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Nutrition and stomach cancer

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Epidemiologic evidence on the relation between nutrition and stomach cancer is reviewed. Stomach cancer shows a distinct international variation and dramatic worldwide decline. These descriptive features suggest that dietary factors are important in determining the risk of stomach cancer. The authors assessed relevant data regarding specific dietary hypotheses in the etiology of stomach cancer. A negative association with fresh vegetables and fruits is highly consistent in numerous case-control studies in different populations. Both epidemiologic and experimental data suggest that vitamins C and carotenoids lower risk of stomach cancer. Evidence is sparse and inconsistent as to protective effects of vitamin E and selenium. Epidemiologic studies have not lent, and will not provide, supportive evidence for an etiologic role of nitrate intake. High salt intake has been associated with an increased risk in many case-control studies and limited cohort studies. Taken together with animal data, it is considered that high salt intake is a risk factor for stomach cancer. Both epidemiologic and experimental data are inconclusive as to whether high-starch diets confer an increased risk. Cohort studies using quantitative dietary assessment and biologic measurement of micronutrients are needed for further understanding of etiologic roles of dietary factors in the causation of stomach cancer.

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References

  1. Coleman MP, Estève J, Damieki P, Arslan A, Renard H. Trends in Cancer Incidence and Mortality. Lyon, France: International Agency for Research on Cancer, 1993; IARC Sci. Pub.No.121: 193–224.

    Google Scholar 

  2. Parkin DM, Pisani P, Ferlay J. Estimates of the world-wide incidence of eighteen major cancers in 1985. Int J Cancer 1993; 54: 594–606.

    Google Scholar 

  3. Parkin DM, Muir CS, Mack T, et al. Cancer Incidence in Five Continents, Vol 6. Lyon, France: International Agency for Research on Cancer, 1992.

    Google Scholar 

  4. Haenszel W, Kurihara M, Studies of Japanese migrants. I. Mortality from cancer and other diseases among. Japanese in the United States. 1968; 40: 43–68.

    Google Scholar 

  5. Correa P, Cuello C, Duque E. Carcinoma and intestinal metaplasia of the stomach in Columbian migrants. JNCI 1970; 44: 297–306.

    Google Scholar 

  6. Howson CP, Hiyama T, Wynder EL. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev 1986; 8: 1–27.

    Google Scholar 

  7. Nomura A, Grove JS, Stemmermann GN, Severson RK. A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption. Cancer Res 1990; 50: 627–31.

    Google Scholar 

  8. Hirayama T. Life-style and Mortality: a Large-scale Census-based Cohort Study in Japan. Basel, Switzerland: Karger, 1990.

    Google Scholar 

  9. Kneller RW, McLaughlin JK, Bjelke E, et al. A cohort study of stomach cancer in a high-risk American population. Cancer 1991; 68: 672–8.

    Google Scholar 

  10. Kato I, Tominaga S, Matsumoto K. A prospective study of stomach cancer among a rural Japanese poulation: a 6-year survey. Jpn J Cancer Res 1992; 83: 68–75.

    Google Scholar 

  11. The Eurogast Study Group. An international association between Helicobacter pylori infection and gastric cancer. Lancet 1993; 341: 1359–62.

    Google Scholar 

  12. Tsugane S, Kabuto M, Imai H. et al. Helicobacter pylori, dietary factors, and atrophic gastritis in five Japanese populations with different gastric cancer mortality. Cancer Causes Control 1993; 4: 297–305.

    Google Scholar 

  13. Forman D, Newell DG, Fullerton F, et al. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. Br J Med 1991; 302: 1302–5.

    Google Scholar 

  14. Parsonnet J, Friedman GD, Vandersteen DP, et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991; 325: 1127–31.

    Google Scholar 

  15. Nomura A, Stemmermann GN, Chyou PH, Kato I, Perez-Perez G, Blaser MJ. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med 1991; 325: 1132–6.

