A William Blackstock, Mabea Aklilu, James Lovato, Michael R Farmer, Girish Mishra, Susan A Melin, Timothy Oaks, Kim Geisinger, Edward A Levine
{"title":"Pathologic complete response may not represent the optimal surrogate for survival after preoperative therapy for esophageal cancer.","authors":"A William Blackstock, Mabea Aklilu, James Lovato, Michael R Farmer, Girish Mishra, Susan A Melin, Timothy Oaks, Kim Geisinger, Edward A Levine","doi":"10.1385/IJGC:37:1:7","DOIUrl":"https://doi.org/10.1385/IJGC:37:1:7","url":null,"abstract":"<p><strong>Background: </strong>We designed a phase II trial to examine the benefit of preoperative hyperfractionated radiation therapy (XRT) and concurrent chemotherapy for patients with locally advanced esophageal cancer (LAEC).</p><p><strong>Aim of study: </strong>The pathologic complete response (pCR) was the primary endpoint to estimate efficacy.</p><p><strong>Methods: </strong>Twenty-three patients with LAEC received twice-daily XRT during wk 1 and 5 and once-daily XRT during wk 2-4 (59 Gy). Cisplatin (100 mg/m(2)) was given on d 1, while 5-fluorouracil (1000 mg/m(2)) was given by continuous infusion the first and fifth weeks of the XRT.</p><p><strong>Results: </strong>The pCR for the 19 patients undergoing esophagectomy was 16%. The study was closed at the interim analysis having not met the required minimum pCR rate of 20%. Hematologic toxicities consisted of grades III and IV neutropenia observed in 33% and 14% of patients, respectively. Grade III nausea and vomiting was seen in 38% of patients. One grade V pulmonary toxicity occurred. The median survival was 44.6 mo with 65% of patients alive at 2 yr.</p><p><strong>Conclusions: </strong>The pCR rate in this trial did not meet the predetermined statistical minimum. With the encouraging 2-yr survival, it is not clear that pCR is a reliable surrogate endpoint to discern treatment efficacy.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"37 1","pages":"7-14"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:37:1:7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26600106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vishal Bhagat, Milind Javle, Jihnhee Yu, Aarti Agrawal, John F Gibbs, Boris Kuvshinoff, Enriquetta Nava, Renuka Iyer
{"title":"Combined hepatocholangiocarcinoma: case-series and review of literature.","authors":"Vishal Bhagat, Milind Javle, Jihnhee Yu, Aarti Agrawal, John F Gibbs, Boris Kuvshinoff, Enriquetta Nava, Renuka Iyer","doi":"10.1385/IJGC:37:1:27","DOIUrl":"https://doi.org/10.1385/IJGC:37:1:27","url":null,"abstract":"<p><strong>Background and aim: </strong>Combined hepatocholangiocarcinoma (CHCC) is an infrequent primary hepatic malignancy with no clearly defined diagnostic criteria, poorly studied natural history, and no guidelines regarding therapy. In this study we attempted to address this need and review our experience.</p><p><strong>Methods and results: </strong>We performed a retrospective review of all CHCC cases at our institute over the last 10 yr. Eight cases were identified; histological and immunohistochemical criteria used for diagnosis were defined. Patients characteristics were: median age 65 yr (range 47-80); five females; risk factors-cholelithiasis (n = 4) and cirrhosis due to chronic viral hepatitis B and C (n = 1). Abdominal pain (n = 6), hepatomegaly (n = 4), and elevated CA 19-9 >40 U/mL (n = 4/5) were frequent. Early TNM stage (I and II) compared with advanced disease (III and IV) correlated with higher overall survival on univariate analyses [37 and 6 mo respectively (p = 0.011)]. Median overall survival was significantly higher in patients who underwent potentially curative resection (23 mo, range 4-48+) compared with patients who underwent non-surgical therapies such as transcatheter arterial chemoembolization and chemotherapy (2 mo, range 1-8) (p = 0.0357, one-sided exact log-rank test).</p><p><strong>Conclusions: </strong>Chronic inflammation and cirrhosis may play a role in pathogenesis of CHCC. Surgical resection and early stage at diagnosis predict longer survival.