Presidential address: Gastrointestinal cancer. Surgical survey of abdominal tragedy

The experience with gastrointestinal cancer at a single large hospital has been utilized as a "micro-model" of the experience for the country at large, and the reasons why such a comparison might be possible have been presented. The incidence of various lesions has been discussed in terms of sex, age, and race. The changing incidence of various lesions has been pointed out. Survival results have been determined for total series, for various types of operative procedures, and for various extents of disease. The comparability of survival results from this one institution and those collected from the literature have been discussed. The emergence of newer diagnostic and therapeutic measures has been highlighted. The importance of education of both patients and physicians is emphasized repeatedly by the late stage at which so many of the patients with any gastrointestinal cancer present to and are diagnosed by the physician. The educational task for all of medicine is apparent and must be faced in some effective fashion.

Pattern of organ involvement in Burkitt's lymphoma in Ibadan: a review

A retrospective study was conducted on 127 patients with Burkitt's lymphoma who had partial or complete records of both clinical and pathologic features of their disease. An analysis and description of the anatomical tumor distribution based on post-mortem examinations was made, highlighting lack of correlation between clinical staging and pathologic findings. A consistent observation was the high incidence of involvement of the kidney, liver, and heart in each of the stages (I-III).The data to be presented will clarify at least in part, the unpredictability of response of Burkitt's lymphoma patients to chemotherapeutic agents, because total cell-kill, needed for cure and/or prevention of relapse, is made almost impossible due to the widespread tumor volume carried by the patients.Effective supportive treatment might be a life-saving adjuvant regimen in treatment of Burkitt's lymphoma patients, where the organs so commonly involved might fail to function.

Cancer of the pancreas in blacks: a ten-year experience

A ten-year retrospective study of cancer of the pancreas in black patients at Howard University Hospital is presented. A total of 68 patients was studied. The authors concluded that no form of treatment had significant effect in terms of survival in stages II, III, and IV disease.

Course and treatment results of young patients with carcinoma of the pancreas

Carcinoma of the pancreas is increasing in incidence and appears to do so, in part, by affecting an increasingly younger population. To define differences or similarities of a young population with those of other reported series, the records of 31 patients less than 46 years of age were summarized and compared. Regardless of age, patients had identical symptoms when first seen, on the average of less than six months' duration. In spite of this short time, the vast majority, 26 of 31 patients, had widespread, unresectable disease at operation. No identifiable difference of epidemiologic significance has been identified. Considerable palliation can be achieved by performing bypass procedures. The three who survived the longest period of time in this group had pancreatoduodenectomies performed for cure.

Cystadenoma and cystadenocarcinoma of the pancreas

Cystadenoma and cystadenocarcinoma comprise the majority of the true neoplastic cysts of the pancreas. Five cystadenomas and two cystadenocarcinomas of the pancreas were found in a review of the clinical records of the University of Minnesota Hospitals and the Minneapolis Veterans Administration Hospital. The report of these cases serves to review the clinical and pathological features of these neoplasms. These rare neoplastic cysts occur predominantly in women and are not associated with a history of trauma, alcoholism, or pancreatitis. They produce symptoms by compression of neighboring organs and are slow growing, often attaining large size. With complete excision the results of surgical treatment are usually good.

Incidence of cancer in United States blacks

Incidence rates for the black population of six Standard Metropolitan Statistical Areas in the United States are examined using data collected in the Third National Cancer Survey, 1969 to 1971. For all sites combined, black males had the highest rates among the four major race-sex groups; black females had the lowest rates. For fourteen common sites accounting for 80% of the cancers among blacks, black/white ratios, survival data, trends between 1935 and 1969, and geographic variation are presented. United States black data adjusted to an African Standard are compared with similar data from Nigeria, Rhodesia, and South Africa.

