438 Chinese Journal of Clinical Oncology Dec. 2007, Vol. 4, No. 6 P 438~441 Zhifeng Chen et al. [SpringerLink] DOI 10.1007/s11805-007-0438-4

Adenocarcinoma of the Esophagogastric Junction: a New Topic for the Tumor Registry

Zhifeng Chen ABSTRACT Linzhou, Yangcheng, Shexian and Yangzhong counties are Jun Hou considered to be high-risk areas for esophageal carcinoma using traditional Yutong He standards. However, based on the incidence of malignant tumors and death [1] Shijie Wang statistics from 1998~2002 in Chinese cities and counties , the incidence of esophageal carcinoma in these counties was not the most prominent. In these areas, the incidence of gastric cancer ranked first. So what are the differences between the above-mentioned areas and Changle in Fujina and Linqu in Shandong Province? The authors have combined the defined norms for cardiac cancer, published by the WHO in 2000, with the epidemiologi- cal changes in high-risk areas of esophageal carcinoma[2]. We propose to Cancer Institute of the No. 4 Hospital, Hebei discuss the importance of cardiac cancer morbidity and death registration in Medical University, Shijiazhuang 050011, He- tumor monitoring sites all over China, and to provide new views related to bei Province, China. this topic of interest.

KEYWORDS: adenocarcinoma of the esophagogastric junction, tumor registry, epidemic disease.