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"37 1","pages":"27-34"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:37:1:27","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26600108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lipoprotein receptor associated protein (LRPAP1) insertion/deletion polymorphism: association with gallbladder cancer susceptibility.","authors":"Sachchida Nand Pandey, Manjusha Dixit, Gourdas Choudhuri, Balraj Mittal","doi":"10.1007/s12029-007-9002-y","DOIUrl":"https://doi.org/10.1007/s12029-007-9002-y","url":null,"abstract":"<p><strong>Background: </strong>Low-density lipoprotein receptor-related protein associated protein (LRPAP1) insertion/deletion polymorphism influences cholesterol homeostasis and may confer risk for gallstone disease and gallbladder carcinoma (GBC) incidence usually parallels with the prevalence of cholelithiosis.</p><p><strong>Aim: </strong>We aimed to examine the role of LRPAP1 polymorphism in susceptibility to GBC.</p><p><strong>Methods: </strong>Present case control study included 129 proven GBC patients, 183 gallstone patients, and 208 healthy controls. Genotyping was done by polymerase chain reaction-restriction fragment length polymorphism method.</p><p><strong>Results: </strong>The D allele of LRPAP1 was significantly higher in GBC patients as compared to gallstone patients (p = 0.013; OR = 1.6, 95% CI = 1.1-2.4). However, II genotype and I allele was associated with reduced risk of GBC as compared to gallstone patients (p = 0.002; OR = 0.1, 95% CI = 0.1-0.6; p = 0.013; OR = 0.6, 95% CI = 0.4-0.8) The increased risk due to D allele was limited to female GBC patients (p = 0.021; OR = 1.8, 95% CI = 1.1-3.0). However, reduced risk due to II genotype and I allele was observed which was also confined to female GBC patients (p = 0.005; OR = 0.1, 95% CI = 0.1-0.6; p = 0.021; OR = 0.5, 95% CI = 0.3-0.8). On comparing GBC patients having gallstone with gallstone patients, high risk was observed in the GBC patients having gallstone due to the presence of D allele (p = 0.032; OR = 1.7, 95% CI = 1.0-2.8). However, low risk was observed because of I allele in GBC patients with gallstone in comparison to gallstone patients (p = 0.032, OR = 0.6, 95% CI = 0.4-0.9).</p><p><strong>Conclusion: </strong>It appears that 'D' allele may modulate the susceptibility of GBC, and the risk is independent to genetic risk of gallstone.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":" ","pages":"124-8"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12029-007-9002-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41020183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lakshmana Ayaru, Stephen G Bown, Stephen P Pereira
{"title":"Photodynamic therapy for pancreatic and biliary tract carcinoma.","authors":"Lakshmana Ayaru, Stephen G Bown, Stephen P Pereira","doi":"10.1385/IJGC:35:1:001","DOIUrl":"https://doi.org/10.1385/IJGC:35:1:001","url":null,"abstract":"<p><p>The prognosis of patients with pancreatic and biliary tract cancer treated with conventional therapies such as stent insertion or chemotherapy is often poor, and new approaches are urgently needed. Surgery is the only curative treatment but is appropriate in less than 20% of cases, and even then it is associated with a 5-yr survival of less than 30% in selected series. Photodynamic therapy represents a novel treatment for pancreaticobiliary malignancy. It is a way of producing localized tissue necrosis with light, most conveniently from a low-power, red laser, after prior administration of a photosensitizing agent, thereby initiating a non-thermal cytotoxic effect and tissue necrosis. This review outlines the mechanisms of action of photodynamic therapy including direct cell death, vascular injury, and immune system activation, and summarizes the results of preclinical and clinical studies of photodynamic therapy for pancreaticobiliary malignancy.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"35 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:35:1:001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24967447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreas Tartaglia, Chiara Vezzadini, Silvia Bianchini, Paolo Vezzadini
