Stomach cancer screening: Difference between revisions
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{{CMG}}{{AE}}{{PSD}} | {{CMG}}; {{AE}} {{PSD}} {{MAD}} | ||
{{Stomach cancer}} | {{Stomach cancer}} | ||
==Overview== | ==Overview== | ||
The two main modalities for [[gastric cancer]] [[Screening (medicine)|screening]] are [[upper endoscopy]] and [[Contrast medium|contrast]] [[radiography]]. Universal [[screening]] is recommended in countries with a high [[incidence]] of [[gastric cancer]] such as East Asian countries. In areas of low [[gastric cancer]] [[incidence]], [[screening]] for [[gastric cancer]] with [[upper endoscopy]] should be reserved specifically for high-risk subgroups. [[Upper endoscopy]] has a sensitivity of 69 % and [[Upper gastrointestinal series|upper GI series]] has a [[Sensitivity (tests)|sensitivity]] of 37%. Both studies have a [[Specificity (tests)|specificity]] of 96%. | |||
==Screening == | |||
The two main modalities for [[gastric cancer]] [[screening]] are [[upper endoscopy]] and [[Contrast medium|contrast]] [[radiography]]. | |||
=== '''Upper endoscopy''' === | |||
* [[Upper endoscopy]] is more [[Sensitivity (tests)|sensitive]] than other [[Screening (medicine)|screening]] studies. It allows direct visualization of the [[gastric]] [[Mucosal|mucosa]] and allows for obtaining [[Biopsy|biopsies]].<ref name="pmid8198977">{{cite journal| author=Pisani P, Oliver WE, Parkin DM, Alvarez N, Vivas J| title=Case-control study of gastric cancer screening in Venezuela. | journal=Br J Cancer | year= 1994 | volume= 69 | issue= 6 | pages= 1102-5 | pmid=8198977 | doi= | pmc=1969457 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8198977 }}</ref> | |||
=== '''Contrast radiography''' === | |||
* [[Barium meal|Barium radiographs]] can identify [[malignant]] [[Gastric ulcer|gastric ulcers]], infiltrating [[lesions]], and some early [[Gastric cancer|gastric cancers]].<ref name="pmid6383166">{{cite journal| author=Dooley CP, Larson AW, Stace NH, Renner IG, Valenzuela JE, Eliasoph J et al.| title=Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study. | journal=Ann Intern Med | year= 1984 | volume= 101 | issue= 4 | pages= 538-45 | pmid=6383166 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6383166 }}</ref> | |||
* [[Barium follow-through|Barium studies]] can be false negative in 50 percent of cases and the [[Sensitivity (tests)|sensitivity]] of a [[Barium meal|barium study]] may be 14 percent.<ref name="pmid2916797">{{cite journal| author=Longo WE, Zucker KA, Zdon MJ, Modlin IM| title=Detection of early gastric cancer in an aggressive endoscopy unit. | journal=Am Surg | year= 1989 | volume= 55 | issue= 2 | pages= 100-4 | pmid=2916797 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2916797 }}</ref> | |||
* In [[patients]] with [[linitis plastica]], a [[Barium follow-through|barium study]] may be superior to [[upper endoscopy]]. | |||
=== '''Sensitivity of tests''' === | |||
* [[Upper endoscopy]] has a [[sensitivity]] of 69 % and [[Upper gastrointestinal series|upper GI series]] has a [[Sensitivity (tests)|sensitivity]] of 37%. | |||
* Both studies had a [[Specificity (tests)|specificity]] of 96%. | |||
==Screening | * The [[upper endoscopy]] [[Sensitivity (tests)|sensitivity]] in detecting a localized [[gastric cancer]] is higher than [[Upper gastrointestinal series|upper GI series]].<ref name="pmid25490528">{{cite journal| author=Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH et al.| title=Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. | journal=Br J Cancer | year= 2015 | volume= 112 | issue= 3 | pages= 608-12 | pmid=25490528 | doi=10.1038/bjc.2014.608 | pmc=4453643 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25490528 }}</ref> | ||
== Screening Strategies == | |||
* | === '''Universal screening''' === | ||
* Universal [[Screening (medicine)|screening]] is recommended in countries with a high [[incidence]] of [[gastric cancer]] such as East Asian countries.<ref name="pmid1759081">{{cite journal| author=Llorens P| title=Gastric cancer mass survey in Chile. | journal=Semin Surg Oncol | year= 1991 | volume= 7 | issue= 6 | pages= 339-43 | pmid=1759081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1759081 }}</ref> | |||
* | * In Japan, population-based [[Screening (medicine)|screening]] for [[gastric cancer]] is recommended for individuals older than 50 years with conventional double-contrast [[barium]] [[radiograph]] with photofluorography every year or [[upper endoscopy]] every two to three years<ref name="pmid25505714">{{cite journal| author=Choi IJ| title=Endoscopic gastric cancer screening and surveillance in high-risk groups. | journal=Clin Endosc | year= 2014 | volume= 47 | issue= 6 | pages= 497-503 | pmid=25505714 | doi=10.5946/ce.2014.47.6.497 | pmc=4260096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25505714 }}</ref> | ||
* [[Screening]] interval is recommended to be every two years but may be widened to a three-year interval without significant effect.<ref name="pmid24613579">{{cite journal| author=Park CH, Kim EH, Chung H, Lee H, Park JC, Shin SK et al.| title=The optimal endoscopic screening interval for detecting early gastric neoplasms. | journal=Gastrointest Endosc | year= 2014 | volume= 80 | issue= 2 | pages= 253-9 | pmid=24613579 | doi=10.1016/j.gie.2014.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613579 }}</ref> | |||
