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Premalignant Lesions of the Stomach

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Endoscopic Oncology

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Abstract

Dysplasia is the precursor lesion for the development of carcinoma throughout the gastrointestinal tract. Certain conditions, which may lead to the occurrence of dysplasia, are labeled precursor conditions. The most readily identified such condition is Barrett’s esophagus. All esophageal adenocarcinoma follows the sequence of intestinalized Barrett’s epithelium progressing to dysplasia and subsequently to adenocarcinoma with relatively measurable frequencies. Gastric dysplasia, however, is usually found in the setting of chronic atrophic gastritis. Unlike the Barrett’s lesion, there are no gross endoscopic features or a demarcated anatomic location. Furthermore, patients with Barrett’s esophagus are at about the same risk for progression to cancer irrespective of ethnicity, environment, and socioeconomic status. However, these are all important factors contributing to gastric cancer risk in patients with atrophic gastritis. Finally, the symptoms of gastro-esophageal reflux characterize the population at risk for Barrett’s, but there are no symptoms attributable to the development of chronic atrophic gastritis (CAG). This chapter reviews the premalignant gastric lesions and their management.

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References

  1. Correa P. A human model of gastric carcinogenesis. Cancer Res 1988; 48:3554–3560.

    CAS  PubMed  Google Scholar 

  2. Sepulveda A, Graham D. Role of Helicobacter pylori in gastric carcinogenesis. Gastroenterol Clin North Am 2002; 31(2):517–535.

    Article  PubMed  Google Scholar 

  3. Faraji E, frank B. Multifocal atrophic gastritis and gastric carcinoma. Gastroenterology Clinics of North America 2002; 31(2):499–516.

    Article  PubMed  Google Scholar 

  4. Genta R, Rugge M. Gastric precancerous lesions: heading for an international consensus. Gut 1999; 45(Suppl I):I5–I8.

    Article  PubMed  Google Scholar 

  5. Haber M. Histologic precursors of gastrointestinal malignancy. Gastroenterology Clinics of North America 2002; 31(2):395–419.

    Article  PubMed  Google Scholar 

  6. Lauwers G. Defining the pathologic diagnosis of metaplasia, atrophy, dysplasia, and gastric adenocarcinoma. J Clin Gastroenterol 2003; 36(Suppl 1):S37–S43.

    Article  PubMed  Google Scholar 

  7. Meining A, Morgner A, Miehlke S, Bayerdorffer E, Stolte M. Atrophy-metaplasia-dysplasia-carcinoma sequence in the stomach: a reality or merely an hypothesis? Best Pract Res Clin Gastroenterol 2001; 15:983–998.

    Article  CAS  PubMed  Google Scholar 

  8. Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori and the development of gastric cancer. N Engl J Med 2001; 345:784–789.

    Article  CAS  PubMed  Google Scholar 

  9. Wong B, Lam S, Wong W, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China. JAMA 2004; 291:87–194.

    Google Scholar 

  10. Sung J, Lin S, Ching J, et al. Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study. Gastroenterology 2000; 119:7–14.

    Article  CAS  PubMed  Google Scholar 

  11. Ley C, Mohar A, Guarner J, et al. helicobacter pylori eradication and gastric preneoplastic conditions: a randomized, double-blind, placebo-controlled trial. Cancer Epidemiol Biomark Prev 2004; 13:4–10.

    Article  CAS  Google Scholar 

  12. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer. N Engl J Med 2000; 343:78–85.

    Article  CAS  PubMed  Google Scholar 

  13. Bakir T, Can G, Siviloglu C, et al. Gastric cancer and other organ cancer history in the parents of patients with gastric cancer. Eur J Cancer Prev 2003; 12:183–189.

    Article  CAS  PubMed  Google Scholar 

  14. Howson CP, Hiyama T, Wynder EL. The decline of gastric cancer, epidemiology of an unplanned triumph. Epidemiol Rev 1986; 8:1–27.

    CAS  PubMed  Google Scholar 

  15. Haenszel W, Kurihara M, Segi M, et al. Stomach cancer among Japanese in Hawaii. J Natl Cancer Inst 1972; 49:969–988.

    CAS  PubMed  Google Scholar 

  16. Staszewski J. Migrant studies in alimentary tract cancer. Recent Results Cancer Res 1972; 39:85–97.

    CAS  PubMed  Google Scholar 

  17. Palli D, Galli M, Caporaso NE, et al. Family history and risk of stomach cancer in Italy. Cancer Epidemiol Biomarkers 1994; 3:15–18.

    CAS  Google Scholar 

  18. Dhillon PK, Farrow DC, Vaughan TL, et al. Family history of cancer and risk of esophageal and gastric cancers in the United States. Int J Cancer 2001; 93:148–152.

