Different Prevalence of Alarm, Dyspeptic and Reflux Symptoms in Patients with Cardia and Non-cardia Gastric Cancer

Abstract

Background and Aims: Symptoms of patients with gastric cancer (GC) are often unspecific and differences in symptoms between patients with cardia and non-cardia GC have been poorly investigated. We aimed to characterize symptoms of patients with cardia and non-cardia GC.
 Methods: Patients with cardia (Siewert type II and III) and non-cardia GC were recruited in the German multicenter cohort of the Gastric Cancer Research (staR) study between 2013 and 2017. Alarm, dyspeptic and reflux symptoms at the time of presentation were documented using a self-administered questionnaire.
 Results: A completed self-administered questionnaire was available for 568/759 recruited patients (132 cardia GC, 436 non-cardia GC, male 61%, mean age 64 years). Dyspeptic symptoms were more common in patients with non-cardia GC (69.0 vs. 54.5%, p=0.0024). Cardia GC patients reported more frequently alarm symptoms (69.7 vs. 44.7%, p<0.0001), and were more likely to have Union for International Cancer Control (UICC) stage III-IV (54.1vs. 38.9%, p=0.0034). Especially, dysphagia and weight loss were more common in patients with cardia GC (49.2 vs. 6.4 %, p<0.0001 and 37.1 vs. 25.7%, p=0.02, respectively). No differences between the two groups were observed with respect to reflux symptoms. Patients with alarm symptoms were more likely to have UICC stage III-IV at presentation (69.4 vs. 42.9%, p<0.0001).
 Conclusions: In clinical practice the symptom pattern at presentation may serve as a hint for tumor localization. Despite the fact that they are common in the general population, dyspeptic symptoms offer a chance for earlier GC detection. Thus, in patients with dyspeptic symptoms who fail empiric approaches, endoscopy should not be delayed.

Trends in gastric cancer mortality 1990–2019 in 36 countries worldwide, with predictions to 2025, and incidence, overall and by subtype

“…The first symptoms of GC such as dyspepsia and early satiety largely overlap with benign conditions such as gastritis and reflux, while more severe symptoms like pain, weight loss, and hematemesis/anemia appear late. 9 Indeed, GC is mainly diagnosed at stages III and IV, when survival is poor. 3 According to Arnold and coauthors, about half of the GC cases diagnosed in Canada, Ireland, Denmark, and the United Kingdom in 2012–2014 belong to stage IV disease.…”

“…This raises interesting questions on whether further reduction could be achieved and what the base incidence of noncardia GC in the absence of Hp infection could be. The first symptoms of GC such as dyspepsia and early satiety largely overlap with benign conditions such as gastritis and reflux, while more severe symptoms like pain, weight loss, and hematemesis/anemia appear late 9 . Indeed, GC is mainly diagnosed at stages III and IV, when survival is poor 3 .…”

“…8 Cardia and noncardia GC subtypes (this latter including fundus, corpus, large and lesser curvatures and antrum) representing 15% and 75% of cases, respectively, can be identified based on the proximal or distal origin of the neoplastic lesions. 9 Given that the anatomical locations are associated with different risk factors, with cardia GC sharing risk factors with esophageal adenocarcinoma such as obesity and gastroesophageal reflux while noncardia GC is strongly associated with Hp infection, GC shows different patterns across subgroups of the population and geographical areas. Conversely, the histological distinction of GC into intestinal and diffuse type does not translate into heterogeneity in GC epidemiology.…”

“…Asian countries experience a heavier burden of GC compared to other regions, with Mongolia, Japan and the Republic of Korea being the countries with the highest GC incidence in 2020 8 . Cardia and noncardia GC subtypes (this latter including fundus, corpus, large and lesser curvatures and antrum) representing 15% and 75% of cases, respectively, can be identified based on the proximal or distal origin of the neoplastic lesions 9 . Given that the anatomical locations are associated with different risk factors, with cardia GC sharing risk factors with esophageal adenocarcinoma such as obesity and gastroesophageal reflux while noncardia GC is strongly associated with Hp infection, GC shows different patterns across subgroups of the population and geographical areas.…”

Mismatch repair deficiency, chemotherapy and survival for resectable gastric cancer: an observational study from the German staR cohort and a meta-analysis

“…Risk factors that increase the risk of GC include Helicobacter pylori gastritis, autoimmune gastritis, age, male gender, smoking, a diet high in salty and smoked foods / low in fruits and vegetables, a family history of GC and a hereditary disposition (Forman and Burley 2006 ; Venerito et al 2016 ; Weise et al 2020 ). Furthermore, obesity, gastroesophageal reflux disease and a medium or high socio-economic status all increase the risk for cardia GC (Franck et al 2021 ).…”