* | |||
=== '''Selective screening of high-risk subgroups''' === | |||
'''Selective screening of high-risk subgroups''' | * In areas of low [[gastric cancer]] [[incidence]], [[screening]] for gastric cancer with [[upper endoscopy]] should be reserved for specific high-risk subgroups.<ref name="pmid1853856">{{cite journal| author=Tersmette AC, Goodman SN, Offerhaus GJ, Tersmette KW, Giardiello FM, Vandenbroucke JP et al.| title=Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients. | journal=Am J Epidemiol | year= 1991 | volume= 134 | issue= 1 | pages= 14-21 | pmid=1853856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853856 }}</ref> | ||
* In areas of low gastric cancer incidence, screening for gastric cancer with | |||
*Individuals at increased risk for gastric cancer include those | *Individuals at increased risk for [[gastric cancer]] include those [[patients]] having the following: | ||
**Gastric adenomas | **[[Gastric]] [[Adenoma|adenomas]] | ||
**Pernicious anemia | **[[Pernicious anemia]] | ||
**Gastric intestinal metaplasia | **[[Gastric]] [[intestinal]] [[metaplasia]] | ||
**Familial adenomatous polyposis | **[[Familial adenomatous polyposis]] | ||
**Lynch syndrome | **[[Lynch syndrome]] | ||
**Peutz-Jeghers syndrome | **[[Peutz-Jeghers syndrome]] | ||
**Juvenile polyposis syndrome | **[[Juvenile polyposis syndrome]] | ||
==References== | ==References== | ||
Latest revision as of 11:55, 5 April 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2] Mohammed Abdelwahed M.D[3]
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Overview
The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography. Universal screening is recommended in countries with a high incidence of gastric cancer such as East Asian countries. In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved specifically for high-risk subgroups. Upper endoscopy has a sensitivity of 69 % and upper GI series has a sensitivity of 37%. Both studies have a specificity of 96%.
Screening
The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.
Upper endoscopy
- Upper endoscopy is more sensitive than other screening studies. It allows direct visualization of the gastric mucosa and allows for obtaining biopsies.[1]
Contrast radiography
- Barium radiographs can identify malignant gastric ulcers, infiltrating lesions, and some early gastric cancers.[2]
- Barium studies can be false negative in 50 percent of cases and the sensitivity of a barium study may be 14 percent.[3]
- In patients with linitis plastica, a barium study may be superior to upper endoscopy.
Sensitivity of tests
- Upper endoscopy has a sensitivity of 69 % and upper GI series has a sensitivity of 37%.
- Both studies had a specificity of 96%.
- The upper endoscopy sensitivity in detecting a localized gastric cancer is higher than upper GI series.[4]
Screening Strategies
Universal screening
- Universal screening is recommended in countries with a high incidence of gastric cancer such as East Asian countries.[5]
- In Japan, population-based screening for gastric cancer is recommended for individuals older than 50 years with conventional double-contrast barium radiograph with photofluorography every year or upper endoscopy every two to three years[6]
- Screening interval is recommended to be every two years but may be widened to a three-year interval without significant effect.[7]
Selective screening of high-risk subgroups
- In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved for specific high-risk subgroups.[8]
- Individuals at increased risk for gastric cancer include those patients having the following:
References
- ↑ Pisani P, Oliver WE, Parkin DM, Alvarez N, Vivas J (1994). "Case-control study of gastric cancer screening in Venezuela". Br J Cancer. 69 (6): 1102–5. PMC 1969457. PMID 8198977.
- ↑ Dooley CP, Larson AW, Stace NH, Renner IG, Valenzuela JE, Eliasoph J; et al. (1984). "Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study". Ann Intern Med. 101 (4): 538–45. PMID 6383166.
- ↑ Longo WE, Zucker KA, Zdon MJ, Modlin IM (1989). "Detection of early gastric cancer in an aggressive endoscopy unit". Am Surg. 55 (2): 100–4. PMID 2916797.
- ↑ Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH; et al. (2015). "Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea". Br J Cancer. 112 (3): 608–12. doi:10.1038/bjc.2014.608. PMC 4453643. PMID 25490528.
- ↑ Llorens P (1991). "Gastric cancer mass survey in Chile". Semin Surg Oncol. 7 (6): 339–43. PMID 1759081.
- ↑ Choi IJ (2014). "Endoscopic gastric cancer screening and surveillance in high-risk groups". Clin Endosc. 47 (6): 497–503. doi:10.5946/ce.2014.47.6.497. PMC 4260096. PMID 25505714.
- ↑ Park CH, Kim EH, Chung H, Lee H, Park JC, Shin SK; et al. (2014). "The optimal endoscopic screening interval for detecting early gastric neoplasms". Gastrointest Endosc. 80 (2): 253–9. doi:10.1016/j.gie.2014.01.030. PMID 24613579.
- ↑ Tersmette AC, Goodman SN, Offerhaus GJ, Tersmette KW, Giardiello FM, Vandenbroucke JP; et al. (1991). "Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients". Am J Epidemiol. 134 (1): 14–21. PMID 1853856.