient intake as a risk factor for esophageal and gastric cancers in a population-based case-control study in Connecticut, New Jersey, and western Washington state. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma (n = 282), adenocarcinoma of the gastric cardia (n = 255), esophageal squamous cell carcinoma (n = 206), and noncardia gastric adenocarcinoma (n = 352), along with population controls (n = 687).

Associations between nutrient intake and risk of cancer were estimated by adjusted odds ratios (ORs), comparing the 75th versus the 25th percentile of intake. The following nutrients were significantly inversely associated with risk of all four tumor types:

fiber, ß-carotene, folate, and vitamins C and B6.

In contrast, dietary cholesterol, animal protein, and vitamin B12 were significantly positively associated with risk of all four tumor types.

Dietary fat [OR, 2.18; 95% confidence interval (CI), 1.27–3.76] was significantly associated with risk of esophageal adenocarcinoma only.

Dietary nitrite (OR, 1.65; 95% CI, 1.26–2.16) was associated with noncardia gastric cancer only. Vitamin C supplement use was associated with a significantly lower risk for noncardia gastric cancer (OR, 0.60; 95% CI, 0.41–0.88).

Higher intake of nutrients found primarily in plant-based foods was associated with a reduced risk of adenocarcinomas of the esophagus and gastric cardia, whereas higher intake of nutrients found primarily in foods of animal origin was associated with an increased risk.

Yale Research: 

Burtness and Yale’s esophageal cancer team are focusing clinical trials to downstage esophageal cancers through neoadjuvent, or preoperative, chemotherapy and radiotherapy. "If we can shrink the tumor and reduce the likelihood of positive lymph nodes and involvement at the surgical margins, we can improve survival rates," she said.
 
 "The most effective treatment appears to be combining radiation and chemotherapy before surgery, rather than surgery alone," she said. "In our recent trial, surgery was followed with a taxol-based regimen that the patient was not ‘resistant’ to." While the median survival has not been reached, 62% of patients were alive at two years. The results are better than previously reported for stage II through IVa cancers treated with surgery alone or with chemoradiation followed by surgery. "Improved survival appears to be tied to the post-surgical chemotherapy fighting cancer that is "lower stage" with fewer positive lymph nodes," Burtness said.

Here is one doctor’s comment:

Careful pre-treatment evaluation is essential. Every effort must be made to pre-stage the cancer properly for prognosis will depend on the accuracy of the evaluation. A PET scan is an essential test before any treatment is initiated. The PET scan is based on the fact that cancer cells pick up glucose with ten times the avidity of normal body cells, so radio-active glucose can be easily seen on spectroscopy. The PET scan will tell more accurately than any other diagnostic test whether the cancer has left its primary source.

If the cancer is localized to the surface of the esophagus, then surgery is all that is needed.

But if the cancer has invaded through the wall of the esophagus and into the surrounding nodes, then pre-operative chemotherapy and radiation therapy may be necessary. I am currently using Taxol, Taxatere and Carboplatinol in the treatment of this disease. At the present time, concurrent chemotherapy and radiation therapy seem to be better than sequential chemotherapy and radiation therapy. Surgery, after this treatment, is very difficult so it is important that experienced surgeons perform the operation. Complications are high and need experienced care.

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