Recent advances in the management of colorectal cancer Vilnius, May 67

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Recent 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
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Colorectal 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

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Colorectal cancer around the world
Based on world experience, what we expect in
future?
  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.
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Colorectal cancer Northern Europe 1997-1999 -
MALE
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Colorectal cancer Northern Europe 1997-1999 -
FEMALE
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Incidence / 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?
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Colorectal cancer in Lithuania - 2004 - male
706 new cases(8,6 male malignancies)
Based on mortality distribution figures,
colorectal cancer for males is the second
ranking place of importance
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Colorectal cancer in Lithuania 2004 - female
736 new cases (9,5 female malignancies)
Based on mortality distribution figures,
colorectal cancer for females is the third
ranking place of importance
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Colorectal 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
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Colon age adjusted incidence and mortality
trends
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Rectum age adjusted incidence and mortality
trends
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Lithuania can we see a progress in control and
management?

• Based on these figures suggestion can been made
  that diagnostic and clinical management has
  improved over last decades. Is the progress
  strong enough?

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Lithuania colon rectum by age lacking power
for incidence cases at elderly
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Colon 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
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Stage 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
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Colorectal cancer stage I-II by age and place of
residence
Diagnostic services should be improved for rural
population
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Colorectal cancer

• Do we have enough power on diagnostics?

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Sporadic and hereditary cancer service
Oncology Institute
University hospitals
Regional Oncology Hospitals
Cancer Registry
DiagnosisConsultingTreatment (reaserch only)
Follow-up
HumanGeneticCenter
Public health
DNA IsolationDNA analysis
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Colorectal cancer in Lithuania by subsite
Number of new cases at right side almost tripled
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Colorectal cancer in Lithuania by subsite
Number of new cases at left side almost doubled
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Colorectal cancer in Lithuania by subsite
Number of new cases has slowdown for females
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MaleSurvival of cancer patients Lithuania
(1990-1992) and Europe (Eurocare2)
Colon and rectum Lithuania is below the
European average
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FemaleSurvival of cancer patients Lithuania
(1990-1992) and Europe (Eurocare2)
Colon and rectumLithuania is below the
European average
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Survival of colorectal cancer in Lithuania
Survival started to improve
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Survival of colorectal cancer stage III
Raising figures Important improvements in
clinical applications
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Colorectal 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

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Lithuania population - nutrition
Positive changes in nutritional pattern during
last 10 years
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Lithuania 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?
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Lithuania 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
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Lithuania we looking forward optimistically
expecting on advanced clinical management of
colorectal cancer
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meantime being engaged in basketball ...
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and song festivals
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Thank You