Title: Recent advances in the management of colorectal cancer Vilnius, May 6-7
1Recent advances in the management of colorectal
cancer Vilnius, May 6-7
- Epidemiology of colorectal cancer what we can
learn from Lithuania
Juozas Kurtinaitis phD, Public health
2Colorectal cancer
- Is the fourth most common cancer in the world
accounting for 8,5 of all new cancers - The developed world accounts for over 63 of all
cases - Colon cancer is more common in developed
countries exhibiting Westernized lifestyle
practices - Lithuania is moving to market economy and is
facing the westernized life style practices
3Colorectal cancer around the world
Based on world experience, what we expect in
future?
Incidence Incidence Mortality Mortality
Region Male Female Male Female
World 20,1 14,6 8,9 7,6
More developed regions 40,0 26,6 27,5 12,3
Less developed regions 10,2 7,7 4,6 4,7
Lithuania 26,5 16,8 18,0 11,3
Based on the figures, we are targeting the more
developed regions and need to pay attention on
the western countries experience. Colorectal
cancer is not only geography.
4Colorectal cancer Northern Europe 1997-1999 -
MALE
Area Incidence Mortality Incidence/mortality ratio
Northern Europe 37,5 17,6 2,1
Denmark 41,0 23,3 1,8
Estonia 31,7 17,9 1,8
Finland 25,5 11,5 2,2
Iceland 34,0 12,8 2,7
Ireland 43,1 23,6 1,8
Latvia 24,2 18,0 1,3
Lithuania 26,5 18,0 1,5
Norway 43,4 20,1 2,2
Sweden 33,4 14,9 2,2
UK 39,2 17,5 2,2
5Colorectal cancer Northern Europe 1997-1999 -
FEMALE
Area Incidence Mortality Incidence/mortality ratio
Northern Europe 26,4 12,7 2,1
Denmark 33,0 19,2 1,7
Estonia 23,2 12,6 1,8
Finland 21,1 9,8 2,2
Iceland 27,0 13,2 2,0
Ireland 27,0 13,7 2,0
Latvia 17,9 12,3 1,5
Lithuania 16,8 11,3 1,5
Norway 37,1 16,8 2,2
Sweden 26,2 11,1 2,4
United Kingdom 26,5 12,4 2,1
6Incidence / mortality ratio -what the figures
stand for?
- Male 26,5 18,0 1,5
- Female 16,8 11,3 1,5
The figure we expect should be around 2
Lithuanian figures tell us unexpected high
mortality compared to incidence
Questions - do we have more advanced stages,
compared to other countries in the region? -
is the cases management according to
best clinical practice? - what is the rank of
colorectal cancer in the country?
7Colorectal cancer in Lithuania - 2004 - male
706 new cases(8,6 male malignancies)
Site of cancer death
Prostate 9,6
Lung 28,6
Colorectal 10,4
Stomach 10,2
Based on mortality distribution figures,
colorectal cancer for males is the second
ranking place of importance
8Colorectal cancer in Lithuania 2004 - female
736 new cases (9,5 female malignancies)
Site of cancer death
Breast 17,4
Colorectal 12,6
Ginecological 19,0
Stomach 9,5
Based on mortality distribution figures,
colorectal cancer for females is the third
ranking place of importance
9Colorectal cancer in Lithuania 1978-2002number
of the new cases
Population size was stable but total number of
cases has doubled
Ageing of population is the most important
contributor of increasing of colorectal cancer.
Woman at elderly make higher proportion of cases
10Colon age adjusted incidence and mortality
trends
Sex Rate, incidence/mortality, cases per 100000, world Rate, incidence/mortality, cases per 100000, world
1978 2002
Male 6,0 / 4,8 15,6 / 8,3
Female 5,6 / 4,8 10,5 / 5,6
11Rectum age adjusted incidence and mortality
trends
Sex Rate, incidence/mortality, cases per 100000, world Rate, incidence/mortality, cases per 100000, world
1978 2002
Male 7,9 / 5,5 18,0 / 9,9
Female 6,4 / 4,8 8,6 / 5,1
12Lithuania can we see a progress in control and
management?
Colon Rate, incidence/mortality, cases per 100000, world Rate, incidence/mortality, cases per 100000, world
1978 2002
Male 6,0 / 4,8 15,6 / 8,3
Female 5,6 / 4,8 10,5 / 5,6
Rectum Rate, incidence/mortality, cases per 100000, world Rate, incidence/mortality, cases per 100000, world
1978 2002
Male 7,9 / 5,5 18,0 / 9,9
Female 6,4 / 4,8 8,6 / 5,1
- Based on these figures suggestion can been made
that diagnostic and clinical management has
improved over last decades. Is the progress
strong enough?
