An explosive increase in the incidence of gastric cancers confined to the cardia has been observed. A shift from distal to proximal stomach cancers was partially due to the decrease in distal cancers. Proximal tumours share demographic and pathological features with Barrett’s associated esophageal adenocarcinoma and are more likely to occur in men; this parallels the male predominance in the increasing incidence of lower-third esophageal carcinoma. Proximal tumours differ from distal tumours in that they are not associated with a severe form of gastritis, characterized by atrophy and/or intestinal metaplasia. They tend to be more aggressive than those arising from distal sites. It has been proposed that environmental factors or chemical carcinogens, eg, cigarettes and alcohol, have been particularly associated with cardiac carcinoma. In fact, it has been proposed that carcinoma at the cardia is a different entity from the rest of the gastric carcinomas.
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The incidence of gastric cancer varies with different geographic regions as well. A high incidence is noted in Asian countries such Japan, Korea and China; parts of Europe such as Ireland; and South American countries such as Chile and Columbia. A difference in incidence and mortality from north to south has been observed in several countries, with the northern prefectures having a higher mortality risk than those in the south. This gradient is particularly marked in the northern hemisphere; in the southern hemisphere, the mortality risk tends to be higher in the southern parts. It appears that higher geographic latitudes are associated with a higher gastric cancer risk.