Cancer incidence and mortality in Antigua/Barbuda

An inquiry into the incidence and mortality of malignant neoplasms in Antigua/Barbuda was undertaken to document the magnitude of the disease. The top ranking cancers diagnosed in 114 males were skin (26.3 percent), prostate (22.8 percent) and upper respiratory and alimentary tract (10.5 percent). In 130 females, the 3 main cancers were breast (23.1 percent), cervix uteri (22.3 percent), and skin (15.3 percent). The main cancers causing death were stomach (22.3 percent) and prostate (17.8 percent) in 157 males; and breast (18.2 percent) and cervix uteri (14.1 percent) in 149 females. Imprecise documentation, insufficient clinico-pathological correlation and the finding of advanced cancers underscore the need for a cancer registry and cancer society in Antigua/Barbuda. (AU)

30-year cancer trends in Jamaica: Kingston & St. Andrew (1958-1987)

A total of 19,225 malignant neoplasms were recorded in Kingston & St.Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2 percent), stomach (10.9 percent) and lung (10.7 percent). In females 24.1 percent of cancers occurred in breast and 20 percent were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns. (AU)

Cancer incidence and mortality in Antigua/Barbuda

An inquiry into the incidence and mortality of malignant neoplasms in Antigua/Barbuda was undertaken to document the magnitude of the disease. The top ranking cancers diagnosed in 114 males were skin (26.3 percent), prostate (22.8 percent) and upper respiratory and alimentary tract (10.5 percent). In 130 females, the 3 main cancers were breast (23.1 percent), cervix uteri (22.3 percent), and skin (15.3 percent). The main cancers causing death were stomach (22.3 percent ) and prostate (17.8 percent) in 157 males; and breast (18.2 percent) and cervix uteri (14.1 percent) in 149 females. Imprecise documentation, insufficient clinico-pathological correlation and the finding of advanced cancers underscore the need for a cancer registry and cancer society in Antigua/Barbuda. (AU)

Adenosquamous carcinoma of the stomach with a note of pathogenesis

A case of the rare adenosquamous carcinoma of the stomach is presented. This unusual type of stomach tumor is the first such case to be reported in Jamaica and in the Commonwealth Caribbean. We provide evidence in support of the metaplastic derivation of the squamous component from an existing adenocarcinoma. (AU)

Comparison of endoscopic brush cytology and biopsy in the evaluation of malignancies of the oesophagus and stomach - abstract

The value of brush cytology was compared to that of standard multiple biopsies in the assessment of lesions suspicious for malignancy at oesophagogastroscopy. Specimens from fifty-six patients were available for analysis: 36 from oesophageal sites and 22 from the stomach. A minimum of four slides were prepared for cytology in each case, and the results graded as negative for malignancy, suspicious, for malignancy or unsatisfactory. In twenty cases, both histology and cytology were positive for malignancy. In a further 11 cases histology was positive while cytology was graded as highly suspicious or suspicious. Three other patients with positive histology were regarded as having unsatisfactor cytological preparations. There were 2 false negative cytologies. On the other hand, there were 6 false negative biopsies with cytology positive or highly suspicious for malignancy, and two others with cytology positive and biopsies for malignancy. Eight patients had positive or highly suspicious cytology with unsatisfactory biopsies. In all cases with negative or unsatisfactory biopsies, malignancy was confirmed at operation or autopsy. One patient had a false positive (highly suspicious) biopsy and negative histology - absence of malignancy was confirmed at surgery. Three other patients had both cytology and biopsy negative; here two have had benign lesions confirmed at repeat endoscopy and one has been lost to follow-up (AU)

A retrospective study (1976-1980) of the incidence and mortality of cancer of the breast, prostate, cervix, stomach and lung in Barbados

There is incomplete collection of data on cancer incidence in Barbados. Although in 1969 cancer became a noticeable disease, the cancer registry established in 1968 was unable to produce valid figures and ceased recording in 1972. No collated data has since been accumulated. Consequently accurate statistics on cancer incidence are lacking. This study has employed a multiple case-finding approach to a retrospective investigation into cancer incidence of the breast, prostate, cervix, stomach and lung from 1976-1980. Registrations of primary cancer for Barbadian residents were used to calculate crude incidence. Intra-regional comparisions elucidated the relative burden of cancer at those sites. Age-specific incidence, adjusted to the 1980 census population, produced patterns for regional and international comparision showing, for prostate cancer, the expected increase after age fifty and for breast, cervix, stomach and lung, and increase in incidence throughout life. World standardisations permitted comparisions of Barbados' rank with those of 79 global registries. Invasive cervical cancer (47 per 100 000) is high. Lung cancer (3.6) is low. Barbados has intermediate rates for breast (31.5), stomach (10.7) and prostate (18.9) cancers. Stomach and lung cancer show the expected 2:1 ratio for male:female incidence. A more extensive breast cancer investigation elucidated laterality, stage, lesion-site, initial and eventual metastatic locations, treatment and survival characteristics. For all sites, tumor grade and histology were analysed. A brief mortality survey (1976-1984) determined crude, age-specific and standardised rates, and male:female ratios. Breast cancer mortality ranked first in females and gastric mortality was higher than prostate mortality in males. Late stage of diagnosis was evident, causing increased morbidity and reducing survival. Emphasis is laid on the need for persistent health education to generate an awareness of symptoms and motivate prompt consultation, and to create in the community a vigilance and concern which will reduce both incidence and mortality (AU)