13Lithuania colon rectum by age lacking power
for incidence cases at elderly
14Colon stage distribution 1998-2002
Stage distribution is comparable to Finland in
the period of 1985-1994
Prediction based on Finland experience 50
patients should survive
15Stage IV - percentage of new cases by subsite
Large number of cases still remains diagnosed
late new clinical implications are needed to
change to the positive trend
16Colorectal cancer stage I-II by age and place of
residence
Diagnostic services should be improved for rural
population
17Colorectal cancer
- Do we have enough power on diagnostics?
18Sporadic and hereditary cancer service
Oncology Institute
University hospitals
Regional Oncology Hospitals
Cancer Registry
DiagnosisConsultingTreatment (reaserch only)
Follow-up
HumanGeneticCenter
Public health
DNA IsolationDNA analysis
19Colorectal cancer in Lithuania by subsite
Subsite right side Lithuania 1998-2002, Lithuania 1998-2002, Other sources,
Subsite right side Male Female Other sources,
Apendix 0,2 0,1 0,5
Caecum 6,2 8,8 8
Ascending 2,5 2,4 3
Hepatic flexsure 5,3 7,5 8
Transverse colon 4,8 6,1 6
Splenic flexsure 2,1 1,9 2
Total 21,1 26,8 27,5
Number of new cases at right side almost tripled
20Colorectal cancer in Lithuania by subsite
Lithuania 1998-2002, Lithuania 1998-2002, Other sources,
Subsite Male Female Other sources,
Descending colon 8,6 8,7 10
Sigmoid colon 19,6 22,2 20
Total 28,4 30,9 30
Number of new cases at left side almost doubled
21Colorectal cancer in Lithuania by subsite
Lithuania 1998-2002, Lithuania 1998-2002, Other sources,
Subsite Male Female Other sources,
Rectum 46,6 37,1 38
Anus 1,1 1,4 3
Total 47,7 38,5 41
Number of new cases has slowdown for females
22MaleSurvival of cancer patients Lithuania
(1990-1992) and Europe (Eurocare2)
Colon and rectum Lithuania is below the
European average
23FemaleSurvival of cancer patients Lithuania
(1990-1992) and Europe (Eurocare2)
Colon and rectumLithuania is below the
European average
24Survival of colorectal cancer in Lithuania
Survival started to improve
1990-92 1993-95 1996-98 1999-01
Male 25,56 27,74 32,32 37,85
Female 29,35 30,60 37,65 40,56
25Survival of colorectal cancer stage III
Raising figures Important improvements in
clinical applications
1990-1992 1993-1995 1996-1998 1999-2001
Male 26,91 30,59 32,55 38,78
Female 32,31 32,97 39,52 43,61
26Colorectal cancer what we can learn
- Based on mortality ranking, the importance of
improvement clinical management of colorectal
cancer in Lithuania is undervalued - Increasing number of cases at right colon
indicate on the needs of more extensive
colonoscopy examination - Incidence not high, there are reasonable
resources, bur the survival is to low clear
indication on improvement of clinical management
of cases
27Lithuania population - nutrition
Positive changes in nutritional pattern during
last 10 years
28Lithuania population selected features
- Total population 3,4 million
- Urban - 67 , rural 33
- Income level (GNP) 5200 USD
- Average size of family 3,18
- Meat consumption - 50 kg per capita per year
(137 g/day) - Alcohol consumption 9,2 ltr per capita year
- Life expectancy
- Male - 67 yr Female 72 yr
- Cars 1 million (one car per family)
- Mobile phones 3,4 million (one per capita)
What the message provide these figures for us?
29Lithuania population selected features
- Total population 3,4 million
- Urban - 67 , rural 33
- Income level (GNP) 5200 USD
- Average size of family 3,18
- Meat consumption - 50 kg per capita per year
(137 g/day) - Alcohol consumption 9,2 ltr per capita a year
- Life expectancy
- Male - 67 yr female 72 yr
- Cars 1 million (one car per family)
- Mobile phones 3,4 million
There is a money but not for health or healthy
life style
30Lithuania we looking forward optimistically
expecting on advanced clinical management of
colorectal cancer
31meantime being engaged in basketball ...
32 and song festivals
33Thank You