Case study of stomach adenocarcinoma conducted at a cancer referral hospital in northern Brazil

Abstract

-Context -Stomach cancer is the second leading cause of death due to cancer in the world and the incidence of this disease continues to be high in Brazil. In the Northern region, gastric cancer is the second most frequent cancer among men and the third among women. In the State of Pará, stomach adenocarcinoma is a public health problem since mortality rates are above the Brazilian average. Objective -To analyze the clinical and anatomopathological profile of stomach adenocarcinoma in patients seen at Ofir Loiola Hospital. Methods -In a retrospective study, records from 302 patients with gastric cancer undergoing surgery between 2006 and 2008 were analyzed. Data regarding patient profile, early symptoms, alterations upon physical examination, type of surgery, and macroscopic and histological findings were obtained from the records. Results -Most patients (63.9%) were men, 48% were older than 60 years, 50.9% were from the metropolitan region of Belém, 68.2% presented epigastric pain as an early symptom, and abdominal tenderness upon palpation was observed in 63.7%. The antrum was the most affected anatomical site (62.1%), followed by the gastric body (26.9%). Borrmann III (ulcerated-infiltrative) was the predominant endoscopic type. Adenocarcinoma accounted for 95.4% of all cases, including the intestinal type in 56.6% and the diffuse type in 41.3%. Most patients had stage IIIB and IV tumors and total gastrectomy was the most frequent type of surgery (37.4%). Conclusion -The present study demonstrated that gastric adenocarcinoma mainly affected men over the age of 60 who were from the metropolitan region of Belém. Most adenocarcinomas were in an advanced stage at the time of diagnosis, a fact requiring more aggressive surgical resection in these cases. These data highlight the urgent need for the implementation of preventive measures and early detection programs of gastric cancer. HEADINGS -Stomach neoplasms. Adenocarcinoma.

Association betweenHelicobacter pylori, Epstein-Barr virus, human papillomavirus and gastric adenocarcinomas

“…While the exact mechanism through which H. pylori may induce gastric carcinogenesis has not yet been fully elucidated, it is known that the inflammatory process caused by this bacterium, coupled with genetic and epigenetic events in the host, is capable of inducing a cascade of morphological events, including both premalignant and malignant transformations (intestinal or diffuse GC)[ 8 , 42 ]. In our study, the presence of the bacterium was more frequent in tumors classified as the intestinal subtype, an association that has also been confirmed in other studies conducted in locations with high GC incidence rates[ 16 , 52 , 56 ].…”

Helicobacter Pylori Infection in Patients With Different Gastrointestinal Diseases From Northern Brazil

“…Detection of infection with H. pylori by a molecular biology method (PCR) revealed a prevalence of 91% among patients with different gastrointestinal diseases. A high incidence of gastric carcinoma and peptic ulcer, as well as a high prevalence of infection with H. pylori, is observed in Brazil, especially in the State of Pará (1,18,36,37) . Some characteristics of H. pylori strains have been associated with the progression of infection to more severe disease.…”

Role of Helicobacter Pylori Infection and Lifestyle Habits in the Development of Gastroduodenal Diseases in a Population From the Brazilian Amazon

“…Epidemiological studies suggest that alcohol plays a fundamental role in the development of gastrointestinal diseases such as peptic ulcer and gastric cancer since it causes gastric mucosal injuries and stimulates parietal cells to produce gastric acid, in addition to its synergistic action with smoking (5,29) . Inadequate dietary habits such as excess intake of salt, preservatives and smoked produced, as well as diets poor in vegetable and fruits, are also strongly associated with the development of gastric cancer (24,28) . Food diaries have been used in studies investigating the association between diet and cancer in different populations in order to obtain nutritional information.…”

“…Nevertheless, despite the errors inherent to surveys of habitual food intake, these tools are important since they provide knowledge of dietary patterns and their temporal variation in different populations worldwide. In this respect, evidence indicates the negative influence of the modern western diet (high in fat and processed foods and low in fibers) on the development of various types of cancer in developed and developing countries (28) . The present results and those of other studies led us to conclude that infection with CagA-positive H. pylori strains, excessive alcohol consumption, smoking and inadequate eating habits increase the risk of developing peptic ulcer and gastric carcinoma.…”