Cancers of the pancreas and biliary tract: epidemiological considerations

The epidemiological patterns for pancreatic and biliary cancers reveal more differences than similarities. Pancreatic carcinoma is common in western countries, although 2 Polynesian groups (New Zealand Maoris and native Hawaiians) have the highest rates internationally. In the United States the disease is rising in frequency, predominating in males and in blacks. The rates are elevated in urban areas, but geographic analysis uncovered no clustering of contiguous counties except in southern Louisiana. The origin of pancreatic cancer is obsure, but a twofold increased risk has been documented for cigarette smokers and diabetic patients. Alcohol, occupational agents, and dietary fat have been suspected, but not proven to be risk factors. Except for the rare hereditary form of pancreatitis, there are few clues to genetic predisposition. In contrast, the reported incidence of biliary tract cancer is highest in Latin American populations and American Indians. The tumor predominates in females around the world, except for Chinese and Japanese who show a male excess. In the United States the rates are higher in whites than blacks, and clusters of high-risk counties have been found in the north central region, the southwest, and Appalachia. The distribution of biliary tumors parallels that of cholesterol gallstones, the major risk factor for biliary cancer. Insights into biliary carcinogenesis depend upon clarification of lithogenic influences, such as pregnancy, obesity, and hyperlipoproteinemia, exogenous estrogens, familial tendencies, and ethnic-geographic factors that may reflect dietary habits. Noncalculous risk factors for biliary cancer include ulcerative colitis, clonorchiasis, Gardner's syndrome, and probably certain industrial exposures. Within the biliary tract, tumors of the gallbladder and bile duct show epidemiological distinctions. In contrast to gallbladder cancer, bile duct neoplasms predominate in males; they are less often associated with stones and more often with other risk factors. In some respects, bile duct and pancreatic tumors are alike. The male predominance of both tumors, an association between cholecystectomy and pancreatic cancer, and other considerations have prompted the notion that the same biliary carcinogens may affect the bile duct, ampulla of Vater, or, by reflux, the pancreatic duct. Various epidemiological and interdisciplinary approaches are needed to further clarify the origins of biliary tract and pancreatic cancers, but nutritional studies hold special promise in laying the groundwork for prevention of these tumors.

Lung cancer and air pollution in southcentral Los Angeles County

An increased rate of lung cancer has been consistently observed from 1968-1972 among males in southcentral Los Angeles. This excess risk occurs across several social classes and occupational categories. No differential excess of oral cavity, pancreatic, laryngeal and bladder cancer was observed in the same area, lessening the possibility that regional variations in smoking habits accounted for the excess lung cancer. Air sampling has indicated an excess of certain polynuclear aromatic hydrocarbons (PAH) in southcentral Los Angeles. There was a correlation between the geographic distribution of lung cancer cases and the general location of industries which have emitted these PAH. A case-controlled study of smoking, occupational and residential history in the southcentral area is underway.

Multiple primary neoplasms in blacks compared to whites. IV. Further cancers in patients with cancer of the digestive organs

Second primary cancers found among whites and blacks with initial cancer of the digestive organs were reported based on data from the Charity Hospital Tumor Registry. Observed second primary cancers were compared to expected numbers to obtain a direct estimate of risk. Both white and black men had about a twofold risk of developing a second cancer. For white men, the excess was limited to a subsequent skin cancer, but this finding was probably an artifact of reporting and lacked biologic significance. Among women, both white and black, large excesses of invasive cancer of the cervix and ovary were found after an initial cancer of the large intestine and anorectum was discovered. No excess of breast cancer was found.

Carcinoma of pancreas, A study based on autopsy data from 1928 to 1972 in Vienna, Austria

The analysis of autopsy data from 1928 to 1972 shows that the relative frequency of carcinoma of pancreas has undergone a threefold increase during the past 30 years. During period B (1953--1972) there has been a real increase (twofold) for the middle and higher age groups as compared with that during period A (1928-1952). Further, it seems that the frequency rises non-linearly with age and that the higher age groups are relatively more prone to a malignant change of the pancreas. The pattern of pathological manifestations has been discussed and its practical importance pointed out.

Cancer patterns in Alameda County, California

There has been a general increase in the incidence of cancer of most major sites during the period 1960-69; this is true even when allowances are made for shifts in the age composition of the population. Improvements in diagnostic procedures may account for some of these increases but it is doubtful that they are solely responsible for the greater incidence recorded.A few sites stand out as being primarily responsible for the increase in the overall cancer incidence. Lung cancer is increasing in both males and females; the rate of increase, however, is much greater among females. It is generally acknowledged that women began smoking cigarettes at a later point in time and to a lesser extent. The pattern which has emerged indicates that females are experiencing a similar trend in lung cancer incidence to that of males. The increase in the incidence of female breast cancer is also noteworthy, although the forces producing this change can only be speculated upon. The high incidence of prostatic cancer among negroes and the increase in the incidence of prostatic cancer in whites are subjects which deserve further investigation, especially since the Alameda County experience is not duplicated in data from the Connecticut Tumour Registry. One of the most encouraging findings is that the incidence of stomach cancer appears to be declining.