Gastric CancerGastrolearning 26/5/2014
F.FarinatiS.LonardiA.Marchet
Padova
Gastric CancerF.Farinati
Epidemiology, precancerous changes, Early Gastric
Cancer
Gastric cancer mortali
ty
Gastric cancer: epidemiology
Almost one million new cases of stomach cancer estimated to have occurred in 2012 (952,000 cases, 7% of the total), the fifth most common malignancy in the world, after the lung, breast, colorectum and prostate.
Globocan IARC 2012
Third leading cause of cancer death in both sexes worldwide (723,000 deaths, 9% of the total). Highest estimated mortality rates in Eastern Asia (24 per 100,000 in men, 9.8 per 100,000 in women), lowest in Northern America (2.8 and 1.5, respectively). High mortality rates are also present in Central and Eastern Europe, and in Central and South America.
Hereditary diffuse gastric cancer (HDGC).
Vogelaar et al. Hereditary Cancer in Clinical Practice 2012, 10:18
The role of diet in gastric cancer: still an open question.
Berretta M et al. Front Biosci (Landmark Ed). 2012 Jan 1;17:1640-7.
• Fruit and vegetables • Salt and salted food • Vitamins and mineral • Alcohol • Nitrate, nitrite and nitrosamines
High dietary salt intake exacerbates Helicobacter pylori-induced gastric carcinogenesis.
Gaddy JA et al 2013 Infect Immun.
Natural history of H. pylori infection
Gastritis
Atrophy
Days
Weeks
Sipponen et al.1993
Duodenal ulcer
Gastric ulcer
Years
Months
Risk
15%
1%NeoplasiaDecades
H. pylori and Cancer Collaborative Group, 2001
Association between Helicobacter pylori infection and non-cardia gastric cancer
The Correa’ s Cascade
Inoue, Cancer. Lett. 2000, RR 2.2 at 5 years in moderate atrophy
You, Int J Cancer 1999 RR = 1
Chronic atrophic gastritis: Cancer risk
Low risk
Gastric atrophy: OLGA staging
M.Rugge et al
Dysplasia (Intra Epithelial neoplasia – IEN
Non Invasive Neoplasia - NIN)
Cancers detected during the follow-up
Early GC
22 = 88%
Advanced GC
3 = 12%
Pathological Stage (pTNM) assessed in 25 patients
30 Gastric Cancers detected among 129
patients
Follow-up > 12 months
Follow-up < 12 months
19 11
Follow-up :mandatory !!!!
Gastric epithelial dysplasia (NIN-IEN)
CAG
DYSPL
Cancer
EGC
ChemotherapyPalliative surgeryRadiation
Progress in the treatment of AGC: median overall survival
BSC1
5FU monotherapy1
Docetaxel-Cisplatin-5FU 2
Capecitabine-Cisplatin (XP)3
5FU-LV-Oxaliplatin (FLO)4
EOX5
Trastuzumab-CT6
4 months
7 months
9.2 months
10.5 months
10.7 months
11.2 months
13.8 months
1.Wagner JCO 03; 2 Van Cutsem ASCO 09; 3. Kang Ann Oncol 09; 4. Al Batran JCO 09; 5. Cunningham NEJM 07; 6. Van Cutsem ASCO 09.
Adapted from Cervantes Gastrointestinal Cancer Symposium Barcellona 2009
O.S.
Gastric Cancer
Early Gastric Cancer
Strip biopsy EMR
Endoscopic Submucosal Dissection ESD