gastrointestinal disorders
Stomach Cancer
Etiology of Stomach Cancer
Risk factors for stomach cancer include the following: Helicobacter pylori Infection (when it is associated with extensive gastric intestinal metaplasia) Autoimmune Metaplastic Atrophic Gastritis None Smoking (and people who smoke may have an impaired response to treatment) Gastric polyps Genetic factors Dietary factors are not proven causes; however, the World Health Organization (WHO) International Agency for Research on Cancer (IARC) has reported a positive association between consumption of processed meat and stomach cancer ( Risk factor references ). Gastric polypscan be precursors of cancer. Inflammatory polyps may develop in patients taking nonsteroidal anti-inflammatory drug (NSAIDs), and fundic foveolar polyps are common among patients taking proton pump inhibitors. Adenomatous polyps, particularly multiple ones, although rare, are the most likely to develop cancer. Cancer is particularly likely if an adenomatous polyp is>2 cm in diameter or has a villous histology. ) and has no precursor lesion. This mutation is an autosomal dominant trait with high penetrance. Affected patients usually develop gastric cancer at an early age (average age 38) and have about an 80% lifetime risk of developing gastric cancer ( Risk factor references ). Affected women are also at high risk of developing lobular breast cancer. Patients with personal or family history of diffuse gastric cancer and/or lobular breast cancer in multiple family members, especially if they were diagnosed before age 50, should be referred for genetic counseling and testing. Prophylactic gastrectomy should be offered to asymptomatic carriers of the 1.Bouvard V, Loomis D, Guyton KZ, et al: Carcinogenicity of consumption of red and processed meat.Lancet Oncol16(16): 1599–1600, 2015. doi: 10.1016/S1470-2045(15)00444-1 2.Pharoah PD, Guilford P, Caldas C; International Gastric Cancer Linkage Consortium: Incidence of gastric cancer and breast cancer in CDH1 (E-cadherin) mutation carriers from hereditary diffuse gastric cancer families.Gastroenterology121(6):1348-1353, 2001. doi: 10.1053/gast.2001.29611 3.Shepard B, Yoder L, Holmes C: Prophylactic total gastrectomy for hereditary diffuse gastric cancer.ACG Case Rep J3(4):e179, 2016. doi: 10.14309/crj.2016.152 4.van der Post RS, Vogelaar IP, Carneiro F, et al: Hereditary diffuse gastric cancer: Updated clinical guidelines with an emphasis on germline CDH1 mutation carriers.J Med Genet52(6):361–374, 2015. doi: 10.1136/jmedgenet-2015-103094 