In France a medical student might find that a caricature of a typical sufferer from oesophageal or gastric cancer would show an old man with a glass of calvados in his hand, a full bottle beside him and a cigarette hanging from his lips.

The picture wouldn’t be too dissimilar in the UK, but with whisky in place of the calvados.

A cartoon of the same subject in a medical journal in the Far East would be very different, though. In Japan the typical sufferer from oesophageal/gastric cancer could be depicted as an old countryman surrounded by his large family in an overcrowded house, enjoying salt-cured fish accompanied by nothing stronger than a glass of water drawn from the local well.

How accurately would these caricatures represent the truth about the incidence of these two cancers? Oesophageal and gastric cancer does predominantly affect older people. Most sufferers are over 55 and they are twice as likely to be men as women, both in Europe and in the Far East.

It is also true that alcohol potentiates the carcinogenic effect of smoking on the oesophagus and stomach. Drinkers — so long as they are neither excessive drinkers nor smokers — are at no greater risk of developing these cancers than others, but someone who drinks even a modest amount and also smokes is more at risk.

My enjoyment of a glass of malt increased after I read research published some years ago on the effect of whisky-drinking on workers at a Scottish distillery. This suggested that unless the workers also smoked, there was no significant increase in the incidence of cancer of the oesophagus and stomach unless their drinking was grossly excessive. A couple of tots a day seems to be fairly harmless; eight or ten could be lethal.

The highest incidences of oesophageal and gastric cancer are in Japan, South America, Eastern Europe and the Middle East.

The stereotypical picture of the Japanese sufferer is not inaccurate but is probably changing. In the Far East, the factors that predispose to these cancers have been the lack of refrigeration and consequent reliance on salt-curing, smoking, pickling and drying. Other factors are drinking water with a heavy concentration of nitrates from local wells, and overcrowding.

The last of these is associated with infection from Helicobacter pylori, the organism responsible for upper intestinal inflammation. In Europe 140,000 people a year die from oesophageal and stomach cancers, but worldwide it is the fourth most commonly diagnosed cancer and the second leading cause of cancer deaths.

In European countries the cancer is more likely to appear in the lower oesophagus or upper stomach; in the East it is usually found in the lower part of the stomach.

At a recent meeting of ASCO, the American society for cancer doctors, Dr Ian Chau, a specialist at the Royal Marsden, gave details of the latest pioneering treatment of these cancers. Xeloda (capecitabine), an oral form of chemotherapy, has been used successfully to lengthen survival times when combined with oxaliplatin, another chemotherapeutic agent. Use of the drug for this purpose began in Korea, and it has recently been studied by a team led by Dr David Cunningham, of the Royal Marsden, in the UK and Australia.