EPIDEMIOLOGY AND CLINICAL PRESENTATION OF ......EPIDEMIOLOGY AND CLINICAL PRESENTATION OF GASTRIC...

EPIDEMIOLOGY AND CLINICAL PRESENTATION OF GASTRIC CANCER

Maria Alsina, MD PhDVall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO)Barcelona, Spain

DISCLOSURE OF INTEREST

Personal financial interest in form of scientific consultancy for BMS, Lilly, MSD and ServierHonorarium for speaking issues from Amgen, BMS, Lilly, MSD, Roche and ServierTravel expenses partially covered by Amgen, Lilly and Roche

OUTLINE

• Epidemiology• Risk Factors• Clinical Presentation

EPIDEMIOLOGY

EPIDEMIOLOGY

• Gastric Cancer remains a world-wide problem:• 6th more frequent tumor, 5th cause of cancer-death

• Wide geographic variation• While the incidence of distal GC is decreasing, the incidence of GEJC is increasing

INCIDENCE AND MORTALITY• Gastric Cancer remains a world-wide problem:

• 6th more frequent tumor, 5th cause of cancer-death

IARC - Globocan 2018

INCIDENCE AND MORTALITYMore frequent few years ago…

Bray et al. Global Cancer Statistics, 2018. CA Cancer J Clin 2018; 68:394–424

5th cause of cancer 3rd cause of cancer death

INCIDENCE BY SEXMore frequent in males…


MALES FEMALES

MORTALITY BY SEXMore frequent in males…


MALES FEMALES

GEOGRAPHIC DISTRIBUTION

• Wide geographic variation

IARC – Globocan 2018

GASTRIC CANCER ESOPHAGEAL CANCER

FROM THE US DATABASE

• The incidence of distal GC is decreasing, while the incidence of GEJC is increasing

Buas et al. Seminars in radiation oncology 2013Siegel, R. L., Miller, K. D. and Jemal, A. (2019), Cancer statistics, 2019. CA A Cancer J Clin, 69: 7-34

Ten Leading Cancer Types, United States 2019

TRENDS IN CANCER MORTALITY RATES (US, 1930 TO 2016)

Siegel, R. L., Miller, K. D. and Jemal, A. (2019), Cancer statistics, 2019. CA A Cancer J Clin, 69: 7-34

INCIDENDE IN EUROPE AND US


MORTALITY IN EUROPE AND US


INCIDENCE IN ASIA AND SUDAMERICA


MORTALITY IN ASIA AND SUDAMERICA


Siegel, R. L., Miller, K. D. and Jemal, A. (2019), Cancer statistics, 2019. CA A Cancer J Clin, 69: 7-34

• 4th in incidence, 4th in mortality,• After colorectal cancer, pancreatic cancer, and liver & intrahepatic bile duct cancers

GASTRIC WITHIN GI CANCERS

RISK FACTORS

• The majority of them have an important role on generating the inflammatory underlying condition:

• For Gastric Cancer (GC)• Atrophic chronic gastritis, pernicious anemia, adenomatous polyps• Genetic Factors• Environmental Factors: smoking, H Pylori, ↓ fruit and vegetables, ↑ salt and smoked, poorly preserved food

• H Pylori accounts for 90% of non-cardia GC (since 1994, declared as a Class I carcinogenic factor by the WHO)

• For Gastro-esophageal Junction Cancer (GEJC)• Environmental Factors: Obesity, GEJ reflux, diet (↓ fiber, ↑ fat)

RISK FACTORS

Ford Br Med J 2014, Ming Cancer 1965, Roder Gastric cancer 2002, Oliveira Lancet Oncol 2015, Milne Human genetics 2009, Shikata Am J Epidem 2008, Forman BJM 1991, Parsonnet1991, WHO Int Agency Res Can 1994, Whiteman Gut 2008, Bahmanyar Nut and Can 2006, Whiteman Gastroenterology 2010, Liao Gastroenterology 2012

CLINICAL PRESENTATION

• Between 40–50% of patients present with metastatic disease at diagnosis• Although > 80% of the patients will develop metastases

• Only 25% of Europeans with gastric cancer are long-term survivors

• Patient variability• Inter-patients (histology, molecular subtypes)• Intra-patient (heterogeneity)


Ebinger SM, et al. Gastric Cancer. 2016;19:723–34; De Angelis R, et al. Lancet Oncol. 2014;15(1):23–34AJCC TNM 2010, 7th Edition; The Cancer Genome Atlas Research Network Nature 2014 & 2017; Pectasides Can Discov 2017

• Symptoms• Malnutrition, weigh loss

• Dysphagia, dyspepsia, vomits (depending on the tumor location)• Asthenia• Pain

• Depending on the tumor location and the metastatic sites

• Analytical findings• Anemia

• Tumor bleeding• Malnutrition• Other analytical errors

• Depending on comorbidities / metastatic location


• 40-50% of patients present metastasiss at diagnosis• 50% of patients will recur after surgery

• Short progression free survival• 5-7 months for the 1st line• 1.5-3 months for the 2nd line


Patient fragility Aggressive disease

• Age (≈ 65y)• Symptoms• Signs• Comorbidities

CONCLUSIONS 1

• Gastric (and gastro-esophageal cancer) remains a world-wide problem• 5-6th more frequent tumor, 3-5th cause of cancer-death• More frequent in men (2:1)

• Wide geographic variation• Highest incidence in East Asia, Central and Eastern Europe and South America• Lowest incidence in North America, Northern Europe and Africa• Differences depending on the risk factors

• Dietary patterns, food storage and availability of fresh products, as well as H Pylori infection

CONCLUSIONS 2

• The incidence of distal GC is decreasing, but the incidence of GEJC is increasing• Changes in life style

• GC patients are really fragile patients• Because of the location of the tumor, which makes this tumor a very symptomatic one• Because of its inherent aggressiveness

THANK YOU FOR YOUR ATTENTION

Epidemiology and clinical presentation of gastric cancerDisclosure of interestOUTLINEEPIDEMIOLOGYEPIDEMIOLOGYINCIDENCE AND MORTALITYINCIDENCE AND MORTALITYINCIDENCE BY SEXMORTALITY BY SEXGEOGRAPHIC DISTRIBUTIONFROM THE US DATABASETrends in cancer mortality rates (us, 1930 to 2016)INCIDENDE IN EUROPE AND USMORTALITY IN EUROPE AND USINCIDENCE IN ASIA AND SUDAMERICAMORTALITY IN ASIA AND SUDAMERICAGASTRIC WITHIN GI CANCERSRISK FACTORSRISK FACTORSCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCONCLUSIONS 1CONCLUSIONS 2Thank you for your attention

EPIDEMIOLOGY AND CLINICAL PRESENTATION OF ......EPIDEMIOLOGY AND CLINICAL PRESENTATION OF GASTRIC...

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