Introduction of Questions

At present, there are 30 tumor registration offices in China, cover- ing 3.04% of the total Chinese population. During the period from Correspondence to: Shijie Wang 1998 to 2002, 8 cities and counties in China, had a high incidence E-mail: [email protected] of male gastric cancer. These areas included Linzhou, Shexian, Yangcheng, Linqu, Changle, Yangzhong, Wuwei and Dafeng. There were 4 counties, where the incidence of male esophageal carcinoma was higher than other areas, i.e. Cixian, Yanting, Fe- icheng and Huaian[1]. It was obvious that the order of incidence of a traditionally high-risk area of esophageal carcinoma had greatly changed. Nevertheless, further analysis has shown that in Shexian county, Hebei province, the yearly incidence of male cardiac cancer reached 65.9/100,000, gastric cancer 69.0/100,000 and esophageal carcinoma 84.3/100,000; at the same time, the rates in females were respectively 29.0/100,000, 25.9/100,000 and 45.8/100,000[3]. In Yangcheng, Shanxi province, the incidence from cardiac cancer amounted to 47.0%[4] of the total gastric cancer patients. In Linzhou, Henan province, a cohort study com- prised of 29,584 cases, with ages ranging from 40-60, indicated in a retrospective study, that during the past 15 years there were 1,958 cases of esophageal carcinoma, 1,089 of cardiac cancer and another 363 with carcinomas of the digestive tract[5] It was found in Cixian, Hebei province, in 2002, by a cohort study of endo- scopic screening of 2,013 cases with ages ranging from 40 to 60[6], Received June 6, 2007; accepted November that of the total cases, the rate of invasive squamous esophageal 17, 2007. carcinoma was 0.70% and that of invasive cardiac adenocarci- noma 0.84%. In Yangzhong, Jiangsu province, the incidence from gastric cancer reached 89.2%, and the most common site was CJCO http://www.cjco.cn E-mail:[email protected] Tel(Fax):86-22-2352 2919 Chinese Journal of Clinical Oncology Dec. 2007, Vol. 4, No. 6 P 438~441 Zhifeng Chen et al. 439 the cardiac body of the stomach[7]. In Nanao county, sis of junctional tumors has never been conducted in Guangdong which was a non-tumor monitoring site, assessment of the tumor incidence in 28 main body the morbility of gastric cancer in 2003 increased by regions. Studies were conducted in five continents 42.8% compared to that in 1995, and the incidence of and were edited by the WHO[14]. The morbility and cardiac cancer accounted for 67.2 % of the total inci- mortality of cardiac cancer in the tumor registry dence of gastric cancer (219/362)[8,9]. sites, especially in the high-risk area of esophageal In Yanting, Sichuan province, when comparing the carcinoma, were rather high, which was quite differ- period of 1990~1997 with 1969~1979, there was a ent with the junctional tumor of other countries and 29.2% decrease in the mortality of esophageal car- regions. In addition, research showed there was a cinoma and a 78.0% ascensus in the death rate from major difference in the etiological factors, diagnosis gastric cancer[10]. The incidence of gastric cancer in and treatment between gastric-antrum cancers, which the male and female populations was respectively ranks first in the high-risk areas of gastric cancer, and 100.9/100.000 and 69.5/100,000 during the period squamous esophageal carcinoma. Therefore, more of 1998~2002, and that of esophageal carcinoma attention should be paid to statistical analysis of soli- 104.0/100,000 and 77.8/100,000[1]. Although the in- tary adenocarcinomas of the esophagogastric junction cidence of cardiac cancer was not mentioned in the (AOG), so as to more objectively reflect the epidemi- epidemiological data from Yanting, Sichuan province, ological features of tumor monitoring sites in China. a total of 9,401 cases were found in the neighboring Guangyuan area by clinical gastroscopy during the Reasons period of 2000~2003, among which 548 cases were esophageal carcinoma, and 486 gastric cancer. The Changes in the diagnostic methods cardiac cancer cases accounted for 48.6% (236/486) Early in the 1970s, retrospective studies of the deaths of the gastric cancers[11]. It was therefore presumed from malignancies in China, showed there were 6 that the incidence of cardiac cancer in the high-risk major high-risk areas for esophageal carcinoma, i.e. area for esophageal carcinoma, with Yanting, north 1) the Taihang mountains in Northern China; 2) Qin- Sichuan province as the center, might be similar to ling mountains in Shaanxi and Henan provinces; 3) north China areas, such as Linzhou in Henan and Dabieshan mountains adjoining the Hubei, Henan Yangcheng in Shanxi. However, in Linqu, Shandong and Anhui provinces; 4) Northern Sichuan province; province, a high-risk area of gastric cancer, 63 % 5) Fujian and Guangdong provinces and 6) Northern of the gastric cancer sites occurred in the gastric Jiangsu province. Over a 40-year period diagnostic antrum[12], while in Zhuanghe, Liaoning province, methods for esophageal carcinoma evolved so there another high-risk area of gastric cancer, the incidence were 4 main stages, i.e., X-ray, exfoliative cytology of gastric antrum cancer ranked first[13]. Based on the screening with X-ray, preliminary exfoliative cytol- code collection analysis of the morbidity and mortal- ogy screening plus endoscopy and direct endoscopy. ity in the tumor monitoring sites of China, cardiac After the middle of the 1990s, endoscopy basically cancer has always been included in the gastric cancer replaced the exfoliative cytology screening method, (C16) statistics, thus inevitably covering up the epi- thus improving the differential diagnosis of squamous demiological features of the incidence and death rate esophageal cancer and cardiac glandular cancer. At from malignant tumors in different high-risk areas in present, from the esophageal cancer monitoring site China. Therefore, how to collect more scientific data in the countryside, the histological diagnosis per- from the tumor monitoring sites and especially, the centage amounted to 45.1% to 69.2% (per 1,000 EC epidemiological changes in the high-risk tumor areas, patients)[1]. It is believed that with further up-grading has become a new topic for the tumor registry. of early clinical diagnosis by endoscopy and develop- ment of endoscopic physical technology, diagnosis of Suggestion cardiac cancer will further be improved. At the same time, there will be an increase in cardiac cancer mor- At one time in China, owing to the similarity in clini- bidity and mortality in the high-risk area of esopha- cal manifestations and therapies between esophageal geal carcinoma. So, it is very necessary to pay more carcinoma and cardiac cancer, as well as to the di- attention to epidemiological surveillance, in order to agnostic techniques, cardiac cancer was statistically reflect the tendency for changes in the frequency of classified as esophageal carcinoma. Since the middle these cancers. of the 1980s, cardiac cancer has been included in a category for gastric cancer based on the international Difference of preventive research classification of diseases. A separate statistical analy- After a comprehensive study in 2000, the WHO sug- 440 Chinese Journal of Clinical Oncology Dec. 2007, Vol. 4, No. 6 P 438~441 Zhifeng Chen et al. gested that the incidence of cardiac cancer was quite a great number of early cardiac cancer cases were different from distal carcinoma of the stomach. Food found, resulting in a persuasive conclusion for a defi- pollution and helicobacter-pylori (HP) infection also nition of cardiac cancer. was different[2]. Similarly, findings in China showed Finally, to decrease the incidence and mortality that[15-17] the regular neoplastic pattern after HP in- rates of esophageal carcinoma in the high-risk areas, fection was as follows: gastric antrum > cardiac and the Chinese central government has launched a re- paraneoplastic tissue > cardiac cancer tissue. Another search program of early diagnosis and treatment of finding was that the level of infection had a negative esophageal carcinoma using endoscopy in the model correlation with atypical hyperplasia. Currently, a bases of 8 counties and 6 provinces. Previous studies well-accepted pathological process for cardiac cancer have shown that the sensitivity of endoscopic iodine development is as the following, i.e. intestinal meta- staining for squamous esophageal cancer amounted plasia →dysplasia → cancer in situ and then early in- to 97.1%, while that for cardiac cancer was 80.0%[19]. vasive carcinoma. 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