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J Clin Gastroenterol 1991 Apr;13(2):191-4 Related Articles, Links Comment in: J Clin Gastroenterol. 1992 Sep;15(2):166. Gastric cancer after gastric bypass for obesity. Case report. Raijman I, Strother SV, Donegan WL. Department of Medicine, University of Wisconsin Medical School, Milwaukee. We describe a patient in whom gastric cancer developed after gastric bypass for morbid obesity. In addition, we review the literature to emphasize the technical problems involved in diagnosing disease in the excluded portion of the stomach.
Aust N Z J Surg 1997 Aug;67(8):580-2 Related Articles, Links Gastric cancer in the bypassed segment after operation for morbid obesity. Lord RV, Edwards PD, Coleman MJ. Department of Surgery, St Vincent's Hospital, Sydney, Australia. A case is reported in which two separate adenocarcinomas were detected in the bypassed distal stomach 13 years after gastric stapling with loop gastro-enterostomy was performed for the treatment of morbid obesity. Retrograde endoscopy via the afferent loop was used to establish the diagnosis. Although gastritis and metaplasia have been described in the bypassed stomach, only one case of carcinoma in this area has previously been reported.
Am J Surg 1981 Apr;141(4):487-91 Related Articles, Links Carcinoma of the stomach after gastric operation. Orlando R 3rd, Welch JP. Seventeen cases of carcinoma of the stomach occurring late after previous gastric operation are presented. In all instances, patients had undergone gastroenterostomy, with or without gastric resection. Most patients had undergone the initial operation for peptic ulcer disease an average of 18 years before presenting with the tumor. Endoscopic biopsy of the gastroenterostomy and gastric cytologic evaluation offered a high degree of sensitivity and specificity in making the diagnosis. These tumors appeared to originate in the gastric mucosa near the stoma. Survival was poor with both curative and palliative therapy. Alkaline bile reflux, achlorhydria and bacterial colonization are discussed as possible causes. Patients who have undergone partial gastric resection are at increased risk for the development of carcinoma of the stomach remnant. We recommend that any patient in whom new upper gastrointestinal symptoms develop more than 10 hears after partial gastrectomy should undergo endoscopy with biopsy of the gastric mucosa adjacent to the anastomosis.
Rev Esp Enferm Dig 1991 Apr;79(4):246-8 Related Articles, Links Erratum in: Rev Esp Enferm Dig 1991 Jul;80(1):80 [The incidence of gastric carcinoma after gastrectomy for peptic ulcer in the Vigo region. A case-control study] [Article in Spanish] Fernandez Rodriguez C, Sopena B, Martinez C, Ruiz Ochoa V, Ledo Barro L, Rodriguez Martinez D, Pereira Bueno S, Gonzalez Carrero J, Naranjo Rodriguez A, Pallares Peral A. S. Aparato Digestivo, Hospital Xeral, Vigo. After reviewing 10,000 upper gastrointestinal endoscopies performed at the endoscopy unit of the city of Vigo over a 38 month period, we have found 485 partial gastric resections for peptic ulcer, 357 gastric carcinomas were found, of which 26 occurred after partial gastric resection for peptic ulcer. Therefore the incidence of gastric cancer in this area was 22-23/100,000. The frequency of gastric cancer after partial resective surgery was lower than expected during the first 20 years after surgery. However, thereafter a significant increase of gastric cancer occurred in those patients in which a Billroth-II but not Billroth-I procedure was used. Nutr Rev 2000 Feb;58(2 Pt 1):54-6 Related Articles, Links Association between body mass index and adenocarcinoma of the esophagus and gastric cardia. Li SD, Mobarhan S. Division of Gastroenterology, Hepatology, and Nutrition, Loyola University Medical Center, Maywood, IL 60153, USA. Obesity is an increasing problem for industrialized nations. The incidence of adenocarcinoma of the esophagus and gastric cardia has also risen during the past two decades. A recently published population-based study attempted to relate this rise to increases in obesity or body mass index. Obesity may not only increase the risk for adenocarcinoma of the upper gastrointestinal tract, but it may also increase the risk of colon cancer and overall mortality. More research is needed to understand obesity's health impact and ways to control this epidemic.
