Early diagnosis of early gastric cancer

• Published in: European journal of gastroenterology & hepatology Vol. 18; no. 8; pp. 821 - 829
• Main Authors: Tan, Yih K, Fielding, John W.L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-08-2006; Lippincott Williams & Wilkins
• Subjects: Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Digestive system. Abdomen; Early Diagnosis; Endoscopy; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Incidence; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Mass Screening; Medical sciences; Risk Factors; Stomach Neoplasms - complications; Stomach Neoplasms - diagnosis; Stomach Neoplasms - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; non-invasive neoplasia; screening; Premalignant lesion; Spirillales; Atrophic gastritis; biomarkers; Spirillaceae; Malignant tumor; Gastroscopy; Medical screening; Stomach cancer; open access gastroscopy; Helicobacter pylori; Intestinal metaplasia; premalignant lesions; Gastroenterology; Digestive diseases; Bacteria; Diagnosis; Gastric disease; early gastric cancer
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/00042737-200608000-00004

The prognosis of gastric cancer is closely related to the stage of disease at diagnosis. Early gastric cancer, whereby disease is limited to mucosa and submucosa, confers a survival rate of greater than 90% in 5 years in many centres. Gastric cancer is still a major cause of cancer mortality worldwide. In high incidence areas such as Japan, screening of asymptomatic population has been advocated. However, in Western countries, mass screening is not cost-effective. Hence, strategy has been directed to screen symptomatic individuals who are at higher risk of gastric cancer. Most patients with early gastric cancer present with symptoms indistinguishable from benign peptic ulcer disease. Screening for this group of patients improves detection rate of early gastric cancer and therefore its prognosis. Endoscopy for surveillance of premalignant lesions has been explored with this objective in mind. Serology testing for biomarkers such as pepsinogen, anti-Helicobacter pylori antibody and gastrin has been studied as an alternative to endoscopy. There is compelling evidence for the role of H. pylori in the initiation of Correaʼs cascade (stepwise progression from chronic active gastritis, atrophic gastritis, intestinal metaplasia, dysplasia and finally adenocarcinoma). Regression of premalignant lesions has been demonstrated with H. pylori eradication. However, it is not known whether this might effectively prevent gastric cancer in either low or high-risk population.