Gastric cancer in very young adults: apropos four patients and a review of the literature

Abstract

Whether gastric cancer in young adults differs from gastric cancer in older patients has been a controversial issue. It has long been suspected that young patients with gastric cancer have different biological features with a more aggressive course of disease and a poorer prognosis than older patients. This, however, has not been firmly substantiated. We report on the clinical course of four patients (three female and one male) with locally advanced (n = 1) or metastasized (n = 3) non-resectable gastric cancer diagnosed under the age of 29 years (23, 25, 27, 28 years). Prior to diagnosis, all three women had recently been pregnant (1-22 months). Diagnosis was endoscopically biopsy-proven and staging work-up was performed by primary explorative surgery (n = 1), laparoscopy and explorative surgery (n = 1) or CAT scan and ultrasound (n = 2). The delay between initial symptoms and diagnosis was 8-22 weeks (median, 10 weeks). The histology was signet-ring cell (n = 2) or undifferentiated (n = 2) gastric cancer. All patients had the diffuse type of gastric cancer according to Lauren. Patients were treated with the FLAP polychemotherapy regimen consisting of leucovorin, 5-fluorouracil, doxorubicin and cisplatinum, as previously reported. The best response after chemotherapy was partial in two patients. Two patients showed progressive disease. Secondary surgery was performed in three responding patients (one of them responded only locally). One patient achieved no evidence of disease after complete tumor resection (R0). In two patients surgery was palliative (R2/exploration). Three patients died 6, 4 and 8 months after diagnosis. One patient is still alive. In our series, very young adults with gastric cancer had adverse clinical and pathological features. In accordance with other reports, we observed a predominance of female patients and a possible association with recent pregnancies. Though the delay between the first symptoms and diagnosis in our patients was no different from that reported for older patients, special emphasis should be given to prompt referral and diagnostic investigations, ensuring the diagnosis of gastric cancer early in the course of disease.

Diabetes increases the risk of breast cancer: a meta-analysis

“…1). Eleven studies were excluded for failing to include an internal control group (De Waard & Baanders Van Halewijn 1974, Ragozzino et al 1982, Adami et al 1991, Hjalgrim et al 1997, Weiderpass et al 1997, Wideroff et al 1997, Kath et al 2000, Zendehel et al 2003, Swerdlow et al 2005, Shu et al 2010, three studies were excluded for investigating mortality rather than incidence (Coughlin et al 2004, Siegelmann-Danieli et al 2006, Tseng et al 2009), one study was excluded for using benign breast disease as a comparator (Muck et al 1975) and the final study was excluded for investigating the effect of glycaemic control on BC incidence (Stefansdottir et al 2011). The remaining 43 studies were included in the meta-analysis.…”

Clinicopathological profile and long-term outcome in young adults with gastric cancer: multicenter evaluation of 214 patients

“…GC is usually diagnosed in the sixth and seventh decades of life, although it may also be found in younger patients. The incidence of GC in subjects 40 years of age or younger is very low and ranges between 2 and 15% [2][3][4]. The clinicopathological characteristics of GC in elderly patients have been extensively discussed in the literature.…”

DNA copy number changes in young gastric cancer patients with special reference to chromosome 19

“…British Journal of Cancer (2003Cancer ( ) 88, 1914Cancer ( -1919 Gastric cancer is the second most frequent cancer worldwide (Parkin et al, 1999), but in young age groups it is rather uncommon. Several studies have been published about gastric cancer in young patients aged 45 years or younger (Kokkola et al, 1996;Maehara et al, 1996;Theuer et al, 1996;Semba et al, 1998;Rugge et al, 1999;Haruma et al, 2000;Kath et al, 2000). These studies have suggested differences between clinicopathological and histological outcome in gastric cancer in young and elderly age groups.…”