|Year : 2019 | Volume
| Issue : 1 | Page : 104-107
Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India
Vandana Shailendra Jain1, Darshana Kawale1, Shailendra M Jain2, Chaitali Waghmare1, Gopal Pemmaraju1
1 Department of Radiotherapy and Oncology, Rural Medical College, Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra, India
2 Department of Microbiology, Rural Medical College, Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra, India
|Date of Web Publication||13-Mar-2019|
Dr. Vandana Shailendra Jain
Department of Radiotherapy and Oncology, Rural Medical College, Pravara Institute of Medical Sciences (DU), Loni, Ahmednagar - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome.
Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India.
Materials and Methods: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study.
Results and Conclusions: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.
Keywords: Gastro intestinal malignancy, risk factors, rural India
|How to cite this article:|
Jain VS, Kawale D, Jain SM, Waghmare C, Pemmaraju G. Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India. J Can Res Ther 2019;15:104-7
|How to cite this URL:|
Jain VS, Kawale D, Jain SM, Waghmare C, Pemmaraju G. Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India. J Can Res Ther [serial online] 2019 [cited 2019 Aug 20];15:104-7. Available from: http://www.cancerjournal.net/text.asp?2019/15/1/104/244242
| > Introduction|| |
Gastro intestinal (GI) tract starts from the mouth and ends at the anus. Its various functions are an intake of food, digestion of food, absorption of various nutrients into the bloodstream, and excretion of residual waste. Carcinomas of various parts of GI system are well known.
Colorectal cancer (CRC) is the third most common cancer in men (663,000 cases, 10% of the total cancers) and the second most common cancer in women (570,000 cases, 9.4% of the total cases) worldwide. The highest rates, being estimated in Australia, New Zealand, and Western Europe, the lowest in Africa (except Southern Africa) and South-Central Asia. Fortunately, the age-adjusted incidence rates of CRC in all the Indian cancer registries are very close to the lowest rates in the world. For colorectal carcinoma risk factors are obesity, physical inactivity, diet high in red meat (such as beef, pork, lamb, or liver), and processed meats (such as hot dogs and some luncheon meats). Heavy alcohol consumption (more than 2 units per day) and smoking are also the risk factors for colorectal carcinoma.,
Esophageal carcinoma is the most common site of GI tract malignancy in some states of India such as Karnataka, Tamil Nadu, Kerala, and Assam. Various risk factors for esophagus and stomach carcinoma are various addictions such as alcohol, smoking, tobacco chewing, and diet high in salt has been linked. Eating fresh fruits and vegetables may help to lower the risk.
Gastric cancer is the second most common GI cancer worldwide and almost two-third of all cases occur in developing countries. It is the fourth most common cancer in men and fifth in women (based on world statistics 2008). Development of gastric cancer is multi-factorial like family history of gastric cancer, Helicobacter pylori infection, history of adenomatous gastric polyp larger than two centimeters, history of chronic atrophic gastritis, history of pernicious anemia, obesity, alcohol, smoking, red meat, and low socioeconomic status are all believed to be important.
GI malignancy accounts for 8%–10% of OPD registrations and is being usually ignored by individuals, by the time they are investigated and diagnosed for the disease this has already reached to the third and fourth stage. This prospective questionnaire-based study is done to find various risk factors in GI malignancy patients reporting in the Department of Radiotherapy and Oncology, in this rural area of Maharashtra, India.
| > Materials and Methods|| |
This prospective study is designed to know about various addiction patterns, dietary habits, associated medical problems and socioeconomic status, along with age, sex, various sites, and the stage at first visit of all histopathologically proven cases of GI malignancies reporting in the Department of Radiotherapy and Oncology for treatment. Oral cavity to cricopharyngeal carcinomas is included in the head-and-neck malignancies. Carcinoma esophagus, carcinoma stomach, carcinoma small intestine, colorectal (colon and rectum), and anal canal carcinomas are considered in gastrointerstitial malignancies (and for this study). Data collection was done from February 2016 to December 2016 for 11 months. A detailed questionnaire was filled after taking written informed consent from the patient. Once the target of 100 patients was achieved all the data were compiled and analyzed for the study. Patients unable to provide or not willing to give desired information were excluded from the study.
