The multidisciplinary management of gastrointestinal cancer. Epidemiology of oesophagogastric cancer.

Oesophagogastric cancer occurs in the oesophagus, the oesophagogastric region and the stomach, including the proximal and distal stomach. In 2005, the worldwide burden of oesophagogastric cancer was estimated to be 1,500,000 new cases (500,000 oesophagus and 1,000,000 stomach). Squamous cell cancer is linked with alcohol and tobacco consumption in Western countries. Its incidence is much higher in regions of Asia with a low-socio-economic status, nutritional deficiencies, poor oral status, carcinogens absorbed with smoked meat, fat-cooked foodstuffs, vegetables containing toxic alkaloids or mycotoxins, and water containing nitrites, nitrates and nitrosamines. Adenocarcinoma develops in the columnar lined oesophagus. Its incidence is still low but there is an increasing trend. The incidence of stomach cancer is decreasing worldwide, but is still high in Japan. Causal factors include Helicobacter pylori infection with atrophic gastritis and a diet poor in fruit and vegetables. Preneoplastic conditions of the oesophagogastric mucosa include erosive oesophagitis in alcoholics, columnar lined oesophagus as a complication of gastro-oesophageal reflux disease, and atrophic gastritis following H. pylori infection.