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    Oesophageal Adenocarcinoma Talk

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    S XUX
    This document discusses oesophageal adenocarcinoma (OAC), including trends, risk factors, and explanations for rising incidence. It finds that [1] OAC incidence and mortality have been rising significantly in Western countries, [2] major established risk factors are gastroesophageal reflux, obesity, smoking, and Barrett's esophagus, and [3] while rising obesity rates contribute, they do not fully explain changing OAC epidemiology, suggesting other unidentified risk factors may be involved. The document examines evidence on relationships between OAC and reflux, obesity, smoking and their synergistic effects, and explores how trends in these risk factors correlate with rising OAC trends.

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    Oesophageal Adenocarcinoma Talk

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    21 views23 pages
    This document discusses oesophageal adenocarcinoma (OAC), including trends, risk factors, and explanations for rising incidence. It finds that [1] OAC incidence and mortality have been rising significantly in Western countries, [2] major established risk factors are gastroesophageal reflux, obesity, smoking, and Barrett's esophagus, and [3] while rising obesity rates contribute, they do not fully explain changing OAC epidemiology, suggesting other unidentified risk factors may be involved. The document examines evidence on relationships between OAC and reflux, obesity, smoking and their synergistic effects, and explores how trends in these risk factors correlate with rising OAC trends.

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    This document discusses oesophageal adenocarcinoma (OAC), including trends, risk factors, and explanations for rising incidence. It finds that [1] OAC incidence and mortality have been rising significantly in Western countries, [2] major established risk factors are gastroesophageal reflux, obesity, smoking, and Barrett's esophagus, and [3] while rising obesity rates contribute, they do not fully explain changing OAC epidemiology, suggesting other unidentified risk factors may be involved. The document examines evidence on relationships between OAC and reflux, obesity, smoking and their synergistic effects, and explores how trends in these risk factors correlate with rising OAC trends.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    21 views23 pages

    Oesophageal Adenocarcinoma Talk

    Uploaded by

    S XUX
    This document discusses oesophageal adenocarcinoma (OAC), including trends, risk factors, and explanations for rising incidence. It finds that [1] OAC incidence and mortality have been rising significantly in Western countries, [2] major established risk factors are gastroesophageal reflux, obesity, smoking, and Barrett's esophagus, and [3] while rising obesity rates contribute, they do not fully explain changing OAC epidemiology, suggesting other unidentified risk factors may be involved. The document examines evidence on relationships between OAC and reflux, obesity, smoking and their synergistic effects, and explores how trends in these risk factors correlate with rising OAC trends.

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    of 23

    Leo Alexandre

    ACF in Gastroenterology

    April 2013
    Outline

    • What is inflammatory bowel disease?

    • The genetic and environmental contribution to inflammatory


    bowel disease aetiology?

    • Do these explain the rising trends?


    Oesophageal cancer: two diseases

    Squamous cell carcinoma Adenocarcinoma

    Lagergren J. BMJ 2010;341:bmj.c6280


    Prognosis of oesophageal adenocarcinoma

    • Majority present with locally advanced or metastatic disease

    • Overall five-year survival less than 20%

    • 39% suitable for curative surgery


    - 46% recurrence within 1 year
    - 47% five-year survival at best
    Incidence of oesophageal adenocarcinoma

    Age-adjusted annual incidence of oesophageal adenocarcinoma (per 100,000)

    Curado A. IARC 2007; 4: 160.


    Trends in the annual incidence of oesophageal adenocarcinoma in
    England and Wales

    Lepage C. Am J Gastroenterol 2008; 103: 2694-9.


    Symptoms

    • Progressive dysphagia

    • Weight loss

    • Regurgitation

    • Odynophagia

    • Hoarseness

    • Cough
    Patient pathway

    Gastroscopy
    Gastroscopy indicating
    indicating oesophageal
    oesophageal cancer
    cancer

    CT
    CT staging,
    staging, endoscopic
    endoscopic ultrasound,
    ultrasound, PET
    PET scan,
    scan, laparoscopy
    laparoscopy

    Multidisciplinary
    Multidisciplinary team
    team approach:
    approach: radiologists,
    radiologists, pathologists,
    pathologists,
    oncologists,
    oncologists, upper
    upper GIGI surgeons,
    surgeons, gastroenterologists,
    gastroenterologists, specialist
    specialist
    nurses,
    nurses, dieticians
    dieticians

    Curative
    Curative or
    or palliative
    palliative approaches:
    approaches: Oesophagectomy
    Oesophagectomy or or
    endoscopic
    endoscopic mucosal
    mucosal resection,
    resection, chemotherapy,
    chemotherapy, radiotherapy,
    radiotherapy,
    endoscopic
    endoscopic stenting,
    stenting, end-of-life
    end-of-life care
    care
    Mechanisms for carcinogenesis

    Smoking
    Reflux

    Obesity
    Is reflux a risk factor?

    Cases = 189
    Controls = 820
    Lagergren J. N Engl J Med 1999; 340: 825-31.
    Barrett’s Oesophagus

    Normal squamous mucosa Barrett’s oesophagus (columnar lined oesophagus)


    Barrett’s Oesophagus is pre-malignant

    • 30-fold increased risk of OAC


    • 1 per 300 patients per year develop OAC

    n = 3345
    23 984 patient-years

    Fitzgerald RC. Aliment Pharmacol Ther 2001; 15: 269-76.


    Desai TK. Gut 2012; 61: 970-6.
    How obesity could be linked to carcinogenesis
    Supportive evidence for obesity

    Renehan AG. Lancet 2008; 371: 569-78.


    Synergy of reflux and obesity

    Cases = 367
    Controls = 1580 Whiteman DC. Gut 2008; 57: 173-80.
    Smoking is carcinogenic

    Cases = 367
    Controls = 1580 Whiteman DC. Gut 2008; 57: 173-80.
    Explaining trends: reflux

    Prevalence of at least weekly heartburn and/or acid regurgitation and publication date

    El-Serag HB. Clin Gastroenterol Hepatol 2007; 5: 17-26.


    Explaining trends: obesity

    Overweight

    Obese
    Percent

    OBESITY AND OAC GRAPH Morbid obese

    Year

    Age-adjusted trends in overweight, obese and morbid obese categories in the US

    Flegal KM. JAMA 2010; 303: 235-41.


    Explaining trends: smoking

    Smoking Prevalence by sex, Great Britain, 1948-2010

    Office for national statistics


    Conclusions

    • OAC is an important global healthcare problem

    • Established risk factors: reflux, obesity, smoking

    • Rising obesity does not alone explain changing epidemiology of OAC

    • Unidentified risk factors

    • Huge research opportunity


    Thank you for listening

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