| > Results|| |
In this study, out of total 100 registered cases of GI malignancy, 61 were male and 39 were female, which show male preponderance. Most of the patients belonged to lower and upper lower class (64%) as per modified BG Prasad classification. Various histopathological types recorded were squamous cell carcinoma (35), adenocarcinoma (60), adenosquamous carcinoma (2), basaloid carcinoma (1) and GI stromal tumor (GIST (2)). Associated medical illnesses were rarely observed (only two cases with diabetes mellitus and three with hypertension), and they were on regular treatment. One patient was on anti-retroviral therapy for human immunodeficiency virus, two were positive for HBsAg and one for VDRL. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach and anal canal (29, 14, 13, and 2, respectively). Mean age was 59.1 years. The youngest patient was 28 years and oldest was 86 years old. There were 45 cases above 60 years, and only five were below 30 years of age. Most of the cases (85%) were in advanced stage of disease (III and IV). Details of various addictions alone and in combinations with duration of consumption are shown in [Table 1]. The most common addiction for all sites was smokeless tobacco (SLT). Majority of cases (81%) were nonvegetarian; only 16% were pure vegetarian, details of dietary habits is shown in [Table 2].
|Table 1: Various addictions with duration in different sites of gastro intestinal malignanc|
Click here to view
|Table 2: Dietary habits of gastro intestinal malignancy (study) patients|
Click here to view
| > Discussion|| |
In our study, 45% of GI malignancy cases were above 60 years of age. In cancer esophagus, 41% of cases were above 60 years which is almost similar as in study done by Giri, et al. from the same center 5 years before. Considering stomach as disease subsite, we observed only 30% of patients were above 60 years of age which does not match with other studies stating elderly age group at risk for carcinoma stomach., The difference might be due to the presence of dietary as well as chemical carcinogens in the form of various addictions more prevalent in younger age group. Colorectal carcinoma together gives elderly age at increased risk. This is similar to statistics from India and other country.
64% of cases were from lower and lower middle socioeconomic status. This may be because of our center being situated in rural area of Maharashtra, India, and population covered is mainly farmers, labourers, some small businessman (traders). Male preponderance is observed for all sites of GI malignancy with a male-to-female ratio of 1.56:1. Various studies done for various GI malignancy sites, all show male preponderance. While comparing various sites for gender ratio except for carcinoma stomach (male to female ratio is 3:1) for other sites, this is almost similar 1.6:1. This indicates comparatively higher risk in males for cancer stomach. The probable explanation could be lifestyle as most of the females are not addicted to tobacco/alcohol through their dietary habits are similar.
The result of dietary habit shows clearly that 81% of cases were regularly taking nonvegetarian diet. The popular nonvegetarian food here in this area is chicken and mutton. Similar observations were reported by Butler et al. and Kampman et al. that dietary factors such as high consumption of red meat such as beef and pork has been associated with an increased relative risk of advanced CRC compared with that in patients who do not consume these meat products., Limited data from the rural population-based registries indicate that the incidence rate of colon cancer is very low in the rural settings. However, the incidence rates of rectal cancer are disproportionately higher in rural India. Similar observations were seen in our study.
There were only 16% of cases taking pure vegetarian diet, but at the same time, they were addicted to one or the other addiction which is well-known risk factor for all GI malignancy sites. Diets with a high amount of fresh vegetables and fruits have been shown to have a protective association with gastric cancer.
SLT consumption was the most common addiction in all GI cancer sites. In carcinoma esophagus second most common addiction was alcohol alone or in combination with smoking (either cigarette, bidi or both) is quite common in this rural population which is mainly of farmers. Long-term consumption (more than 20 years) of SLT, alcohol, smoking alone or in combination, further increases risk of esophagus cancer. In our study, out of 41 carcinoma esophagus cases 23, (56%) disclosed for their addiction habit, for more than 20 years.
