Gastritis and Gastric Cancer: Time for gastric cancer prevention
Gastric cancer represents a major clinical problem, associated with significant morbidity and mortality. Work over several decades has identified multiple risk factors for gastric cancer, which can be best classified as environmental and host-related factors. Gastric cancer is divided into intestinal-type and diffuse type. Precursor lesions for intestinal-type cancer are atrophic gastritis, intestinal metaplasia and dysplasia, while for diffuse type, that are less common, is the lack of intracellular adhesions (loss of E-cadherin protein). Currently, there are neither surveillance strategies nor clear-cut estimates of the benefits and risks of endoscopic surveillance. Thus gastroenterologists must individualize their approach to each patient, which may include frequent endoscopy, topographic mapping of the entire stomach, chromoendoscopy and magnifying endoscopy. In all cases of course the wishes of the patient must be factored in, but a frank discussion with patients and their relatives can be immensely helpful. Unlike colon cancer, for which clear and generally accepted guidelines have been developed over the years, the situation for gastric cancer remains still incompletely developed, reflecting, no doubt, our still limited understanding of gastric cancer pathogenesis. More work is needed to develop a rational and effective approach to the prevention of gastric cancer, mainly in the areas of the detection of early lesions and optimal allocation of limited resources to an effective screening program.