    Article  CAS  PubMed  Google Scholar 

  19. Lissowska J, Groves FD, Sobin LH, et al. Family history and risk of stomach cancer in Warsaw, Poland. Eur J Cancer Prev 1999; 8:223–227.

    CAS  PubMed  Google Scholar 

  20. La Vecchia C, Negri E, Franceschi S, et al. Family history and the risk of stomach and colorectal cancer. Cancer 1992; 70:50–55.

    Article  PubMed  Google Scholar 

  21. Bakir T, Can G, Siviloglu C, et al. Gastric cancer and other organ cancer history in the parents of patients with gastric cancer. Eur J Cancer Prev 2003; 12:183–189.

    Article  CAS  PubMed  Google Scholar 

  22. Parsonnet J. When Heredity is Infectious. Gastroenterology 2000; 118:222–224.

    Article  CAS  PubMed  Google Scholar 

  23. Brenner H, Bode G, Boeing H. Helicobacter pylori infection among offspring of patients with stomach cancer. Gastroenterology 2000; 118:31–35.

    Article  CAS  PubMed  Google Scholar 

  24. El-Omar EM, Oien K, Murray LS, et al. Increased prevalence of precancerous changes in relatives of gastric cancer patients: critical role of H. pylori. Gastroenterology. 2000; 118:22–30.

    Article  CAS  PubMed  Google Scholar 

  25. Machado JC, Pharoah P, Sousa S, et al. Interleukin 1B and inter-leukin 1RN polymorphisms are associated with increased risk of gastric carcinoma. Gastroenterology 2001; 121:823–829.

    Article  CAS  PubMed  Google Scholar 

  26. Zwick A, Munir M, Ryan C, et al. Gastric adenocarcinoma and dys-plasia in fundic gland polyps of a patient with attenuated adenomatous polyposis. Gastroenterology 1997; 113:659–663.

    Article  CAS  PubMed  Google Scholar 

  27. Aarnio M, Salovaara R, Aaltonen L, et al. Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 1997; 74:551–555.

    Article  CAS  PubMed  Google Scholar 

  28. Sawada T, Muto T. Familial adenomatous polyposis: Should patients undergo surveillance of the upper gastrointestinal tract? Endoscopy 1995; 27:6–11.

    CAS  PubMed  Google Scholar 

  29. Appropriate use of gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 2000; 52: 831–837.

    Google Scholar 

  30. Kelley JR, Duggan JM. Gastric cancer epidemiology and risk factors. J Clin Epidemiol 2003; 56:1–9.

    Article  PubMed  Google Scholar 

  31. Ramon J, Serra L, Cerdo C, et al. Dietary factors and gastric cancer risk: A case control study in Spain. Cancer 1993; 71:1731–1735.

    Article  CAS  PubMed  Google Scholar 

  32. Ji B, Chow W, Yang G, et al. Dietary habits and stomach cancer in Shanghai, China. Int J Cancer 1998; 76:659–664.

    Article  CAS  PubMed  Google Scholar 

  33. Joossens JV, Hill MJ, Elliott P, et al. Dietary salt, nitrate, and stomach cancer mortality in 24 countries. Int J Epidemiol 1996; 24:494–504.

    Article  Google Scholar 

  34. Hansson LE, Nyren O, Bergstrom R, et al. Diet and risk of gastric cancer. A population-based case control study in Sweden. Int J Cancer 1993; 55:181–189.

    Article  CAS  PubMed  Google Scholar 

  35. Lee JK, Park BJ, Yoo KY, et al. Dietary factors and stomach cancer: a case-control study in Korea. Int J Epidemiol 1995; 24:33–41.

    Article  CAS  PubMed  Google Scholar 

  36. Fox J, Dangler C, Taylor N, et al. High-salt intake induces gastric epithelial hyperplasia and parietal cell loss, and enhances Helicobacter pylori colonization in C57BL/6 mice. Cancer Res 1999; 59:4823–4822.

    CAS  PubMed  Google Scholar 

  37. Buiatti E, Palli D, Decarli A, et al. A case-control study of gastric cancer and diet in Italy, II. Association with nutrients. Int J Cancer 1990; 45:896–901.

    Article  CAS  PubMed  Google Scholar 

  38. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process. First American Cancer Society award lecture on cancer epidemiology and prevention. Cancer Res 1992; 52:6735–6740.

    CAS  PubMed  Google Scholar 

  39. Mowat C, Carswell A, Wirz, et al. Omeprazole and dietary nitrate independently affect levels of vitamin C and nitrite in gastric juice. Gastroenterology 1999; 116:813–822.

    Article  CAS  PubMed  Google Scholar 

  40. You WC, Blot WJ, Chang YS, et al. Diet and high risk stomach cancer in Shandong, China. Cancer Res 1988; 48:3518–3523.

