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Gastric Cancer Prevention

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  • 1. Gastric Cancer Prevention
    • Luis S. Mon, M.D., F.A.C.S.
    • Carlos A. Perurena, M.D.
  • 2. Gastric Cancer Prevention
    • Drs. Mon and Perurena are proffesors or Surgery at the University of Panama´s Medical School. They can be contacted at [email_address]
    • Gastric Cancer is the fifth most frequent cancer and the second most lethal in the Republic of Panama.
  • 3. Gastric Cancer Prevention
    • Learning Objectives:
    • 1. State the basic biological characteristics of Adenocarcinoma of the Stomach.
    • 2. Describe the principal epidemiological features of the disease.
    • 3. Recognize the most probable risk factors for the disease.
    • Performance Objectives:
    • 1. Propose specific strategies for Gastric Cancer primary prevention.
    • 2. Propose strategies for Gastric Cancer secondary prevention.
  • 4. Gastric Cancer Prevention
    • Biology
    • Epidemiology
    • Risk Factors
    • Primary Prevention
    • Secondary Prevention
  • 5. Gastric Cancer Prevention: Biology
    • There are several Hystological types of Gastric Cancer of which adenocarcinoma is by far the most frequent.
    • Sarcomas and Lymphomas can also occur.
    • This presentation refers basically to adenocarcinoma.
  • 6. Gastric Cancer Prevention Biology: Hystopathology
    • Two types of adenocarcinoma are recognized:
    • 1. Intestinal: resembles colon cancer, can be polypoid or ulcerated, occurs usually in the distal stomach and has a prolonged pre-cancerous phase.
  • 7. Gastric Cancer Prevention Biology: Hystopathology
    • 2. Difusse: Extends widely with no distinct margins and the glandular structure is rarely present.
    • Patients tend to be younger and have a worst prognosis.
  • 8. Gastric Cancer Prevention Biology: Hystopathology
    • Adenocarcinoma is considered early when it´s confined to the mucosa and sub-mucosa, irrespective of lymph node affection.
    • Otherwise it’s called advanced.
  • 9. Gastric Cancer Prevention: Epidemiology
    • Infrequent before 40 years of age.
    • Twice as frequent in men than in women.
    • Leading cause of death from cancer worldwide.
  • 10. Gastric Cancer Prevention: Epidemiology
    • Highest incidence in Japan, South America and Eastern Europe.
    • Adjusted rate worldwide is 15.62 per 100 000
    • Adjusted rate for Latin America is variable.
  • 11. Gastric Cancer Prevention: Epidemiology
    • In Costa Rica the incidence rate for men is 51.5 and 28.7 for women.
    • In Panama ( a country that borders Costa Rica) the global rate is 11.5
  • 12. Gastric Cancer Prevention: Epidemiology
    • In the United States the incidence has been decreasing and unexplainedly the cancer has migrated proximally.
    • Gastro-esophageal lesions are
    • more frequent than antral lesions.
  • 13. Gastric Cancer: Risk Factors and Primary Prevention
    • Gastric Cancer is a very common disease that carries a high mortality.
    • The diagnosis in early phases, when better results should be expected, is difficult due to the unspecifity of early symptoms.
  • 14. Gastric Cancer: Risk Factors and Primary Prevention
    • Recognition of risk factors and application of strategies directed towards their elimination are of paramount importance.
    • We will discuss the most probable and convincing risk factors related to this disease.
  • 15. Gastric Cancer Prevention: Chronic Atrophic Gastritis
    • Chronic Atrophic Gastritis is thought to be the initial step in the development of most Gastric Cancers.
  • 16. Gastric Cancer Prevention: Chronic Atrophic Gastritis
    • Chronic Atrophic Gastritis has been shown to appear in patients with:
    • 1. Tobacco use.
    • 2. H. pylori infection.
    • (cont.)
  • 17. Gastric Cancer Prevention: Chronic Atrophic Gastritis
    • 3. Diets with high levels of nitrites, nitrates, salt and smoked foods.
    • 4. Previous Gastric Surgery.
    • 5. Pernicious Anemia.
  • 18. Gastric Cancer Prevention: Tobacco
    • Smoking increases the risk of Gastric Cancer by 50% to 60%
    • It is estimated that smoking tobacco is responsible for 11% of all Stomach Cancers worldwide.
  • 19. Gastric Cancer Prevention: Tobacco
    • Tobacco use decreases the levels of Carotenoids and Vitamin C which act as protective agents against this disease.
  • 20. Gastric Cancer Prevention: Tobacco
    • Tobacco use is associated with Helycobacter pylori infection which in turn leads to Atrophic Gastritis.
  • 21. Gastric Cancer Prevention: Tobacco
    • Smoking cessation returns the risk to that of the general population after 20 years.
  • 22. Gastric Cancer Prevention: Helycobacter pylori
    • H. pylori is associated with a two to sixfold increase in the risk of developing Gastric Cancer.
    • Many believe that genetic and environmental factors also need to be present for H. pylori to cause cancer.
  • 23. Gastric Cancer Prevention: Helycobacter pylori
    • In 1994 the World Health Organization designated
    • H. pylori a Group 1 carcinogen
  • 24. Gastric Cancer Prevention: Dietary Factors
    • Consumption of fruit, vegetables and fiber has shown, in the majority of controled studies published, a protective effect against Gastric Cancer.
    • This effect is probably due to Vitamin C or carotenes.
  • 25. Gastric Cancer Prevention: Dietary Factors
    • Nitrates and nitrites found in salted, smoked and dried foods lead to atrophic Gastritis which in turn leads to Gastric Cancer.
  • 26. Gastric Cancer Prevention: Genetic Factors
    • All of the following genetic factors have been shown to increase the risk of Gastric Cancer.
  • 27. Gastric Cancer Prevention: Genetic Factors
    • Blood type A.
    • Hereditary non-polyposis colorectal cancer.
    • e-cadherin gene mutations.
    • A first degree relative with Gastric Cancer.
  • 28. Gastric Cancer Prevention: Genetic Factors
    • Presently they are not subject to preventive measures except for prophylactic gastrectomy in e-cadherin mutations.
  • 29. Gastric Cancer Prevention: Secondry Prevention
    • Secondary prevention is the “early” detection of cancer through screening.
    • This is done in populations where the disease is a major health problem.
    • Examples of this approach can be found in Japan and Costa Rica.
  • 30. Gastric Cancer Prevention: Secondary Prevention
    • In Japan gas-contrast Stomach Fluorography is done in the mass population.
    • (cont.)
  • 31. Gastric Cancer Prevention: Secondary Prevention
    • Those considered abnormal (about 13%) will undergo further studies, including endoscopy and biopsy.
  • 32. Gastric Cancer Prevention: Conclusions
    • The best primary prevention strategies are:
  • 33. Gastric Cancer Prevention: Conclusions
    • Smoking avoidance or cessation.
    • Diets rich in fruit, vegetables and fiber.
    • Avoidance of salted, smoked and poorly preserved foods.
    • Erradication of H. pylori.
  • 34. Gastric Cancer Prevention: Conclusions
    • Mass screening is a viable strategy in high risk populations.