Gastric cancer: Prevention, screening and early diagnosis

Abstract

Gastric cancer continues to be an important healthcare problem from a global perspective. Most of the cases in the Western world are diagnosed at late stages when the treatment is largely ineffective. Helicobacter pylori (H. pylori) infection is a well-established carcinogen for gastric cancer. While lifestyle factors are important, the efficacy of interventions in their modification, as in the use of antioxidant supplements, is unconvincing. No organized screening programs can be found outside Asia (Japan and South Korea). Although several screening approaches have been proposed, including indirect atrophy detection by measuring pepsinogen in the circulation, none of them have so far been implemented, and more study data is required to justify any implementation. Mass eradication of H. pylori in high-risk areas tends to be cost-effective, but its adverse effects and resistance remain a concern. Searches for new screening biomarkers, including microRNA and cancer-autoantibody panels, as well as detection of volatile organic compounds in the breath, are in progress. Endoscopy with a proper biopsy follow-up remains the standard for early detection of cancer and related premalignant lesions. At the same time, new advanced high-resolution endoscopic technologies are showing promising results with respect to diagnosing mucosal lesions visually and targeting each biopsy. New histological risk stratifications (classifications), including OLGA and OLGIM, have recently been developed. This review addresses the current means for gastric cancer primary and secondary prevention, the available and emerging methods for screening, and new developments in endoscopic detection of early lesions of the stomach.

Silicon Nanowire Sensors Enable Diagnosis of Patients via Exhaled Breath

“…53 Whilst in population-based screening settings, the sensitivity of pepsinogen tests is 67-85% and the specificity 76-87% for the detection of atrophy, the sensitivity of gastric cancer detection is only 37-62%. 53 In comparison to these values, S3, for example, is the frontrunner for clinical use as populationbased diagnostic or screening tool.…”

“…In another example, upper endoscopy with a full biopsy is the gold standard for diagnosing and screening gastric cancer and the related precancerous lesions. 53 However, this is not a feasible screening approach outside Asia and the cost-effectiveness in other this parts of the world has not been assessed. The cost-effectiveness of our sensors would thus be more affordable and give greater compliance for an at-risk population.…”

Portuguese Version of the EORTC QLQ-OES18 and QLQ-OG25 for Health-Related Quality of Life Assessment

“…1,5 Although GC incidence and mortality rates have been reported to be declining, the number of cases is expected to increase, due to an aging population. 2,3 Also, EC incidence is overall expected to rise over the next 10 years, mainly due to a rapid increase in distal esophageal adenocarcinoma, even if squamous cell carcinoma remains the most common histological type. 6,7 However, the diagnosis is often made at an advanced stage, as a result of the late appearance and/or nonspecificity of symptoms.…”

“…Hence, the prognosis is almost invariably poor, with dismal 5-year survival rates, not exceeding 20% for EC and 25% for GC. 3,5,8 Health-related quality of life (HRQoL) is a subjective concept, comprising four primary domains -physical, psychological/emotional, social and occupational wellbeing. 9,10 In oncology, the pertinence of its assessment has become increasingly clear, as it can help improving care for patients, not exclusively as a predictor of morbidity and mortality, but also as a noteworthy parameter in treatment decision making (moreover, when it comes to palliative care).…”

“…Gastric cancer (GC) is the second leading cause of cancer-related death [1][2][3] and in Portugal represents about a tenth of all cancer-related mortality, with almost twice the average mortality of European Union countries and the highest among all Western European countries. 2,4 Esophageal cancer (EC) is the sixth most common cause of cancer-related mortality worldwide.…”