Second cancer following cancer of the digestive system in Connecticut, 1935-82.

National Cancer Institute monograph Pub Date : 1985-12-01
S K Hoar, J Wilson, W J Blot, J K McLaughlin, D M Winn, A F Kantor
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Abstract

The risk of developing a second primary cancer was evaluated in approximately 64,000 persons diagnosed with cancer of the digestive system in Connecticut during 1935-82. Significant excesses of all second cancers combined were observed following cancer of the esophagus (58 observed vs. 33 expected), small intestine (41 vs. 24), and colon (2,268 vs. 1,714). A slight excess of multiple primaries was observed following cancer of the liver and biliary tract (47 vs. 40). The observed number of second cancers was nearly equal to the expected number for persons initially diagnosed with cancers of the stomach (251 vs. 258), rectum (952 vs. 941), and pancreas (40 vs. 40). Persons with initial cancers of the small intestine, colon, and rectum also had excess second cancers arising primarily in the colon, which suggested the influence of common etiologic factors or possibly misclassified metastases in some. Shared dietary, socioeconomic, or hormonal factors may explain the excess of uterine and ovarian cancers among patients with colon cancer and the excess of breast cancer among patients with colon and rectal cancers. Oral and respiratory cancers occurred more frequently than expected in persons with an initial esophageal cancer, which is likely due to common risk factors of cigarette smoking or alcohol intake, or both. The elevations in cancer of the prostate among males with cancers of the esophagus, small intestine, colon, rectum, liver/biliary, and pancreas are probably artifacts associated with increased medical surveillance of cancer patients. The prostate cancer excesses were limited to the first year after diagnosis of the initial cancer or decreased over time for all but cancer of the colon and small intestines. Increased medical surveillance may also contribute to the excess renal and bladder cancers seen within 5 years of diagnosis of stomach cancer. Excesses were also seen for second pancreatic cancer among small intestine and liver/biliary cancer patients and second kidney and brain cancers among those with colon cancer. The deficits of stomach and rectal cancer among persons initially diagnosed with the same tumors, respectively, were anticipated because surgical removal of the organ is the primary form of treatment. Patients with rectal cancer also had deficits of stomach and pancreatic cancers. Future research should clarify the role of diet, alcohol, metabolic and endocrine factors, and host susceptibility on the risk of second neoplasms following cancer of the digestive system.

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1935年至1982年在康涅狄格发生的继消化系统癌症之后的第二种癌症。
在1935年至1982年期间,对康涅狄格州约64,000名被诊断患有消化系统癌症的人进行了第二原发癌症风险评估。在食道癌(观察到58例,预期33例)、小肠(41例,预期24例)和结肠癌(2268例,预期1714例)之后,所有第二种癌症的发生率均显著升高。在肝癌和胆道癌后观察到多发原发灶(47 vs. 40)。观察到的第二种癌症的数量几乎等于最初诊断为胃癌(251对258)、直肠癌(952对941)和胰腺癌(40对40)的患者的预期数量。原发性小肠癌、结肠癌和直肠癌患者也有过多的继发性癌症,主要发生在结肠,这表明在某些情况下,常见病因的影响或可能是错误分类的转移。共同的饮食、社会经济或激素因素可以解释结肠癌患者中子宫癌和卵巢癌的高发以及结肠癌和直肠癌患者中乳腺癌的高发。口腔癌和呼吸道癌在最初食管癌患者中发生的频率高于预期,这可能是由于吸烟或饮酒或两者兼而有之的共同危险因素。在患有食道癌、小肠癌、结肠癌、直肠癌、肝癌/胆道癌和胰腺癌的男性中,前列腺癌的发病率升高可能是与癌症患者医疗监测增加有关的人为现象。前列腺癌的过度行为仅限于确诊后的第一年,而随着时间的推移,除了结肠癌和小肠癌外,其他癌症的过度行为都在减少。增加的医疗监测也可能导致胃癌诊断后5年内出现过多的肾癌和膀胱癌。在小肠癌和肝癌/胆道癌患者中,在第二胰腺癌患者中,在结肠癌患者中,第二肾癌和脑癌患者中,也发现了过量。胃癌和直肠癌在最初诊断为相同肿瘤的患者中的缺陷是可以预料到的,因为手术切除器官是主要的治疗形式。直肠癌患者也有胃癌和胰腺癌的缺陷。未来的研究应明确饮食、酒精、代谢和内分泌因素以及宿主易感性在消化系统癌症后发生第二肿瘤的风险中的作用。
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