Jean Powell

Continuing rising trend in oesophageal adenocarcinoma

Our study provides an update of the incidence of oesophageal cancer in the West Midland region of England and Wales from 1992–96. A total of 2,671 cases of oesophageal cancer were identified during the 5‐year study period, with an age‐standardised annual incidence (ASR) of 5.24 per 100,000 (95% CI: 5.02, 5.45). Similar numbers of adenocarcinoma and squamous cell carcinoma were found. Only 152 (5.6%) had no histology. There was a 5‐fold difference in age‐standardised annual incidence rates between males and females for adenocarcinoma of oesophagus, but no gender difference for squamous cell carcinoma. The parallel but higher ASR in males compared to females for adenocarcinoma of both oesophagus and cardia merits further investigation. The similarities in the patterns of age‐ and sex‐specific rates and in the socioeconomic profiles could indicate a common aetiology for adenocarcinoma of oesophagus and gastric cardia. Quality control in Cancer Registries needs to focus on the accuracy and consistency of subsite classification to ensure that trends in incidence are identified. In the absence of accurate subsite classification of stomach cancers, the proportions of adenocarcinoma and squamous cell carcinoma of oesophagus (or the absolute rate of adenocarcinoma of oesophagus) may provide a useful tool in indicating whether adenocarcinoma of gastric cardia is likely to be increasing in incidence.

Introduction and Methods

Of the many varieties of cancer which affect man, cancer of the larynx has an importance which is quite disproportionate to its frequency. In Great Britain it is not common, and indeed by world standards the incidence is relatively low. In men it amounts to approximately 1% of all cancers, but it is significantly less common in women, a feature which summons up thoughts of possible occupation based aetiology. It is not a homogeneous cancer, by which is meant it does not affect the larynx uniformly. The larynx is a complex organ, and its various discrete parts are affected with unequal frequency (again, by international comparisons, in a manner differing from some other parts of the world). Cancers of the subsections of the larynx — supraglottis, glottis and subglottis, show variations in behaviour and in their tendency to metastasise. Some remarkable differences in metastasising capacity are portrayed.

Cancer of the large bowel

Epidemiology histology presentation and investigation treatment and survival stages appendix and anal canal lymphoma and sarcoma. Appendices: standardized rates census populations.

Sequelae of Neonatal Jaundice

A total of 371 newborn infants falling into 3 groups, non-haemolytic jaundice, haemolytic jaundice, and non-jaundiced controls, have been reassessed in the 6th year of life as regards neurological, audiological, and psychological function. Neurological handicap was concentrated among the infants of low birth weight and was not related to jaundice, apart from one case of athetoid cerebral palsy with deafness. No other cases of perceptive deafness were discovered. Intelligence testing on the Stanford Binet scale showed no relation between depth of jaundice and I.Q. These findings support the majority of reports in the literature that reduction in intelligence does not occur in non-haemolytic jaundiced babies with serum bilirubin below about 20 mg./100 ml. In haemolytic jaundice slight doubt remains. There is no indication for changing present standards for exchange transfusion.

The influence of age on the surgical management of carcinoma ofthe stomach

The medical records of 31,808 patients with gastric cancer registered with the West-Midlands Cancer Registry between 1957-1981 were reviewed to determine the influence of age on presentation, stage assessment, management, survival and mortality rates. When analysed by stage, and excluding post-operative deaths, survival was similar in all age groups. This study confirms stage of disease to be the single most important prognostic factor. The inverse relationship between laparotomy and age implies inadequate assessment of stage in the elderly. The poor prognosis in unresected cases suggests that increased precise staging by laparotomy or laparoscopy will have minimal adverse effects. On the other hand this may result in increased resections and survival.

Staging carcinoma : its value in cancer of the larynx

Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.

Cancer of the Larynx

Introduction and methods epidemiology - demographic aspects multiple primaries, social class and occupation histology incidence by sub-site stage - supraglottis, glottis, subglottis survival - larynx, treatment survival related to treatment second treatments. Appendices: Birmingham and West Midlands Regional Cancer Registry standarized rates census and inter-censal populations TNM classification of malignant tumours - larynx.

Primary treatment of cancer of the larynx

Analysis of 3,445 cases of cancer of the larynx with a follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.

Extent of Disease

Unfortunately Dukes staging was only available for the period 1977–81, so the results for the entire 25 years could only be analysed on a broad grouping of node negative cases (equivalent to Dukes AB) or node positive cases (equivalent to Dukes C).

Palliative or No Treatment

For the sake of completeness an analysis of various palliative treatments has been undertaken and the results of these are presented in this Chapter. Some of the information, is perforce, incomplete and certain subgroups are too small to permit valid statistical conclusions to be drawn.