{"title":"Gastrinoma of the stomach: a case report.","authors":"Andreas Tartaglia, Chiara Vezzadini, Silvia Bianchini, Paolo Vezzadini","doi":"10.1385/IJGC:35:3:211","DOIUrl":"https://doi.org/10.1385/IJGC:35:3:211","url":null,"abstract":"<p><p>Gastrinomas of the stomach are extremely rare endocrine tumors producing Zollinger-Ellison syndrome. We report here the case of a patient with gastrinoma of the stomach who presented regional and hepatic metastases at the time of diagnosis. The endocrine tumor was discovered incidentally 8 yr after the onset of symptoms related to peptic ulcer, which responded to medical treatment with a proton pump inhibitor. Surgery did not cure the patient, as demonstrated by provocative tests showing serum gastrin responses indicative of residual disease. A long-term treatment with the somatostatin analog lanreotide induced a biochemical response and was associated with a substantially stable disease.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"35 3","pages":"211-6"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:35:3:211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25256274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajesh Kannangai, Jianzhou Wang, Qiong Z Liu, Fikret Sahin, Michael Torbenson
{"title":"Survivin overexpression in hepatocellular carcinoma is associated with p53 dysregulation.","authors":"Rajesh Kannangai, Jianzhou Wang, Qiong Z Liu, Fikret Sahin, Michael Torbenson","doi":"10.1385/IJGC:35:1:053","DOIUrl":"https://doi.org/10.1385/IJGC:35:1:053","url":null,"abstract":"<p><strong>Background: </strong>Survivin is a recently described anti-apoptotic protein that is suppressed by wild-type p53 and is overexpressed in 41-70% of hepatocellular carcinomas from Asia. Two alternatively spliced transcripts have also been described: anti-apoptotic survivin-DeltaEx3 and non-anti-apoptotic survivin-2B. Survivin splice variant expression has not been studied in HCC, and little is known about survivin expression in hepatocellular carcinomas arising in other parts of the world, where risk factors are often different than they are in Asia.</p><p><strong>Aim of the study: </strong>We studied survivin mRNA and protein expression in a United States cohort of hepatocellular carcinomas and correlated the findings with p53 immunopositivity.</p><p><strong>Methods: </strong>RT-PCR was performed for survivin, survivin-2B, and survivin-DeltaEx3 in 20 HCCs and one intrahepatic cholangiocarcinoma. Expression levels of total survivin were evaluated with real-time PCR. Protein expression was examined by immunohistochemistry.</p><p><strong>Results: </strong>Survivin was the major transcript, and all transcripts were present in all normal and neoplastic tissues; 11/20 (55%) HCCs and the one cholangiocarcinoma showed twofold or greater overexpression of survivin. Next, we examined survivin and p53 protein expression by immunohistochemistry on a separate series of 79 HCC, 13 fibrolamellar carcinomas, and 15 hepatic adenomas; 14/79 (17%) HCC, but none of the fibrolamellar carcinomas or hepatic adenomas, showed survivin protein overexpression, and 25/79 HCC (32%) showed abnormal nuclear accumulation of p53, which correlated with increased survivin expression.</p><p><strong>Conclusions: </strong>All three survivin transcripts are present in normal liver and HCC. Survivin is the dominant transcript in HCC and is overexpressed in 55% of cases. Survivin protein overexpression is associated with aberrant p53 nuclear positivity.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"35 1","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:35:1:053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25136187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T Nakajima, T Kamano, K Shibasaki, K Watanabe, H Meguro, Y Tomiki, S Kasamaki, M Adachi, Y Watanabe