    Google Scholar 

  16. UK Sub-Group of the ECP-EURONUT-Intestinal Mctaplasia Study Group (presented by Filipe MI, Newell DG, Johnston BJ, Caygill C. Reed PI). Helicobacter pylori in patients with intestinal metaplasia and in controls: a seriological and biopsy study in four UK centres. Eur J Cancer Prev 1995; 4: 175–80.

    Google Scholar 

  17. el-Gunsid A, el-Sherif AM, Murray-Lyon IM, Zureikas N, Shousha S. Effect of chewing Oat on mussosal histology and prevalence of Helicobacter pylori in the oesophagus, stomach and duodenum of Yemeni patients. Histopathology 1991; 19: 437–43.

    Google Scholar 

  18. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—first American Cancer Society award lecture on cancer epidemiology and prevention, Cancer Res 1992; 52: 6735–40.

    Google Scholar 

  19. Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 1975; 15: 617–31.

    Google Scholar 

  20. Correa P, Cuello C, Fajardo L, Haenszel W, Bolanos O, de Ramirez B. Diet and gastric cancer: nutrition survey in a high-risk area. JNCI 1983; 70: 673–8.

    Google Scholar 

  21. Kneller RW, Guo WD, Hsing AW, et al. Risk factors for stomach cancer in sixty-five Chinese counties. Cancer Epidemiol Biomark Prev 1992; 1: 113–8.

    Google Scholar 

  22. Hirayama T. Epidemiology of cancer of the stomach with special reference to its decrease in Japan. Cancer Res 1975; 35: 3460–3.

    Google Scholar 

  23. Hirayama T. Epidemiology of stomach cancer. Gann Monogr Cancer Res 1971; 11: 3–19.

    Google Scholar 

  24. Graham S, Schotz W, Martino P. Alimentary factors in the epidemiology of gastric cancer. Cancer 1972; 30: 927–38.

    Google Scholar 

  25. Haenszel W, Kurihara M, Segi M, Lee RKC. Stomach cancer among Japanese in Hawaii. JNCI 1972; 49: 969–88.

    Google Scholar 

  26. Bjelke E. Epidemiologic studies of cancer of the stomach, colon, and rectum; with special emphasis on the role of diet. Scand J Gastroenterol 1974; 9(suppl 31): 1–235.

    Google Scholar 

  27. Haenszel W, Kurihara M, Locke FB, Shimizu K, Segi M. Stomach cancer in Japan. JNCI 1976; 56: 265–78.

    Google Scholar 

  28. Correa P, Fontham E, Pickle LW, Chen V, Lin Y, Haenszel W. Dietary determinants of gastric cancer in south Louisiana inhabitants. JNCI 1985; 75: 645–54.

    Google Scholar 

  29. Risch HA, Jain M, Choi NW, et al. Dietary factors and the incidence of cancer of the stomach. Am J Epidemiol 1985; 122: 947–59.

    Google Scholar 

  30. Trichopoulos D, Ouranos G, Day NE, et al. Diet and cancer of the stomach: a case-control study in Greece, Int J Cancer 1985; 36: 291–7.

    Google Scholar 

  31. Jedrychowski W, Wahrendorf J, Popiela T, Rachtan J. A case-control study of dietary factors and stomach cancer risk in Poland. Int J Cancer 1986; 37: 837–42.

    Google Scholar 

  32. La Vecchia C, Negri E, Decarli A, D'Avanzo B, Franceschi S. A case-control study of diet and gastric cancer in northern Italy. Int J Cancer 1987; 40: 484–9.

    Google Scholar 

  33. Kono S, Ikeda M, Tokudome S, Kurastune M. A case-control study of gastric cancer and diet in northern Kyushu, Japan. Jpn J Cancer Res 1988; 79: 1067–74.

    Google Scholar 

  34. You WC, Blot WJ, Chang YS, et al. Diet and high risk of stomach cancer in Shandong, China. Cancer Res 1988; 48: 3518–23.

