Stomach cancer primary prevention
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
Effective measures for the primary prevention of stomach cancer include smoking cessation, eradication of Helicobacter pylori infection, and having a balanced diet rich in fruits and vegetables. In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved for specific high-risk subgroups. Individuals at increased risk for gastric cancer include; gastric adenomas, pernicious anemia, gastric intestinal metaplasia, familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome.
Primary prevention
Lifestyle modifications
Lifestyle modifications include following:[1]
- Dietary modification is an important approach to control gastric cancer. There is a link between physical inactivity and obesity to many types of cancer.
- Diet with low consumption of red meat, high in fruits and vegetables may have a protective effect against many cancers.
- The World Health Assembly adopted the WHO Global Strategy on Diet, Physical Activity, and Health, in May 2004 to reduce deaths and diseases.
H.pylori eradication
- The incidence of metachronous gastric cancer following the endoscopic resection of a gastric neoplasm is known to be reduced by the eradication of H. pylori infection. [1][2]
Prevention Through Screening
- In countries with a high incidence of gastric cancer such as east Asia countries, universal screening is recommended.
- Japan has a high incidence of gastric cancer; therefore annual screening via double contrast barium radiography and photofluorography every year or upper endoscopy every two to three years [3]
- Screening interval is recommended to be every two years but may be extended to a three-year interval without significant difference in effect. ??
Prevention of Hereditary Cancer
Screening
- In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved for specific high-risk subgroups
- Individuals at increased risk for gastric cancer include those with the following:
- Gastric adenomas
- Pernicious anemia
- Gastric intestinal metaplasia
- Familial adenomatous polyposis
- Lynch syndrome
- Peutz-Jeghers syndrome
- Juvenile polyposis syndrome
Prevention
- Asymptomatic patients with a family history of HDGC and CDH1 mutations have a high probability of developing signet ring cell adenocarcinoma of the stomach. Prophylactic total gastrectomy is recommended for patients with family history of HDGC and CDH1 mutations.[4][5]
- For patients with a CDH1 mutation but who are not from an HDGC family, individualized evaluation at an experienced center before prophylactic total gastrectomy is recomended.[6]
- Prophylactic gastrectomy is often advised between age 20 and 30.
- Some suggest timing total gastrectomy in CDH1 mutation carriers at an age that is five years younger than the youngest family member who developed gastric cancer.[7]
- Older patients are less likely to benefit from a prophylactic gastrectomy than younger patients because of a shorter life-expectancy and a higher perioperative risk.[5]
- Patients who are older than 75 years should not undergo such a procedure, as their mortality from the procedure outweighs their mortality from gastric cancer.
- Decisions should be individualized based upon their comorbidities and the age of gastric cancer onset in their respective kindred.[8]
Gastric Polyps
- Polypectomy should be performed for all known neoplastic polyps and for all polyps ≥1 cm in diameter, as biopsies alone cannot exclude foci of high-grade dysplasia or early gastric cancer.
- In patients with multiple polyps, the largest polyp should be excised and representative biopsies should be obtained from the remaining polyps.
- Fundic gland polyps are associated with a low risk of progression to cancer.
- Small proximal gastric polyps should be biopsied in patients with familial adenomatous polyposis (FAP) to confirm their histology.
- Large or irregular appearing polyps should be biopsied or resected completely to assess for dysplasia.
- Low-grade dysplasia is common in fundic gland polyps, but surgery should be reserved for high-grade dysplasia or cancer.
- Antral polyps are usually adenomas and should be completely resected endoscopically if possible. ?
Hyperplastic polyps
- Hyperplastic polyps occur in association with H. pylori-related atrophic gastritis.
- Surveillance with upper endoscopy should be performed based on the risk factors for gastric cancer one year after initial resection of adenomatous gastric polyps.
- In individuals at high risk for gastric cancer, surveillance is continued long life.
Juvenile Polyposis Syndrome
- Screening the upper gastrointestinal tract with upper endoscopy starting at the age of 12 years.
- If polyps are detected, upper endoscopy should be repeated annually.
- In the absence of upper gastrointestinal tract polyps, upper endoscopy can be performed every two to three years.
Lynch Syndrome
- Individuals with a germline mutation in the DNA mismatch repair MMR or EPCAM genes have a definitive diagnosis of Lynch syndrome and should undergo screening for Lynch syndrome associated cancers.
- Extent of screening in these individuals can be individualized based on their personal and family cancer history and evidence of microsatellite instability on tumor testing.
- Individuals at risk for Lynch syndrome include:
- Individuals in families meeting Amsterdam I or II criteria or revised Bethesda guidelines
- Endometrial cancer prior to age 50 years
- First-degree relative of those with known MMR/EPCAM gene mutation
- Individuals with >5 percent chance of an MMR gene mutation
References
- ↑ 1.0 1.1 Park JY, von Karsa L, Herrero R (November 2014). "Prevention strategies for gastric cancer: a global perspective". Clin Endosc. 47 (6): 478–89. doi:10.5946/ce.2014.47.6.478. PMC 4260094. PMID 25505712.
- ↑ García Martín R, Matía Cubillo Á (May 2016). "[INFLUENCE OF DIET IN PRIMARY PREVENTION OF GASTRIC CANCER, IN PATIENTS INFECTED WITH HELICOBACTER PYLORI]". Rev Enferm (in Spanish; Castilian). 39 (5): 33–8. PMID 27405145.
- ↑ Ohata H, Oka M, Yanaoka K, Shimizu Y, Mukoubayashi C, Mugitani K, Iwane M, Nakamura H, Tamai H, Arii K, Nakata H, Yoshimura N, Takeshita T, Miki K, Mohara O, Ichinose M (October 2005). "Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography". Cancer Sci. 96 (10): 713–20. doi:10.1111/j.1349-7006.2005.00098.x. PMID 16232204.
- ↑ Keller G, Vogelsang H, Becker I, Hutter J, Ott K, Candidus S; et al. (1999). "Diffuse type gastric and lobular breast carcinoma in a familial gastric cancer patient with an E-cadherin germline mutation". Am J Pathol. 155 (2): 337–42. doi:10.1016/S0002-9440(10)65129-2. PMC 1866861. PMID 10433926.
- ↑ 5.0 5.1 Abreu E (1997). "[Primary prevention and detection of gastric cancer]". Cad Saude Publica (in Portuguese). 13 Suppl 1: 105–108. PMID 10886930. Vancouver style error: initials (help)
- ↑ Pharoah PD, Guilford P, Caldas C, International Gastric Cancer Linkage Consortium (2001). "Incidence of gastric cancer and breast cancer in CDH1 (E-cadherin) mutation carriers from hereditary diffuse gastric cancer families". Gastroenterology. 121 (6): 1348–53. PMID 11729114.
- ↑ Norton JA, Ham CM, Van Dam J, Jeffrey RB, Longacre TA, Huntsman DG; et al. (2007). "CDH1 truncating mutations in the E-cadherin gene: an indication for total gastrectomy to treat hereditary diffuse gastric cancer". Ann Surg. 245 (6): 873–9. doi:10.1097/01.sla.0000254370.29893.e4. PMC 1876967. PMID 17522512.
- ↑ Chun YS, Lindor NM, Smyrk TC, Petersen BT, Burgart LJ, Guilford PJ; et al. (2001). "Germline E-cadherin gene mutations: is prophylactic total gastrectomy indicated?". Cancer. 92 (1): 181–7. PMID 11443625.