    CAS  PubMed  Google Scholar 

  41. Steinmeitz KA, Potter JD. Vegetables, fruit and cancer prevention: a review. J Am Diet Assoc 1996; 96:1027–1039.

    Article  Google Scholar 

  42. Kobayashi M, Tsubono Y, Sasazuki S, et al. Vegetables, fruit and risk of gastric cancer in Japan: a 10 year follow-up of the JPHC Study Cohort I. Int J Cancer 2002; 102:39–44.

    Article  CAS  PubMed  Google Scholar 

  43. Serafini M, Bellocco R, Wolk A, et al. Total antioxidant potential of fruit and vegetables and risk of gastric cancer. Gastroenterology 2002; 123:985–991.

    Article  CAS  PubMed  Google Scholar 

  44. Blot WJ, Li JY, Taylor PR, et al. Nutrition intervention trial in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence and disease-specific mortality in the general population. J Natl Cancer Inst 1993; 85:1483–1492.

    Article  CAS  PubMed  Google Scholar 

  45. Drake I, Davies M, Mapstone N, et al. Ascorbic acid may protect against gastric cancer by scavenging mucosal oxygen radicals. Carcinogenesis 1996; 17:559–562.

    Article  CAS  PubMed  Google Scholar 

  46. Neugut AI, Hayek M, Howe G. Epidemiology of gastric cancer. Semin Oncol 1996; 23:281–291.

    CAS  PubMed  Google Scholar 

  47. Correa P, Fontham E, Bravo JC, et al. Chemoprevention of Gastric Dysplasia: Randomized trial of antioxidant supplements and antihelicobacter pylori therapy. J Natl Cancer Inst 2000; 92:1881–1888.

    Article  CAS  PubMed  Google Scholar 

  48. Chow W, Swanson C, Lissowska J, et al. Risk of stomach cancer in relation to consumption of cigarettes, alcohol, tea and coffee in Warsaw, Poland. Int J Cancer 1999; 81:871–876.

    Article  CAS  PubMed  Google Scholar 

  49. You W, Zhang L, Gail MH, et al. Gastric dysplasia and gastric cancer: Helicobacter pylori, serum vitamin C and other risk factors. J Natl Cancer Inst 2000; 92:1607–1612.

    Article  CAS  PubMed  Google Scholar 

  50. Mizoue T, Tokui N, Nishisaka K, et al. Prospective study on the relation of cigarette smoking with cancer of the liver and stomach in an endemic region. Int J Epidemiol 2000; 29:232–237.

    Article  CAS  PubMed  Google Scholar 

  51. Toh BH, van Driel IR, Gleeson PA. Pernicious Anemia. N Eng J Med 1997; 337:1441–1448.

    Article  CAS  Google Scholar 

  52. Hsing AW, Hansson LE, McLaughlin JK, et al. Pernicious anemia and subsequent cancer. A population-based cohort study. Cancer 1993; 71:745–750.

    Article  CAS  PubMed  Google Scholar 

  53. Balfour DC. Factors influencing the life expectancy of patients operated on for gastric surgery. Ann Surg 1922; 76:405–408.

    Article  CAS  PubMed  Google Scholar 

  54. Tersemette AC, Offerhaus GJ, Tersmette KW, et al. Meta-analysis of the risk of gastric stump cancer: Detection of high risk patients for stomach cancer after remote partial gastrectomy for benign conditions. Cancer Res 1990; 50:6486–6489.

    Google Scholar 

  55. Stalnikowicz R, Benbassat J. Risk of gastric cancer after gastric surgery for benign disorders. Arch Intern Med 1990; 150:2022–2026.

    Article  CAS  PubMed  Google Scholar 

  56. Tersmette AC, Goodman SN, Offerhaus GJA, et al. Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of post-gastrectomy patients. Am J Epidemiol 1991; 134:14–21.

    CAS  PubMed  Google Scholar 

  57. Antonioli D. Gastric carcinoma and its precursors. Monogr Pathol 1990; 31:144–180.

    PubMed  Google Scholar 

  58. Lundegardh G, Adami H-O, Helmick C, et al. Stomach cancer after partial gastrectomy for benign disease. N Engl J Med 1988; 319:195–200.

    Article  CAS  PubMed  Google Scholar 

  59. Sano C, Kumashiro R, Saito T, et al. Promoting effect of partial gastrectomy in carcinogenesis in the remnant stomach of rats after oral administration of N-methyl-N-nitrosoguanidine. Oncology 1984; 41:124–128.

    Article  CAS  PubMed  Google Scholar 

  60. Domellof L, Eriksson S, Janunger K. Carcinoma and possible precancerous changes of the gastric stump after Billroth n resection. Gastroenterology 1977; 73:462–468.