    Google Scholar 

  35. Coggon D, Barker DJP, Cole RB, Nelson M. Stomach cancer and food storage. JNCI 1989; 81: 1178–82.

    Google Scholar 

  36. Buiatti E, Palli D, Decarli A, et al. Case-control study of gastric cancer and diet in Italy. Int J Cancer 1989; 44: 611–6.

    Google Scholar 

  37. Boeing H, Frentzel-Beyme R, Berger M, et al. Case-control study on stomach cancer in Germany. Int J Cancer 1991; 47: 858–64.

    Google Scholar 

  38. González CA, Sanz JM, Marcos G, et al. Dietary factors and stomach cancer in Spain: a multi-centre case-control study. Int J Cancer 1991; 49: 513–9.

    Google Scholar 

  39. Boeing H, Jedrychowski W, Wahrendorf J, Popiela T, Tobiasz-Adamczyk B, Kulig A. Dietary risk factors in intestinal and diffuse types of stomach cancer: a multicenter case-control study in Poland. Cancer Causes Control 1991; 2: 227–33.

    Google Scholar 

  40. Tuyns AJ, Kaaks R, Haelterman M, Riboli E. Diet and gastric cancer: a case-control study in Belgium. Int J Cancer 1992; 51: 1–6.

    Google Scholar 

  41. Ramón JM, Serra L, Cerdó C, Oromi J. Dietary factors and gastric cancer risk: a case-control study in Spain. Cancer 1993; 71: 1731–5.

    Google Scholar 

  42. Hansson LE, Nyrén O, Bergström R, et al. Diet and risk of gastric cancer. A population-based case-control study in Sweden. Int J Cancer 1993; 55: 181–9.

    Google Scholar 

  43. Wynder EL, Kmet J, Dungal N, Segi M. An epidemiological investigation of gastric cancer. Cancer 1963; 16: 1461–94.

    Google Scholar 

  44. Acheson ED, Doll R. Dietary factors in carcinoma of stomach: a study of 100 cases and 200 controls. Gut 1964; 5: 126–31.

    Google Scholar 

  45. Willett WC. Nutritional Epidemiology. Oxford, UK: Oxford University Press, 1990: 245–71.

    Google Scholar 

  46. Buiatti E, Palli D, Bianchi S, et al. A case-control study of gastric cancer and diet in Italy. III. Risk patterns by histologic type. Int J Cancer 1991; 48: 369–74.

    Google Scholar 

  47. Palli D, Bianchi S, Decarli A, et al. A case-control study of cancers of the gastric cardia in Italy. Br J Cancer 1992; 65: 263–6.

    Google Scholar 

  48. Dorant E, van den Brandt PA, Goldbohm RA, Hermus RJJ, Sturmans F. Garlic and its significance for the prevention of cancer in humans: a critical review. Br J Cancer 1993; 67: 424–9.

    Google Scholar 

  49. You WC, Blot WJ, Chang YS, et al. Allium vegetables and reduced risk of stomach cancer. JNCI 1989; 81: 162–4.

    Google Scholar 

  50. Hirohata T. A case-control study of stomach cancer (in Japanese). Proceedings of the 21st General Congress of Japan Medical Association 1983; 953–5.

  51. Chyou PH, Nomura AMY, Hankin JH, Stemmermann GN. A case-control study of diet and stomach cancer. Cancer Res 1990; 50: 7501–4.

    Google Scholar 

  52. Willett WC. Selenium, vitamin E, fiber, and the incidence of human cancer: an epidemiologic perspective. Adv Exp Med Biol 1986; 206: 27–34.

    Google Scholar 

  53. Steinmetz K, Potter JD. Vegetables, fruits, and cancer. II. Mechanisms. Cancer Causes Control 1991; 2: 427–42.

    Google Scholar 

  54. Mirvish SS. The etiology of gastric cancer. Intragastric nitrosamide formation and other theories. JNCI 1983; 71: 629–47.

    Google Scholar 

  55. Mirvish SS. Effects of vitamins C and E on N-nitroso compound formation, carcinogenesis, and cancer. Cancer 1986; 58: 1842–50.