Gastric carcinoma in the West Indies: a Trinidad study

Gastric carcinoma, the commonest cause of death from malignant disease in Trinidad, has decreased steadily over the period 1968-1977. Of the 1052 deaths during this time, females accounted for a relatively high percentage (45 percent) of cases. There is a predominance of antral tumors, and most cases present with very advanced disease (88 percent with stage III&IV). This results in a low resectability rate (32 percent). Its racial predilection for blacks of the lower income group suggest that both genetic and environmental factors may be important. The possible role of dietary factors is discussed.(AU)

Torsion of a gastric leiomyoma

A patient with an extraluminal gastric leiomyoma, which presented as an emergency because of torsion, is reported. This is thought to be the first report of such an occurrence. The diagnosis was not made preoperatively in spite of intensive investigation.(AU)

Comparative radiology of the proximal gastro-intestinal tract in Jamaica

A study of the radiological appearances and pathological features of a series of 17 cases of hypertrophic pyloric stenosis of the adult revealed several interesting features. It was shown that the generally accepted radiological description of smooth, severe and regular narrowing and elongation of the pyloric canal is only present in a proportion of cases. The radiological picture is very variable and many cases presented with an irregular pyloric canal and antrum with only moderate degree of narrowing or of pyloric stenosis. The classical pathological changes are said to be those of hypertrophy and hyperplasia of the circular muscle of the pyloric canal and adjacent part of the antrum. The use of special staining techniques revealed varying amounts of fibrous tissue in the hypertrophied smooth muscle in every case, a feature only briefly referred to in one or two previous communications. The presence of fibrous tissue is compatible with the theory that hypertrophic pyloric stenosis of the adult is secondary to pyloric channel ulcer and further evidence is presented in support of this. In a significant proportion of cases, the pyloric muscle hypertrophy is complicated by the presence of a benign ulcer on the lesser curvature of the stomach. The significance of this is also discussed

Duodenal ulcer and carcinoma of the stomach: a rare association - abstract

Recently, a barium meal examination performed on a middle-aged man referred to the X-ray Department for investigation of gastro-intestinal symptoms demonstrated deformity of the duodenal bulb consistent with scarring from a chronic duodenal ulcer and a filling defect of the fundus of the stomach consistent with a carcinoma. A bone marrow examination demonstrated the presence of malignant cells which could be metastases from a gastric neoplasm. Therefore, there is good evidence of the co-existence of duodenal ulcer and cancer of the stomach in this patient. However, a review of the literature revealed that although carcinoma of the stomach is not uncommon in patients who have had an operation for duodenal or gastric ulcer it is extremely rare in patients who have a duodenal ulcer and have not undergone surgical treatment. This rare association was confirmed by a review of 3,800 barium swallow and meal examinations. Of these examinations, 1077 demonstrated a duodenal ulcer and association was noted to be common with gastric ulcer, hiatus hernia, hypertrophic pyloric stenosis and duodenal diverticula and also to occur with carcinoma of the oesophagus and pancreas but not a single examination demonstrated duodenal ulcer and carcinoma of the stomach in the same patient. This lack of association is even more striking because in the same series of barium examinations there were 173 cases of carcinoma of the stomach which next to duodenal ulcer, was the most common lesion (AU)

Benign Lesions of the stomach simulating neoplasm with special reference to giant ulcers

Nine case of benign gastric lesions are presented. Clinically, radiologically and macroscopically they were suggestive of malignancy. In three cases extensive surgery has been performed in the belief that these cases were undoubtedly malignant. The clinical and operative criteria of inoperable malignancy were very large palpable masses, hard craggy liver, widespread infiltration involving adjacent structures, and fixity to the retroperitoneal structures. In addition one case had about six litres of straw-coloured ascitic fluid. Lymphadenopathy along the left gastric vessels and in the greater omentum was not taken into consideration in classifying these lesions as benign or malignant. Such prolonged operations include Whipple's, and oesophagectomy with partial pancreatectomy were performed twice. Subtotal gastrectomy with left lobar hepatectomy and partial pancreatectomy was performed once. Less radial procedures were performed on five occasions. On two occasions a simple two-thirds partial gastrectomy was peformed. The true benign nature of these lesions was established only after dissecting into the crater of the lesions. Gastrojejunostomy and vagotomy was performed once. In this case infiltration was so extensive that no attempts were made to resect the lesion. Vagotomy was also done because of the possible benign nature of the mass. The clinical course proved that the lesion was in fact benign. In another similar case the same clinical improvement followed gastrojejunostomy only. A large fungating and haemorrhagic mass was also discovered laparotomy. This patient had an oesophago-gastrectomy with splenectomy, partial pancreatectomy and left adrenalectomy. The histological diagnosis was Leiomyoma and Phaeochromocytoma. The aetiology of these giant infiltrating gastric ulcers are discussed. The duration of symptoms are analysed. Case (8) shows that low grade malignancy may be associated with these large giant ulcers(AU)