1: Lakartidningen 2000 Apr 19;97(16):1950-3 Related Articles, Links [Increased incidence of adenocarcinoma of the esophagus and cardia. Reflux and obesity are strong and independent risk factors according to the SECC study] [Article in Swedish] Lagergren J. Karolinska institutet, Danderyds sjukhus, Stockholm. jesper.lagergren@mep.ki.se In a Swedish nationwide case-control study, gastroesophageal reflux and obesity were identified as strong and independent risk factors for esophageal adenocarcinoma. A moderately strong association was found with adenocarcinoma of the gastric cardia. No significant association was found with squamous cell carcinoma of the esophagus. With increasing duration and severity of reflux symptoms and with increasing body mass index (BMI) the risk increased in a dose-dependent manner. When combined, reflux symptoms and obesity entailed greatly increased risk estimates, with relative risks exceeding 100 compared with persons with neither reflux symptoms nor obesity. However, because adenocarcinoma of the esophagus and gastric cardia are rarities, the absolute risk of developing these tumors was still not high. Our calculations revealed that even in the group with the highest risk, endoscopic surveillance is not readily recommended. Possible reasons for the increasing incidence of adenocarcinoma of the esophagus include 1) a suspected increase in the prevalence of reflux disease; 2) the increasing prevalence of obesity reported in western populations; and 3) the widespread use of medications that relax the lower esophageal sphincter and might cause reflux. All of these hypotheses suffer from inconsistencies that need to be solved before any firm conclusions can be drawn concerning the reasons for the increasing incidence of esophageal adenocarcinoma. Publication Types: Review Review, Tutorial PMID: 10826353 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 2: J Natl Cancer Inst 1998 Jan 21;90(2):150-5 Related Articles, Links Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. Chow WH, Blot WJ, Vaughan TL, Risch HA, Gammon MD, Stanford JL, Dubrow R, Schoenberg JB, Mayne ST, Farrow DC, Ahsan H, West AB, Rotterdam H, Niwa S, Fraumeni JF Jr. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. BACKGROUND: Incidence rates have risen rapidly for esophageal adenocarcinoma and moderately for gastric cardia adenocarcinoma, while rates have remained stable for esophageal squamous cell carcinoma and have declined steadily for noncardia gastric adenocarcinoma. We examined anthropometric risk factors in a population-based case-control study of esophageal and gastric cancers in Connecticut, New Jersey, and western Washington. METHODS: Healthy control subjects (n = 695) and case patients with esophageal squamous cell carcinoma or noncardia gastric adenocarcinoma (n = 589) were frequency-matched to case patients with adenocarcinomas of esophagus or gastric cardia (n = 554) by 5-year age groups, sex, and race (New Jersey only). Classification of cases by tumor site of origin and histology was determined by review of pathology materials and hospital records. Data were collected using in-person structured interviews. Associations with obesity, measured by body mass index (BMI), were estimated by odds ratios (ORs). All ORs were adjusted for geographic location, age, sex, race, cigarette smoking, and proxy response status. RESULTS: The ORs for esophageal adenocarcinoma rose with increasing adult BMI. The magnitude of association with BMI was greater among the younger age groups and among nonsmokers. The ORs for gastric cardia adenocarcinoma rose moderately with increasing BMI. Adult BMI was not associated with risk of esophageal squamous cell carcinoma or noncardia gastric adenocarcinoma. CONCLUSIONS: Increasing prevalence of obesity in the United States population may have contributed to the upward trends in esophageal and gastric cardia adenocarcinomas. PMID: 9450576 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 3: Cancer Causes Control 1993 Mar;4(2):123-32 Related Articles, Links Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia. Kabat GC, Ng SK, Wynder EL. Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461. Little is known about the etiology of adenocarcinoma of the distal esophagus/cardia, a cancer which has increased in incidence in the United States over the last two decades. We analyzed data on smoking, alcohol use, dietary intake, and other factors obtained from 173 hospitalized males with adenocarcinoma of the distal esophagus/cardia (cases) and 4,544 hospitalized males with diseases not related to smoking and of other organ systems than the gastrointestinal tract (controls). Cases of squamous cell carcinoma of the esophagus (n = 136) and adenocarcinoma of the distal stomach (n = 122) were included as separate case groups. All subjects were interviewed in 28 hospitals in eight cities in the US between 1981 and 1990. After adjustment for covariates, the odds ratio (OR) for adenocarcinoma of the distal esophagus/cardia for current smokers was 2.3 (95 percent confidence interval [CI] = 1.4-3.9) and that for ex-smokers was 1.9 (CI = 1.2-3.0) relative to never-smokers. The OR for drinkers of four or more ounces of whiskey-equivalents of alcohol per day (relative to those consuming less than one drink per week) was 2.3 (CI = 1.3-4.3). Intakes of total fat and vitamin A from animal sources were significant risk factors and fiber intake was associated inversely with adenocarcinoma of the distal esophagus/cardia. Although the number of female cases of adenocarcinoma of the distal esophagus/cardia was small (n = 21), significant associations were observed for smoking and alcohol. PMID: 8481491 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 4: Cancer Epidemiol Biomarkers Prev 1995 Mar;4(2):85-92 Related Articles, Links Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Vaughan TL, Davis S, Kristal A, Thomas DB. Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104, USA. Adenocarcinomas of the esophagus and gastric cardia were once rare. However, for unknown reasons, their incidence has been increasing rapidly over the past 15 years in the United States and parts of Western Europe. In contrast, the incidence of esophageal squamous cell carcinomas has remained relatively constant. To investigate possible reasons for these diverging incidence rates we analyzed data from two population-based case-control studies of cancers of the esophagus and gastric cardia that were conducted among male and female residents of western Washington between 1983 and 1990. Information on body mass index, cigarette use, alcohol intake, and other possible risk factors was collected via personal interviews with 404 cases or their next of kin (including 298 adenocarcinomas and 106 squamous cell carcinomas) and 724 controls identified by random digit dialing. Use of alcohol and cigarettes were significant risk factors for both histological types. The increase in risk for current smokers of 80 or more pack-years compared to nonsmokers was substantially higher for squamous cell cancer [odds ratio (OR) = 16.9; 95% confidence interval (CI) = 4.1-69.1] than for adenocarcinoma (OR = 3.4; 95% CI = 1.4-8.0), as was the increase for persons who typically drank 21 or more drinks/week compared to those who drank <7/week (OR = 9.5; 95% CI = 4.1-22.3 versus OR = 1.8; 95% CI = 1.1-3.1). For squamous cell carcinoma, body mass index was inversely associated with risk, whereas for adenocarcinoma, the highest risk was observed among persons who were in the highest decile of body mass index (OR = 1.9; 95% CI = 1.1-3.2).(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7742727 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 5: Nutr Rev 2001 Nov;59(11):372-4 Related Articles, Links Preventive role of dietary fiber in gastric cardia cancers. Roth J, Mobarhan S. Department of Medicine at the Loyola University Medical Center, Maywood, IL 60153, USA. The incidence of adenocarcinoma of the esophagus and gastric cardia is increasing. Many factors are presumed to be associated: symptoms of gastroesophageal reflux disease, tobacco use, alcohol consumption, dietary factors, and obesity. A recent large population-based case-control study evaluated the association between dietary fiber intake and cancers of the gastric cardia and esophagus. This interesting study indicated that high intake of cereal fiber may significantly decrease the risk of gastric cardia cancer. More research is needed on this topic in the hope that dietary intake may decrease the incidence of these cancers. Publication Types: Review Review, Tutorial PMID: 11720343 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 6: Ann Intern Med 1999 Jun 1;130(11):883-90 Related Articles, Links Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Lagergren J, Bergstrom R, Nyren O. Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden. Jesper.Lagergren@mep.ki.se BACKGROUND: The incidence of esophageal and gastric cardia adenocarcinoma is, for unknown reasons, increasing dramatically. A weak and inconsistent association between body mass index (BMI) and adenocarcinoma of the esophagus and gastric cardia has been reported. OBJECTIVE: To reexamine the association between BMI and development of adenocarcinoma of the esophagus and gastric cardia. DESIGN: Nationwide, population-based case-control study. SETTING: Sweden, 1995 through 1997. PATIENTS: Patients younger than 80 years of age who had recently received a diagnosis were eligible. Comprehensive organization ensured rapid case ascertainment. Controls were randomly selected from the continuously updated population register. Interviews were conducted with 189 patients with adenocarcinoma of the esophagus and 262 patients with adenocarcinoma of the gastric cardia; for comparison, 167 patients with incident esophageal squamous-cell carcinoma and 820 controls were also interviewed. MEASUREMENTS: Odds ratios were determined from BMI and cancer case-control status. Odds ratios estimated the relative risk for the two adenocarcinomas studied and were calculated by multivariate logistic regression with adjustment for potential confounding factors. RESULTS: A strong dose-dependent relation existed between BMI and esophageal adenocarcinoma. The adjusted odds ratio was 7.6 (95% CI, 3.8 to 15.2) among persons in the highest BMI quartile compared with persons in the lowest. Obese persons (persons with a BMI > 30 kg/m2) had an odds ratio of 16.2 (CI, 6.3 to 41.4) compared with the leanest persons (persons with a BMI < 22 kg/m2). The odds ratio for patients with cardia adenocarcinoma was 2.3 (CI, 1.5 to 3.6) in those in the highest BMI quartile compared with those in the lowest BMI quartile and 4.3 (CI, 2.1 to 8.7) among obese persons. Esophageal squamous-cell carcinoma was not associated with BMI. CONCLUSIONS: The association between BMI and esophageal adenocarcinoma is strong and is not explained by bias or confounding. The carcinogenic mechanism, however, remains to be clarified. The increasing prevalence of obesity in western countries could be important in understanding the increasing occurrence of this tumor. PMID: 10375336 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 7: Cancer Causes Control 2001 Oct;12(8):721-32 Related Articles, Links A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Wu AH, Wan P, Bernstein L. Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, USA. annawu@hsc.usc.edu OBJECTIVES: Since the 1970s incidence rates for esophageal and gastric cardia adenocarcinomas have risen substantially, particularly among white males in the United States. Reasons for the increase of these tumor types are not well understood. We sought to determine the role of smoking, alcohol use, and body size characteristics in the etiology of esophageal, gastric cardia, and distal gastric adenocarcinomas. MATERIALS AND METHODS: A population-based case-control study that included Whites, African-Americans, Latinos and Asian-Americans diagnosed with incident esophageal (n = 222), gastric cardia (n = 277), and distal gastric adenocarcinomas (n = 443), and 1356 control subjects was conducted in Los Angeles County. Unconditional logistic regression was used to calculate odds ratios (ORs), as an estimate of the relative risk, and corresponding 95% confidence intervals (CIs) for the three tumor types of interest. RESULTS: After adjustment for age, gender, race, birthplace, and education, current cigarette smoking was a significant risk factor for all tumor types; the association was strongest for esophageal adenocarcinomas (OR = 2.80, 95% CI = 1.8-4.3), intermediate for gastric cardia adenocarcinomas (OR = 2.12, 95% CI = 1.5-3.1), and weaker for distal gastric adenocarcinomas (OR= 1.50, 95% CI = 1.1-2.1). For esophageal adenocarcinomas only, cigarette smoking had a long-lasting deleterious effect, even 20 years after smoking cessation. Alcohol use was not associated with an increased risk of these tumor types. Risks of esophageal and gastric cardia adenocarcinomas also increased statistically significantly in a dose-dependent manner with increasing body mass index measured at ages 20 and 40 years and recently. The positive associations with smoking and body mass index were generally consistent when evaluated separately for Whites, non-Whites, males, and females. CONCLUSIONS: Cigarette smoking and high body mass index are significant, independent risk factors for esophageal and gastric cardia adenocarcinomas. Studies designed to understand the mechanisms whereby smoking and high body mass influence these tumor types are needed. PMID: 11562112 [PubMed - indexed for MEDLINE] |
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