    Google Scholar 

  56. Buiatti E, Palli D, Decarli A, et al. A case-control study of gastric cancer and diet in Italy. II. Association with nutrients. Int J Cancer 1990; 45: 896–901.

    Google Scholar 

  57. Graham S, Haughey B, Marshall J, et al. Diet in the epidemiology of gastric cancer. Nutr Cancer 1990; 13: 19–34.

    Google Scholar 

  58. Ramón JM, Serra-Majem L, Cerdó C, Oromi J. Nutrient intake and gastric cancer risk: a case-control study in Spain. Int J Epidemiol 1993; 22: 983–8.

    Google Scholar 

  59. González CA, Riboli E, Badosa J, et al. Nutritional factors and gastric cancer in Spain. Am J Epidemiol 1994; 139: 466–73.

    Google Scholar 

  60. Hansson LE, Nyrén O, Bergstrõm R, et al. Nutrients and risk of gastric cancer. A population-based case-control study in Sweden. Int J Cancer 1994; 57: 638–44.

    Google Scholar 

  61. Haenszel W, Correa P, López A, et al. Serum micronutrient levels in relation to gastric pathology. Int J Cancer 1985; 36: 43–8.

    Google Scholar 

  62. Zhang L, Blot WJ, You WC, et al. Serum micronutrients in relation to precancerous gastric lesions. Int J Cancer 1994; 56: 650–4.

    Google Scholar 

  63. Nomura AMY, Stemmermann GN, Heilbrun LK, Salkeld RM, Vuilleumier JP. Serum vitamin levels and the risk of cancer of specific sites in men of Japanese ancestry in Hawaii. Cancer Res 1985; 45: 2369–72.

    Google Scholar 

  64. Wald NJ, Thompson SG, Densem JW, Boreham J, Bailey A. Serum beta-carotene and subsequent risk of cancer: results from the BUPA study. Br J Cancer 1988; 57: 428–33.

    Google Scholar 

  65. Knekt P, Aromaa A, Maatela J, et al. Serum vitamin A and subsequent risk of cancer: cancer incidence follow-up of the Finnish mobile clinic health examination survey. Am J Epidemiol 1990; 132: 857–70.

    Google Scholar 

  66. Stähelin HB, Gey KF, Eicholzer M, et al. Plasma antioxidant vitamins and subsequent cancer mortality in the 12-year follow up of the prospective Basel Study. Am J Epidemiol 1991; 133: 766–75.

    Google Scholar 

  67. Nomura A, Heilbrun LK, Morris JS, Stemmermann G. Serum selenium and the risk of cancer, by specific sites: case-control analysis of prospective study. JNCI 1987; 79: 103–8.

    Google Scholar 

  68. Knekt P, Aromaa A, Maatela J, et al. Serum selenium and subsequent risk of cancer among Finnish men and women. JNCI 1990; 82: 864–8.

    Google Scholar 

  69. van den Brandt PA, Goldbohm RA, van't Veer P, et al. A prospective cohort study on toenail selenium levels and risk of gastrointestinal cancer. JNCI 1993; 85: 224–9.

    Google Scholar 

  70. Blot WJ, Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin-mineral combinations, cancer incidence, and disease-specific mortality in the general population. JNCI 1993; 85: 1483–92.

    Google Scholar 

  71. Li JY, Taylor PR, Li B, et al. Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. JNCI 1993; 85: 1492–2.

    Google Scholar 

  72. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994; 330: 1029–35.

    Google Scholar 

  73. Kinsky N. Effects of carotenoids in cellular and animal systems. Am J Clin Nutr 1991; 53: 238S-46S.

    Google Scholar 

  74. Moon RC, Mehta RG. Anticarcinogenic effects of retinoids in animals. Adv Exp Med Biol 1986; 206: 339–411.

    Google Scholar 

  75. Milner JA. Inhibition of chemical carcinogenesis and tumorigenesis by selenium. Adv Exp Med Biol 1986; 206: 449–63.

    Google Scholar 

  76. Santamaria L, Bianchi A, Ravetto C, Arnaboldi A, Santagati G, Andreoni L. Prevention of gastric cancer induced by N'-methyl-N'nitro-N-nitrosoguanidine in rats fed supplemental carotenoids. J Nutr Growth Cancer 1987; 4: 175–81.

