Gastric Cancer in Young Adults: A Different Clinical Entity from Carcinogenesis to Prognosis

Abstract

Approximately 5.0% of gastric cancer (GC) patients are diagnosed before the age of 40 and are not candidates for screening programs in most countries and regions. The incidence of gastric cancer in young adults (GCYA) has declined over time in most countries except in the United States. Genetic alterations, environmental factors, and lifestyle may predispose some young adults to GC. According to molecular classifications, the cancer of most GCYA patients belongs to the genomically stable or microsatellite stable/epithelial-mesenchymal transition subtype, with the common genetic aberrations being mutations in CDH1. What characterizes GCYA are a higher prevalence in females, more aggressive tumor behaviors, diagnosis at advanced stages, fewer comorbidities and being better treatment candidates, and a similar or better survival outcome when compared with older patients. Considering the greater loss of life-years in younger patients, lowering the incidence of GC and diagnosing at a relatively early stage are the two most effective ways to decrease GC mortality. To achieve these goals, the low awareness of GCYA among general people, policy-makers, clinicians, and researchers should be changed.

Incidence, Survival, and Mortality Trends of Cancers Diagnosed in Adolescents and Young Adults (15–39 Years): A Population-Based Study in The Netherlands 1990–2016

“…Studies focusing on young patients (not necessarily AYAs), have shown that younger patients (aged < 50 years) with lung, liver, pancreas, and stomach carcinomas are more often diagnosed with more aggressive disease with higher grade, more advanced stage and higher metastatic rates when compared with older populations [ 64 , 65 , 68 , 69 , 70 , 71 , 72 ]. This likely relates in part to delays in diagnosis and higher frequencies of driver mutations (e.g., EGFR and ALK mutations in lung cancer patients) [ 72 , 73 , 74 ]. In addition, survival outcomes for younger pancreatic and lung cancer patients did not improve drastically when treated with more aggressive treatment regimens [ 67 , 75 ].…”

“…In addition, survival outcomes for younger pancreatic and lung cancer patients did not improve drastically when treated with more aggressive treatment regimens [ 67 , 75 ]. This might explain why younger patients, in some studies, show similar or worse overall survival outcomes compared with older populations even though they generally suffer from less comorbidities and are better able to resist more intensive treatment regimens [ 65 , 68 , 69 , 72 , 73 , 76 ]. Considering the more aggressive disease biology and that younger patients have more potential life-years to lose, these cancers should receive increased attention in future research, as literature on these cancers among AYAs is scarce [ 9 , 65 , 71 , 72 , 73 ].…”

“…The five-year relative survival of all AYAs combined improved significantly over time from 73 Table 2, Tables S3 and S4, and Figure 3). Survival outcomes in 2010-2016 were similarly high for most age groups around 87-90% at five-years of follow-up for both sexes, but lagged somewhat behind in male AYAs aged 35-39 years (80.5% [95%CI: 79.1, 81.9]) ( Table 2, Tables S3 and S4, and Figure 3).…”

Gastric carcinoma: Insights into risk factors, methods of diagnosis, possible lines of management, and the role of primary care

“…This classification is essential in determining the extent of the surgical resection of gastric carcinoma. [ 25 ]…”

Integrative Bioinformatics Analysis of iNOS/NOS2 in gastric and colorectal cancer

“…It was estimated 27600 new stomach and 147950 new colorectal cancer cases would be diagnosed in the year 2020 [1]. The general prognosis of gastric and colorectal cancers are poor due to advanced stages when fist diagnosis [2][3][4]. Although gastric and colorectal cancer are frequent and have poor prognosis, the molecular carcinogenesis for their development, cell migration and invasion are not completely understood yet.…”