    CAS  PubMed  Google Scholar 

  61. Kondo K. Duodenogastric reflux and gastric stump carcinoma. Gastric Cancer 2002; 5:16–22.

    Article  PubMed  Google Scholar 

  62. Yamakazi, H, Oshima A, Murakami R, et al. A long-term follow-up study of patients with gastric cancer detected by mass screening. Cancer 1989; 63:613–617.

    Article  Google Scholar 

  63. Hisamichi S, Sugawara N, Fukao A. Effectiveness of gastric mass screening in Japan. Cancer Detect Prev 1988; 11:323–329.

    CAS  PubMed  Google Scholar 

  64. Inaba S, Hirayama H, Nagata C, et al. Evaluation of a screening program on reduction of gastic cancer mortality in Japan: Preliminary results from a cohort study. Prev Med 1999; 29:102–106.

    Article  CAS  PubMed  Google Scholar 

  65. Llorens P. Gastric cancer mass survey in Chile. Sem Surg Oncol 1991; 7:339–343.

    Article  CAS  Google Scholar 

  66. Pisani P, Oliver WE, Parkin DM, et al. Case-control study of gastric cancer screening in Venezuela. Br J Cancer 1994; 69:1102–1105.

    CAS  PubMed  Google Scholar 

  67. Whiting JL, Sigurdsson A, Rowlands DC, et al. The long term results of endsocopic surveillance of premaligant gastric lesions. Gut 2002; 50:378–381.

    Article  CAS  PubMed  Google Scholar 

  68. Lahner E, Caruana P, D’Ambra G, et al. First endsocopic histologic follow-up in patients with body predominant atrophic gastritis: When should it be done? Gastrointestinal Endoscopy 2001; 53:443–448.

    Article  CAS  PubMed  Google Scholar 

  69. Dinis-Ribeiro M, Lopes C, Costa-Pereira AD, et al. A follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia. J Clin Pathol 2004; 57:177–182.

    Article  CAS  PubMed  Google Scholar 

  70. Silva S, Filipe MI, Pinho. Variants of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow up study. Gut 1990; 31:1097–1104.

    Article  CAS  PubMed  Google Scholar 

  71. Sossai P, Barbazza R. Is it useful to follow-up intestinal metaplasia in the stomach? Analysis of Cost/Effectiveness. J Clin Gastroenterol 1992; 14:356–357.

    Article  CAS  PubMed  Google Scholar 

  72. Fennerty MB. Gastric Intestinal metaplasia on routine endoscopic biopsy. Gastroenterology 2003; 125:586–590.

    Article  PubMed  Google Scholar 

  73. Rokkas T, Filipe MI, Sladen GE. Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up. Gut 1991; 32:1110–1113.

    Article  CAS  PubMed  Google Scholar 

  74. Petersson F, Borch K, Franzen LE. Prevalence of subtypes of intestinal metaplasia in the general population and in patients with autoimmune chronic atrophic gastritis. Scand J Gastroenterol 2002; 37:262–266.

    Article  CAS  PubMed  Google Scholar 

  75. El-Zimaity HMT, Ramchatesingh J, Ali Saeed M, et al. Gastric intestinal metaplasia: subtypes and natural history. J Clin Pathol 2001; 54:679–683.

    CAS  PubMed  Google Scholar 

  76. Morales TG, Camargo E, Bhattacharyya A, et al. Long-term follow-up of intestinal metaplasia of the gastric cardia. Am J Gastroenterol 2000; 95:1677–1680.

    Article  CAS  PubMed  Google Scholar 

  77. Fennery MB, Sampliner RE, McGee DL, et al. Intestinal metaplasia of the stomach: identification by a selective mucosal staining technique. Gastointest Endosc 1992; 38:695–698.

    Google Scholar 

  78. Lauwers GY, Riddell RH. Gastric epithelial dysplasia. Gut 1999; 45:784–790.

    Article  CAS  PubMed  Google Scholar 

  79. Di Gregorio C, Morandi P, Fante R, et al. Gastric dysplasia. A follow-up study. Am J Gastroenterol 1993; 88:1714–1719.

    Google Scholar 

  80. Rugge M, Farinati F, Baffa R, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107:1288–1296.

    CAS  PubMed  Google Scholar 

  81. Schlemper RJ, Riddell RH, Kato Y, ete al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47:251–255.

    Article  CAS  PubMed  Google Scholar 

  82. Weinstein WM, Goldstein NL. Gastric dysplasia and its management. Gastroeneterology 1994; 107:1543–1559.

    CAS  Google Scholar 

  83. Farinati F, Rugge M, Di Mario F, et al. Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. A prospective study.Endoscopy 1993; 25:261–264.

    CAS  Google Scholar 

  84. Fertitta AM, Comin U, Terruzzi V, et al. Clinical significance of gastric dysplasia: a multicenter follow-up study. Endoscopy 1993; 25:265–268.

    CAS  PubMed  Google Scholar 

  85. