Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

Abstract

The mortality rates of gastric carcinoma remain high, despite the progress in research and development in disease mechanisms and treatment. Therefore, recognition of gastric precancerous lesions and early neoplasia is crucial. Two subtypes of sporadic gastric cancer have been recognized: cardia subtype and non-cardia (distal) subtype, the latter being more frequent and largely associated with infection of Helicobacter pylori, a class I carcinogen. Helicobacter pylori initiates the widely accepted Correa cascade, describing a stepwise progression through precursor lesions from chronic inflammation to gastric atrophy, gastric intestinal metaplasia and neoplasia. Our knowledge on He-licobacter pylori is still limited, and multiple questions in the context of its contribution to the pathogenesis of gastric neoplasia are yet to be answered. Awareness and recognition of gastric atrophy and intestinal metaplasia on high-definition white-light endoscopy, image-enhanced endoscopy and magnification endoscopy, in combination with histology from the biopsies taken accurately according to the protocol, are crucial to guiding the management. Standard indications for endoscopic resections (endoscopic mucosal resection and endoscopic submucosal dissection) of gastric dysplasia and intestinal type of gastric carcinoma have been recommended by multiple societies. Endoscopic evaluation and surveillance should be offered to individuals with an inherited predisposition to gastric carcinoma.

Pyloric Gastric Adenoma: Endoscopic Detection, Removal, and Echoendosonographic Characterization

“…The length of surveillance is unknown but should take into consideration the relative cancer risk of the individual by weighing several factors including family history of gastric cancer, migrant status from high incidence area, Operative Link on Gastritis Assessment stage 3-4, and history of familial polyposis syndrome. 18 In 2 multicenter clinicopathological studies of PGAs, the 21 pooled cases of intramucosal/invasive adenocarcinoma were associated exclusively with histological findings of high-grade dysplastic PGAs. This finding really underscores the risk of progression through the stepwise carcinogenic sequence of low-grade dysplasia, high grade, and adenocarcinoma, making resection of these precancerous lesions with curative intent imperative to curb the natural progression to malignancy.…”

“…The length of surveillance is unknown but should take into consideration the relative cancer risk of the individual by weighing several factors including family history of gastric cancer, migrant status from high incidence area, Operative Link on Gastritis Assessment stage 3–4, and history of familial polyposis syndrome. 18 …”

Gastric precancerous lesions:occurrence, development factors, and treatment

“…Several societies have recommended the standard indications for endoscopic resection of GPL and intestinal GC. Endoscopic evaluation and monitoring should be carried out for patients with genetic susceptibility to GC ( 105 ). Low-grade dysplastic gastric mucosal lesions with a diameter of less than 1 cm can be treated with either Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), but ESD is better for patients with large lesions and those who have high-grade dysplasia (HGD) or early gastric cancer (EGC) ( 106 ).…”

SERPINB5 is a novel serum diagnostic biomarker for gastric high-grade intraepithelial neoplasia and plays a role in regulation of macrophage phenotypes

“…Although magnification endoscopy, chromoendoscopy, narrow band imaging, autofluorescence, and confocal endomicroscopy may improve the detection of precancerous lesions, making an appropriate diagnosis for GPL in clinical practice is challenging due to the subtle changes in endoscopic imaging and the diverse morphological features of lesions, and many of these advanced techniques can only be performed by a few experts [10] , [11] , [12] . Furthermore, thus far, there are no reliable nonendoscopic biomarkers for screening these precancerous lesions in general populations [ 13 , 14 ]. Therefore, it is urgent to find a low-cost, high-accuracy, and noninvasive screening tool to detect premalignant conditions with a high risk of GC and improve diagnostic accuracy.…”