In carcinoma stomach alcohol consumption alone or in combination with SLT or smoking was more commonly observed addiction. As most of the cases were above 50 years of age, the duration of various addictions was 30 years or more. Alcohol has been identified as risk factor for disease progression,, and the combined effect of alcohol and smoking increases the risk of noncardiac gastric cancer, same is observed in our study also. Study by Neagoe et al. shows heavy alcohol consumption (more than 2 units per day) and long-term cigarette smoking as risk factor for many cancers as well as colorectal carcinoma, but in our study SLT is commonly consumed.
| > Conclusion|| |
Gastrointestinal malignancy is showing increasing trends (colorectal carcinoma). This study gives an idea about various risk factors for the increasing trends of GI malignancy. The present study shows that carcinoma esophagus is the commonest and cancer rectosigmoid in second most common GI malignancy. Mostly, the cases were addicted to one or other addiction and were taking regularly nonvegetarian diet. Awareness program for harmful effects of various addictions and importance of high fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.
We would like to thank to Mr. Kakade S. M. (Clerk) and Mrs. Pandit S. S. (Attendant) for providing technical support for taking out hospital records from medical record section of the Institute.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanne M, et al
., editors. Cancer Incidence in Five Continents. No 160 IARC. Vol. 9. Lyon: IARC Scientific Publication; 2007.
Nooyi SC, Murthy NS, Shivananjaiah S, Sreekantaiah P, Mathew A. Trends in rectal cancer incidence – Indian scenario. Asian Pac J Cancer Prev 2011;12:2001-6.
Neagoe A, Molnar AM, Acalovschi M, Seicean A, Serban A. Risk factors for colorectal cancer: An epidemiologic descriptive study of a series of 333 patients. Rom J Gastroenterol 2004;13:187-93.
Chitra S, Ashok L, Anand L, Srinivasan V, Jayanthi V. Risk factors for esophageal cancer in Coimbatore, Southern India: A hospital-based case-control study. Indian J Gastroenterol 2004;23:19-21.
] [Full text]
Bode C, Bode JC. Alcohol's role in gastrointestinal tract disorders. Alcohol Health Res World 1997;21:76-83.
Zali H, Rezaei-Tavirani M, Azodi M. Gastric cancer: Prevention, risk factors and treatment. Gastroenterol Hepatol Bed Bench 2011;4:175-85.
Mahajan BK, Gupta MC, editors. The Text Book of Preventive and Social Medicine. 3rd
ed. 2003. p. 117-8.
Giri PA, Singh KK, Phalke DB. Study of socio-demographic determinants of esophageal cancer at a tertiary care teaching hospital of Western Maharashtra, India. South Asian J Cancer 2014;3:54-6.
] [Full text]
Hundahl SA, Phillips JL, Menck HR. The national cancer data base report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer Staging, proximal disease, and the “different disease” hypothesis. Cancer 2000;88:921-32.
Lai JF, Kim S, Li C, Oh SJ, Hyung WJ, Choi WH, et al.
Clinicopathologic characteristics and prognosis for young gastric adenocarcinoma patients after curative resection. Ann Surg Oncol 2008;15:1464-9.
Kemppainen M, Räihä I, Rajala T, Sourander L. Characteristics of colorectal cancer in elderly patients. Gerontology 1993;39:222-7.
Butler LM, Sinha R, Millikan RC, Martin CF, Newman B, Gammon MD, et al.
Heterocyclic amines, meat intake, and association with colon cancer in a population-based study. Am J Epidemiol 2003;157:434-45.
Kampman E, Slattery ML, Bigler J, Leppert M, Samowitz W, Caan BJ, et al.
Meat consumption, genetic susceptibility, and colon cancer risk: A United States multicenter case-control study. Cancer Epidemiol Biomarkers Prev 1999;8:15-24.
Graham S, Haughey B, Marshall J, Brasure J, Zielezny M, Freudenheim J, et al.
Diet in the epidemiology of gastric cancer. Nutr Cancer 1990;13:19-34.
Leung WK, Lin SR, Ching JY, To KF, Ng EK, Chan FK, et al.
Factors predicting progression of gastric intestinal metaplasia: Results of a randomised trial on Helicobacter pylori
eradication. Gut 2004;53:1244-9.
Sjödahl K, Lu Y, Nilsen TI, Ye W, Hveem K, Vatten L, et al.
Smoking and alcohol drinking in relation to risk of gastric cancer: A population-based, prospective cohort study. Int J Cancer 2007;120:128-32.
Mohandas KM. Colorectal cancer in India: Controversies, enigmas and primary prevention. Indian J Gastroenterol 2011;30:3-6.
[Table 1], [Table 2]