P-0170 Epidemiology of Digestive Tract Cancers in Western India: Recent Trends and Lesson Learnt

Abstract

ABSTRACT Introduction Pattern of gastro-intestinal malignancies differ in different geographical areas and depends upon the genetic, cultural, dietary and socioeconomic factors. Therefore studying pattern of gastro-intestinal cancers help to identify high risk groups, recommend preventive measures or advise appropriate screening in high risk population. The present study was undertaken to determine the pattern of gastrointestinal malignancies at Jaipur, Rajasthan, India. Methods A ten-year retrospective data from local referring hospitals was analyzed from 2000 to December 2010 at our centre. All the gastro-intestinal malignancies diagnosed were retrieved from pathology and imaging reports, and socio-epidemiological data of the patients was collected from files and hospital notes. The cases were analysed for Demography, site of involvement, and histological types. Results Gastro-intestinal malignancies constituted 24% of all the malignancies diagnosed. Males were more frequently affected than females, M:F ratio was 1:0.58. Peak incidence was in 7th decade. Esophagus (31%), was the commonest type, followed by Stomach (15%), rectum (8%), colon (6%) and primary liver cancer (5%).Pancreatobiliary malignancy was also a major group comprising 30% of carcinoma, Carcinoma gallbladder was commonest 41% among them, followed by carcinoma pancreas 33% ( half of them in head and remaining half in body and tail), Periampullary carcinoma 16%, cholangiocarcinoma 10%. Other less common cancer types were small intestinal carcinoma, gastrointestinal stromal tumor, cystic duct carcinoma etc. Majority of histological type were Adenocarcinoma. Yearwise distribution showed gradual increase in incidence of cancer. In the present study gastro-oesophageal malignancies and gallbladder malignancy were the most common gastro-intestinal malignancy in this part of India, which in turn reflects on potential lifestyle, genetic and environmental factors. The incidence rates of both large and small bowel cancer are low in India, and rectal cancer is more common than colon cancer. One intriguing observation is the higher occurrence of rectal cancer in young Indians. Rural incidence rates for large bowel cancers in India are approximately half of urban rates. Significant increase in the incidence of colon cancer, Gastroesophageal junction has been reported for both men and women, but the rates of rectal cancer are steady. The low incidence of large bowel cancers in Indians can be attributed to high intake of fiber and the presence of natural antioxidants such as curcumin in Indian cooking. The role of hereditary factors has been evaluated in a few studies. There are no Indian studies on large bowel cancer prevention. The prevalence of adenomas is rare in elderly Indians undergoing colonoscopy, even in those with large bowel cancers. Small bowel cancers are extremely rare in India. Conclusion The incidence of large and small bowel adenomas and cancers is low in Indians. Increase in the incidence of large bowel cancers, Gastroesophageal junction in urban Indians compared to rural populations supports a role for environmental risk factors like diet and lifestyle. High rates of gallbladder cancers in Indians, specially females has many hypothesis regarding etiopathogenesis, including diet, genetic and environmental factors.