{"title":"Colonic carcinoma resembling submucosal tumor: report of a case and review of the literature.","authors":"T Nakajima, T Kamano, K Shibasaki, K Watanabe, H Meguro, Y Tomiki, S Kasamaki, M Adachi, Y Watanabe","doi":"10.1385/IJGC:36:3:155","DOIUrl":"https://doi.org/10.1385/IJGC:36:3:155","url":null,"abstract":"<p><p>Submucosal tumor-like colorectal carcinoma, most of whose surface is covered with normal mucosa, is very rare. We report a case of colonic carcinoma resembling submucosal tumor. A 54-yr-old man visited our institution for an evaluation of a positive fecal occult blood test. Colonoscopic examination revealed a small, mainly red polypoid lesion with a central deep ulceration and many white spots in the sigmoid colon. Indigocarmine staining demonstrated that the white spots were faint shallow depressions. Magnifying colonoscopic examination showed that the lesion surface, except for the ulceration and the depressions, was covered with normal mucosa. Although the tumor was small, we strongly suspected its malignancy due to a deep ulceration. As we could not excise it endoscopically, we performed sigmoidectomy. The lesion was 12 mm in size. Histologic examination revealed that the lesion was a moderately differentiated adenocarcinoma that was mainly covered with normal mucosa, that carcinoma was exposed only at the ulceration and the depressions on the surface, and that it had expanded to the muscularis propria. Together with considerations from the literature, this type of colorectal carcinoma is supposed to be invasive and surgical resection should be considered, no matter how small it may be.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"36 3","pages":"155-61"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:36:3:155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26041859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrence of primary hepatic carcinoid tumor in the remnant liver 13 yr after resection.","authors":"Hiroyuki Nishimori, Kunihiko Tsuji, Noriyuki Miyamoto, Yasuo Sakurai, Shinya Mitsui, Jong-Hon Kang, Masafumi Yoshida, Masashi Nomura, Itokawa Fuminori, Hirotoshi Ishiwatari, Takahiro Matsunaga, Manabu Osanai, Akio Katanuma, Kuniyuki Takahashi, Yoshinori Anbo, Tomoshige Masuda, Nobuichi Kashimura, Toshiya Shinohara, Hiroyuki Maguchi","doi":"10.1385/ijgc:35:2:147","DOIUrl":"https://doi.org/10.1385/ijgc:35:2:147","url":null,"abstract":"<p><p>We report here a case of primary hepatic carcinoid tumor (PHCT) recurring in the remnant liver 13 yr and 10 mo after first resection. A 70-yr-old man developed four hypervascular tumors in the liver in December 2003. He had undergone curative left-lobe hepatectomy for PHCT in February 1990. Histopathological examination of the tumor biopsy specimen showed that the tumor was composed of uniform round-to-oval cells with solid arrangement and the tumor cells stained positive for chromogranin A, synaptophysin, and neuron-specific enolase. We diagnosed this case as an intrahepatic metastasis of PHCT with a long latency period, based on the fact that no primary site of carcinoid tumor could be found despite intensive examination and the immunohistochemical findings of the resected tumors were essentially same as those of PHCT in 1990. Although PHCT is reported to have a more favorable prognosis than other hepatic cancer or metastatic carcinoid tumor in the liver, long-term observation is recommended.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"35 2","pages":"147-51"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/ijgc:35:2:147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25098106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joëlle Egreteau, Eveline Boucher, Sophie de Guibert, Christian Jacquelinet, Bernard Meunier, Karim Boudjema, Jean-Luc Raoul