    Google Scholar 

  77. Forman D. Dietary exposure to N-nitroso compounds and the risk of human cancer. Cancer Surv 1987; 6: 719–39.

    Google Scholar 

  78. Forman D. Are nitrates a significant risk factor in human cancer? Cancer Surv 1989; 8: 443–58.

    Google Scholar 

  79. Hill MJ, Hawksworth G, Tattersall G. Bacteria, nitrosamines and cancer of the stomach. Br J Cancer 1973; 28: 562–7.

    Google Scholar 

  80. Cuello C, Correa P, Haenszel W, et al. Gastric cancer in Colombia. I. Cancer risk and suspect environmental agents. JNCI 1976; 57: 1015–20.

    Google Scholar 

  81. Armijo R, Coulson AH. Epidemiology of stomach concer in Chile: the role of nitrogen fertilizers. Int J Epidemiol 1975; 4: 301–9

    Google Scholar 

  82. Kamiyama S, Ohshima H, Shimada A, et al. Urinary excretion of N-nitrosoamino acids and nitrate by inhabitants in high and low risk areas for stomach cancer in Northern Japan. In: Bartsch H, O'Neill IK, Schulte-Herman R, eds. Relevance of N-Nitroso Compounds to Human cancer: Exposure and Mechanisms. Lyon, France: International Agency for Research on Cancer, 1987: 497–502.

    Google Scholar 

  83. Chen J, Ohshima H, Yang H, Li J, Campbell TC, Bartsch H. A correlation of urinary excretion of N-nitroso compounds and cancer mortality in the People's Republic of China: interim results. In: Bartsch H, O'Neill IK, Schulte-Herman R, eds. Relevance of N-Nitroso Compounds to Human Cancer: Exposure and Mechanisms. Lyon, France: International Agency for Research on Cancer, 1987: 503–6.

    Google Scholar 

  84. Forman D, Al-Dabbagh SA, Doll R. Nitrates, nitrites and gastric cancer in Great Britain. Nature 1985; 313: 620–5.

    Google Scholar 

  85. Yang D, Tannenbaum SR, Buch C, Lee GCM. 4-Chloro-6-methoxyindole is the precursor of a potent mutagen that forms during nitrosation of fava beans (Vicia faba). Carcinogenesis 1984; 5: 1212–24.

    Google Scholar 

  86. Marquardt H, Rufino R, Weisburger JH. On the aetiology of gastric cancer: mutagenicity of food extracts after incubation with nitrite. Food Cosmet Toxicol 1977; 15: 97–100.

    Google Scholar 

  87. Weisburger JH, Marquardt H, Hirota N, Mori H, Williams GM. Induction of cancer of the glandular stomach in rats by an extract of nitrite-treated fish. JNCI 1980; 64: 163–7.

    Google Scholar 

  88. Joossens JV, Geboers J. Nutrition and gastric cancer. Nutr Cancer 1981; 2: 250–261.

    Google Scholar 

  89. Kono S, Ikeda M, Ogata M. Salt and geographical mortality of gastric cancer and stroke in Japan. J Epidemiol Community Health 1983; 37: 43–6.

    Google Scholar 

  90. Honjo S, Kono S, Yamaguchi M. Salt and geographic variation in stomach cancer mortality in Japan. Cancer Causes Control 1994; 5: 285–6.

    Google Scholar 

  91. Tsugane S, Akabane M, Inami T et al. Urinary salt excretion and stomach cancer mortality among four Japanese populations. Cancer Causes Control 1991; 2: 165–8.

