According to studies in India: 1) Esophageal cancer is most commonly squamous cell carcinoma, with adenocarcinoma accounting for about 8% of cases. Risk factors for esophageal cancer include HPV infection and p53 mutations. 2) Stomach cancer is most prevalent in Northeast India, particularly in Mizoram. Risk factors include H. pylori infection, pickled foods, smoked foods, and GSTM1 mutations. 3) Liver cancer is usually hepatocellular carcinoma developing in cirrhotic livers. Risk factors are HBV, HCV, alcohol, and dual infections. 4) Gallbladder cancer incidence varies by region but presents at advanced stages with poor survival rates

1. GI MALIGNANCIES –
INDIA SCENARIO
SHANKAR ZANWAR

3. ESOPHAGUS
• Epidemiology -
• Study by Dr Jijo Cherian, Dr Jayanti – 2007, J Gastro – Liver dis, trends in ca
esophagus
• Retrospective study 994 ca esophagus pts – 1989-2004
• Most common squamous cell ca – 912 -92%
• Adenocarcinoma – 82 patients – 8%

4. • Squamous cell carcinoma
• No significant difference in presenting symptoms, over study period
• There was decrease in number of patients detected as SCC below age 40
• No significant changes in trends of gender distribution
• Overall – 2.16:1 – M:F
• Upper – 1.73
• Middle – 2.08
• Lower – 2.35

5. • Adenocarcinoma
• 65 – EGJ malignancy
• 17 distal third
• None in the upper or middle third
• Over the study years no time trends seen in terms of frequency and gender(M:F – 3.6:1)
was seen
• Significant increase in the number of pts detected ca. below age 40 in last 4 years of
study

6. RISK FACTORS FOR CA.ESOPHAGUS
• Study by Dr Chitra and Dr Jayanti V, 2007 ISG journal
• 90 consecutive patients studied

8. • Study by Sanjay Katiyar, Khuroo et al – Cancer 2005
• HPV infection
• High in NE region – 44% of ca esophagus biopsies very less in Delhi region
• Mutation in p53
• High in Delhi – 30.6% compared to NE and Kashmir

9. CLINICO-PATHOLOGICAL PROFILE
• Study from Kashmir, Nazir Khan - 2004
• 680 patients studied
• Presentation
• MC dysphagia to solids – 90%
• Loss of appetite – 80%
• Generalized weakness – 70%
• Weight loss – 50%
• Retro sternal pain – 40%
• Vomiting regurgitation – 20%
• Development of trachea-esophageal fistula grave prognosis – 2.6%(n=16), all died within
6 month.

11. STOMACH
• Highest prevalence seen in NE –Mizoram
• Accounting 30% of all cancers there - Tuibur - tobacco smoke water and meizol
– local cigarette high in carcinogens – ICMR 2004
• Second commonest location is south India >4X that of north.
Keechilat Pavithran, IJGCA journal 2002

12. • Site –
• MC body of stomach 40.7%
• Pylorus – 35%
• Cardia – 25%
• Nearly 95% are adenocarcinoma.
• Intestinal type is more common diffuse type as compared to west.
• More than 90% are diagnosed at advanced stage, >70% at surgery have serosal
infiltration.
Keechilat Pavithran, IJGCA journal 2002

13. • Risk factors
• H pylori – Prevalence varies from – 56-89%
• South India – pickled foods – OR 1.8 (CI 1.2 -3.2) independent risk factor – Dr. Sumathi,
2009 SMJ
• NE – Kalakhar – particular variety banana skin used in curries – 8X increased risk
• Salted tea use in Kashmir
• GSTM -1 mutations a/w OR – 1.98, Malik et al
Rajesh Dixit, Ind Jour Oncol 2011

14. • Male : female – 2.6: 1
• Age
• <30years - <10%
• 30-60 years ~50%, rest >60yr
• Treatment and survival
• Extensive LN dissection as in Japan is not practiced in India
• Curative surgery done in only – 20%
• 5 year over all survival – 5-18%
Keechilat Pavithran, IJGCA journal 2002

15. HEPATOCELLULAR CARCINOMA

16. INCIDENCE
• About 70-97% seen in cirrhotics as globally
• Etiological distribution –
• HBV – 36.6%
• HCV – 27.8%
• Dual – 6%
• Others – 29.4%
• Long term cohort study – annual risk of HCC
• HBV – 2.2%, depends also on HbeAg, DNA status
• HCV – 3.8%
• Alcohol – 1.7%
Shashi Paul, IJG 2007

18. CLINICAL PRESENTATION
R Kumar, S K Sarin QJM, oxford 2008

21. INASL consensus, Puri recommendation
2014
• Age adjusted rate of HCC
• Men 0.7-7.5, female 0.2-2.2 per 1lakh
• Male : female 4:1
• Mortality – 6.8/1lakh for men and 5.1/1lakh for women
• Incidence in cirrhotics – 1.6% per year
• Screening – Six monthly screening by EXPERIENCED personnel
• No additive role of alfa- fetoprotein in screening

22. GALL BLADDER
• This is 5th commonest GI cancer
• Incidence in registries – 1.01 in M to -2.3 in F /lakh
• Study by Nissar Hussain – Calcutta 2012
• n=198, M – 25.3%, F- 75.5%

24. K Mohandas, IJG 1999

25. GB CA. INDIA DISMAL PICTURE – BATRA, JGH
2005
• Study 634 patients, over 1 years
• Gall stones present in 54%
• Surgery – 46%, endotherapy – 19%
• 30 day mortality – 10%
• Median survival – 33.5m after simple cholecystectomy, 12m after radical
surgey
• Debulking and palliative bypass surgery survival – 1-3months

26. CA PANCREAS
• Incidence of ca pancreas is amongst the lowest in Indians
• Mean incidence 1.1 to 1.8 per lakh
• No regional variation unlike GBC
• Location wise distribution in Tata
• Head – 84%, body 4%, tail 7%, non specified – 5%
Mohandas IJG, 1999
• Risk factors for ca pancreas
• Tropical pancreatitis – commonest in Kerala
Chari, Madanagopal, Pitchumani, Pancreas 1994
• Cancer develops mainly in body, but studies from else where no correlation with tropical pancreatitis

27. MALIGNANT BILIARY OBSTRUCTION
N=110 of obstructive jaundice, Meerut
S Verma, Internet Journal of Tropical medicine 2010

29. • There is no study on epidemiological profile of cholangiocarcinoma from India.

30. COLORECTAL
• Annual incidence rates, 4.4 per lakh
• Ranks 8th in cancers in male
• Presentation is a decade earlier than west - ICMR
• Highest incidence from – Trivandrum,
• Study from Kochi – 220 pts. By Peedikayil, IJG 2009

32. Peedikayil – 2009 Mohandas, IJG 2009

33. THANK YOU