سرطان کاردیای معده؛ شایعترین نوع سرطان دستگاه گوارش فوقانی در اردبیل

Title

Gastric Cardia Cancer; The Most Common Type of Upper Gastrointestinal Cancer in Ardabil, Iran: An Endoscopy Clinic Experience

English Abstract

Background-According to a recent report published by the Ministry of Health and Medical Education of the I. R. of Iran, gastric cancer (GC) is the most common fatal cancer in this country and its prevalence is highest in Ardabil province, Northwest of Iran. This descriptive endoscopic survey was designed to determine the type of upper gastrointestinal (GI) malignancy in this high prevalence area. Method-This study was conducted in the first established subspeciality outpatient GI clinic in the city of Ardabil. From 11,518 patients who attended this clinic in a one-year period, 1,152 (10%) with persistent upper GI symptoms underwent upper GI fiberoptic endoscopy and 162 (14.1%) had a tumor with malignant appearance. At least six endoscopic punch biopsies were obtained from all the tumors and sent for histopathologic examination. Demographic data was obtained from all 162 patients. Statistical analysis was performed using the SPSS statistical package. Results-GI cancer was diagnosed histologically in 467 patients (15.0%). Gastric cancer constituted 299 cases (64.0%), esophageal cancer 167 (35.8%), and cancer of gastrojejunostomy site 1 (0.2%). The most frequent site of upper GI malignancy was the gastric cardia 150 (32.1%), followed by esophageal body 89 (19.1%), the antrum 84 (18.0%), gastric body 65 (13.9%), distal esophagus 56 (12.0%), and proximal esophagus 22 (4.7%). All cardia cancers (100%) was adenocarcinoma, but 4 cases of malignant lymphoma and 2 carcinoid tumor were found in other parts of the stomach. The mean age of the patients with cancer was 63.2 (95% CI: 61.4-64.9) that is lower than corpus cancer 68.5 (95% CI: 66.7-70.2) and is similar to antrum 62.1 (95% CI: 59.7-64.5). Weight loss with OR=1.62 (1.09-2.40), bleeding [OR=2.43 (1.01-5.85)] and dysphagia [OR=1.69 (1.13-2.52)] are more frequent in cardia cencer rather than other sites in stomach. Conversely vomiting [OR=0.25 (0.07-0.84) and abdominal pain [OR=0.54 (0.34-0.84)] are less frequent in cardia cancer. Smoking, alcohol, opium, and residental region haven't significant associations with cardia cancer. Conclusion-Cancer of the gastric cardia is now the most common upper GI malignancy in Ardabil and constitutes more than 50% of gastric cancers. It is recommended that subsite-specific gastric cancer risk factors, including H. pylori and dietary nitrates, be studied in this region in the future.

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