Atherosclerosis in persons with selected diseases

Comparison has been made of measures of coronary and aortic atherosclerosis in autopsied persons having five selected diseases (lung cancer,stomach cancer, other cancer, cirrhosis of the liver, and tuberculosis) with similar measures in control cases. There appears to be a slight but not significant tendency for lung cancer to be associated with more severe atherosclerosis within age-location-race subgroups. The tendency is strongest in the abdominal aorta. None of the other four diseases appears to be associated with increased or decreased severity of atherosclerosis in comparison with the control groups.(AU)

The five most frequent cancers in Jamaica

The pattern of cancer in Jamaica is in several respects remarkably different from that in Africa, yet also quite different from that in temperate zones (Fig. 6 Table 2). It is unlikely that genetic differences could account for this. A search for possible environmental aetiological factors is clearly indicated for such neoplasms as oesophageal cancer, where Jamaica shows the highest figures of 25 countries compared and where the Caribbean seems to be especially afflicted (Table 2). Carcinoma of the cervix, the highest ranking cancer in females, shows an incidence second to Cali, Columbia. Our present knowledge of the environmental aetiology of this disease, justifies the recommendation that circumcision of newborn boys should be widely offered in Jamaica. This practice would also offer virtually complete protection against penile cancer, a relatively frequent cancer in males. In any event, the knowledge that reasonable cleanliness would go a long way in preventing both cervical and penile cancers should be widely disseminated throughout the Jamaican population. Our breast cancer incidences are remarkably high and indicate that a careful epidemiological study should be dine of the practice of breast-feeding in patients with breast cancer as compared with controls. Gastric cancer, the highest ranking cancer in males, is not frequent in absolute terms when compared with other countries (AU)

Cancer of the stomach in British Guiana: a review of cases admitted to the Georgetown Hospital 1956-1959

All cases of established carcinoma of the stomach occurring at the Georgetown Hospital during the years 1956 to 1958 are reviewed. Racial analysis is particularly interesting showing a high incidence among the Negro population and a low incidence among the East Indians. Various etiological factors are considered including diet but none seems to account for the difference. An examination of blood groups suggests a hereditary factor but the figures are small and inconclusive. Gastric ulcer does not appear to be a predisposing factor. Most cases were advanced when first seen and the prognosis was corespondingly poor. Radiology has been the main means of establishing the diagnosis and a barium meal examination is essential where there is the least suspicion of malignant disease of the stomach. Where any doubt still remains, recourse should be made to early laparotomy. Only thus is there any prospect of improvement in the low resection rate and the even gloomier survival figures (Summary)

Analysis of 136 consecutive cases of malignant neoplasms of the stomach

One hundred and thirty-six consecutive cases of malignant neoplasms of the stomach are analysed. These cases were taken from the files of the Jamaica Cancer Registry but were not otherwise selected. The incidence of this tumor in Jamaica is compared with similiar studies in standard populations in Denmark, England and Africa and the general pathology and natural history reviewed. Cases of carcinomas of the stomach in Jamaica first present themselves at a late stage, and results of surgical treatment are correspondingly poor. The role of gastric cytology in the early diagnosis of carcinoma of the stomach is discussed (AU)

The use of gastric cytology in the early diagnosis of carcinoma of the stomach

Hitherto the diagnosis of gastric carcinoma has been made by the clinician with the assistance of the gastrocopist and radiologist. The results remain dissappointing for not more than 50 percent of the cases are operable when first seen and of these only about 10 percent survive post-operatively for five years or more. An earlier diagnosis is required if results are to be improved. Exfoliative gastric cytology is a new diagnostic procedure which in the hands of the trained pathologist can reveal the presence of malignant cells in gastric washings in over 90 percent of gastric cancers. Experience has shown that cells are shed from even the smallest carcinoma in situ and that by cytology it is possible to detect a growth before there is any radiological or positive gastroscopic evidence of it. Gastric resections in these cases furnish material for the study of these early lesions and the surgeon may reasonably hope that his results will be vastly improved. The associations of such lesions with chronic atrophic gastritis suggests that this is a malignant condition (AU)

Observations on cancer of the stomach in Jamaica

Data on 182 cases of carcinoma and five cases of rare malignant tumours of the stomach treated at the University College Hospital of the West Indies in the six-year period (September 1952 to August 1958) are presented. In Jamaica patients with cancer of the stomach attended hospital at a very advanced stage of the disease. The prognosis is bad. Better results will be obtained with better cancer education of the public, the realization that cancer of the stomach occurs commonly in the young patient and above all by provision of facilities for early radiological investigation easily available to poor Jamaican patients in all parts of the island. (AU)