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August 1988, Volume 38, Issue 8

Short Reports

GASTRIC CANCER IN KARACHI - SOME PRELIMINARY OBSERVATIONS

Khalid Ismail  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi-35. )
Sarwar J. Zuberi  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi-35. )

INTRODUCTION

Differences in the incidence of gastric cancer in the developing and developed world may be due to differences in the frequency of various risk factors.1-6 This study reports some preliminary observations in patients with gastric malignancy seen at this Centre.

PATIENTS,METHODS AND RESULTS

The medical records of 110 cases of gastric cancer seen over a period of 9 years (1979-87) were reviewed. Detailed clinical and endoscopic data was analysed. Those with incomplete record and negative biopsy were excluded leaving 53 histologically confirmed cases of adenocarcinoma for further analysis.
The age ranged from 19-85 years (mean 48.4) and the male to female ratio was 23:1.
Sixtythree percent of patients were migrants from India and 37% were born in Pakistan. Of those born in Pakistan 65% bad their origin in North West Fronteir Province (69.2%) and Baluchistan (30.8%).
The lesions of Pyloroantrum accounted for 56.7% followed by body of the stomach (28.3%) and cardia (15%). Ulcerated lesions were seen in 35.8%, fungating in 30.1%, diffuse in 13.2% and polypoid in 113% of patients. In the remaining 9.6% appearance was not described.

COMMENTS

Mean age (48.4 years) of the patients was less but male to female ratio (2.3:1) and prepon­ derance of ulcerated and pyloroantral lesions is similar to other reported series.2,7,8.
Of those born in Pakistan 65% patients has their origin in NWFP or Baluchistan indicating a greater exposure or increased susceptibility to gastric carcinogens.
Nitrate rich well water is used for drinking and irrigation in mountainous country. Nitro­samines from nitrate rich preserved meat4,9,12 and high benzpyrene content of the smoked meat4’6 ,9 consumed in the northern areas are potent carcinogens. Pickles contain nitrosamine and secondary amine contents are high in cereals and tea.9 Potatoes13 and root vegetables14 an important source of carbohydrate are also known to be associated with gastric cancer. Dietary habits in high incidence areas indicate increased con­sumption of potential carcinogens. In order to confirm these observations, a detailed study is needed on the frequency of gastric cancer and its association with local dietary habits in various regions of Pakistan.

REFERENCES

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2. Malik, M.O.A., laid Eldin, Z.A. and El Masri, S.H. Cancer of the alimentary tract in the Sudan. A study of 546 cases. Cancer, 1976; 37:2533.
3. Acker Man, L.V. Some thoughts on food and cancer. Nutr. Today, 1972; 7:2-9.
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5. Martman-Moe, H. and Hartveit, F. On the Reputed decline in gastric carcinoma; necropsy study from western Norway. Br. Med. J., 1985; 290: 103.
6. Robbins, S.L., Cotran, R.S. and Kumar, V. Pathologic basis of diseases. 3rd ed. Philadelphia, Saunders, 1984, P. 820.
7. ReMine, W.H. and Priestely, J.T. Trends in prog­noses and surgical treatment of cancer of stomach. Ann. Surg., 1966; 163: 736.
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9. Kolonel, L.N., Nomura, A,M.Y. , Hirohata, T., Hankin, J.H. and Hinds, M.W. Association of diet and place of birth with stomach cancer incidence in Hawaii Japanese and Caucasians. Am. J. Clin.Nutr.,1981; 34: 2478.
10. Haenszel, W. Cancer mortality among the foreign born in the United States. J. Nat. Cancer Inst., 1961; 26:37.
11. Cuello, C., Correa, P., Haenszel, W., Gordiuo. G., Brown, C., Archer. M. and Tannen Baum, S. Gastric cancer in Columbia. I. Cancer risk and suspect environmental agents. J. Nat. Cancer Inst., 1976; 57: 1015.
12. Lijinsky, W. Nitrosamines and nitrosamides in the etiology of gastrointestinal cancer. Cancer, 1977; 40: 2446.
13. Graham, S., Lilienfield, A.M. and Tidings, J.E. Dietary and purgation factors in the epidemio­logy of gastric cancer. Cancer, 1967; 20:2224.
14. Williams, R.H.P., Smith, J., Cole, T.J. and Craven, J.L. Dietary and smoking habits in gastric cancer; a detailed study of 64 cases and controls. Gut, 1975; 16:843.

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