{"title":"New drugs for colorectal cancer (irinotecan, oxaliplatin, raltitrexed) meet expectations in routine practice: a single center's experience before and after their introduction.","authors":"Joëlle Egreteau, Eveline Boucher, Sophie de Guibert, Christian Jacquelinet, Bernard Meunier, Karim Boudjema, Jean-Luc Raoul","doi":"10.1385/IJGC:35:1:069","DOIUrl":"https://doi.org/10.1385/IJGC:35:1:069","url":null,"abstract":"<p><strong>Background and aims: </strong>Treatment of metastatic colorectal cancer with new drugs (NDs) as oxaliplatin and irinotecan had improved response and survival. In order to check whether the promising achievements of the trials are obtained in routine clinical practice, we have reviewed retrospectively our results for two periods, before (period A: 1993-1995, n=63) and after (period B:1998-2000 n=103) the introduction of these NDs. Patients characteristics, treatment modalities, survival, and prognostic factors were compared.</p><p><strong>Patients: </strong>There were 74 women and 92 men, aged 60.8+/-11.6 yr, 7 patients received best supportive care only, 91 had synchronous metastasis.</p><p><strong>Results: </strong>Period B patients were older, with WHO score>1 more often, more adjuvant treatment, more metachronous metastasis, and NDs used more frequently (24% vs 59%). Median survival was similar (16 vs 15 mo). But when looking at the population aged<75 years with WHO score<2, median survival was 13 mo (period A) vs 21 mo (period B); survival at 1, 2, and 3 yr were respectively 59.5+/-8%, 16.2+/-6 %, 13.5+/-6 % vs 69.8+/-6%, 49.6+/-7%, 29.8+/-7%, p<0.01). In multiparametric analysis, factors correlated with survival were the absence of elevated serum alkaline phosphatase, a unique metastatic organ, and administration of NDs.</p><p><strong>Conclusion: </strong>In our routine clinical experience the use of NDs for metastatic CRC has allowed a significant improvement in survival among patients with unresectable tumors.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"35 1","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:35:1:069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25136189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deteriorating stage profile of gastrointestinal cancer in Finland.","authors":"Hannu Paimela, Oksala Niku, Mustonen Harri","doi":"10.1385/IJGC:36:2:89","DOIUrl":"https://doi.org/10.1385/IJGC:36:2:89","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of patients with gastrointestinal (GI) cancer is mainly due to the stage of the tumor at the diagnosis. Regardless of several innovations in diagnostic and therapeutic gastroenterology, there is no longitudinal data of the trends of stage profile of patients with gastrointestinal cancer in Finland.</p><p><strong>Aim: </strong>To study the incidence by stage of GI cancer in Finland in the past 15 yr in the entire country as well as in two subpopulations with different population profile: in a population with a small number of residents over 65 yr of age (Jorvi district) and in a population with a large number of residents over 65 yr of age (Kanta-Häme district).</p><p><strong>Methods: </strong>The hospital discharge records of patients with upper or lower GI cancer between 1986 and 2000 were evaluated in Finland as well as in Jorvi and Kanta-Häme hospital districts. The data were obtained from the National Research and Development Centre for Welfare and Health, from the Centre of Statistics and from the Finnish Cancer Registry.</p><p><strong>Results: </strong>The relative incidence of a localized esophagogastric cancer against more severe stages decreased from 37.9% to 29.3% in the entire country, from 40.8% to 19.1% in Kanta-Häme, and from 44.2% to 33.3% in Jorvi area. Respectively, the relative incidence of localized colorectal cancer decreased from 53.6% to 48.0% in the entire country, from 49.7% to 42.5% in Kanta-Häme, and from 54.5% to 48.4% in Jorvi area.</p><p><strong>Conclusions: </strong>During the past 15 yr the incidence by stage of both upper and lower GI cancer is deteriorating in the entire country as well as in areas with low and high percentage of residents over 65 yr of age indicating the increase of the more severe cases. The deterioration has become more pronounced in the 1990s, which requires a careful scrutiny of the function of primary diagnostic services.</p>","PeriodicalId":84927,"journal":{"name":"International journal of gastrointestinal cancer","volume":"36 2","pages":"89-94"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1385/IJGC:36:2:89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26437201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}