    Google Scholar 

  92. Hirohata T. Analytic epidemiologic studies on the association between lifestyle and environmental factors and occurrence of cancer (in Japanese), Tokoyo, Japan: Report of the Studies in 1991 Supported by the Ministry of Health and Welfare of Japan (1–6): 9–12.

  93. Tuyns AJ. Salt and gastrointestinal cancer. Nutr Cancer 1988; 11: 229–32.

    Google Scholar 

  94. Nazario CM, Szklo M, Diamond E et al. Salt and gastric cancer; a case-control study in Puerto Rico. Int J Epidemiol 1993; 22: 790–7.

    Google Scholar 

  95. Takahashi M, Kokubo T, Furukawa F et al. Effect of high salt diet on rat gastric carcinogenesis induced by N-methyl-N′-nitro-N-nitrosoguanidine. Jpn J Cancer Res 1983; 74: 28–34.

    Google Scholar 

  96. Takahashi M, Kokubo T, Furukawa F et al. Effects of sodium chloride, saccharin, phenobarbital and aspirin on gastric carcinogenesis in rats after initiation with N-methyl-N′-nitro-N-nitrosoguanidine. Jpn J Cancer Res 1984; 75: 494–501.

    Google Scholar 

  97. Modan B, Lubin F, Barell V, Greenberg RA, Modan M, Graham S. The role of starches in the etiology of gastric cancer. Cancer 1974; 34: 2087–92.

    Google Scholar 

  98. Yu G-p, Hsieh C-c. Risk factors for stomach cancer: a population-based case-control study in Shanghai. Cancer Causes Control 1991; 2: 169–74.

    Google Scholar 

  99. Yu G-p, Hsieh C-c, Wang L-y, Yu S-z, Li X-l, Jin T-h. Green tea consumption and risk of stomach cancer: a population-based case control study in Shanghai, China. Cancer Causes Control 1995; 6: 532–8.

    Google Scholar 

  100. International Agency for Research on Cancer. Coffee, Tea, Mate, Methylxanthines and Methylglyoxal. Lyon, France: IARC, 1991; IARC Monogr Eval Carcinog Risks Hum, Vol 51: 207–71.

    Google Scholar 

  101. Yang CS, Wang ZY. Tea and cancer. JNCI 1993; 85: 1038–49.

    Google Scholar 

  102. Yamane T, Takahashi T, Kuwata K et al. Inhibition of N-methyl-N′ nitro-N-nitrosoguanidine-induced carcinogenesis by (-)-epigallocatechin gallate in the rat glandular stomach. Cancer Res 1995; 55: 2081–4.

    Google Scholar 

  103. Toth B, Rogan E, Walker B. Tumorigenicity and mutagenicity studies with capsaicin of hot peppers. Anticancer Res 1984; 4: 117–20.

    Google Scholar 

  104. Agrawal RC, Wiessler M, Hecker E al. Tumour-promoting effect of chili extract in Balb/c mice. Int J Cancer 1986; 38: 689–95.

    Google Scholar 

  105. Lopez-Carrillo L, Avila MH, Dubrow R, Chili pepper consumption and gastric cancer in Mexico: a case-control study. Am J Epidemiol 1994; 139: 263–71.

    Google Scholar 

  106. Hoey J, Montvernay C, Lambert R. Wine and tobacco: risk factors of gastric cancer in France. Am J Epidemiol 1981; 113: 668–74.

    Google Scholar 

  107. Gordon T, Kannel WB. Drinking and mortality: the Framingham Study. Am J Epidemiol 1984; 120: 97–107.

    Google Scholar 

  108. International Agency for Research on Cancer. Alcohol Drinking. Lyon, France: IARC, 1988; IARC Monogr Eval Carcinog Risks Hum, Vol. 44: 194–207.

    Google Scholar 

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This study was supported in part by a Grant-in-Aid for Cancer Research (4-2) from the Ministry of Health and Welfare, Japan.

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Kono, S., Hirohata, T. Nutrition and stomach cancer. Cancer Causes Control 7, 41–55 (1996). https://doi.org/10.1007/BF00115637

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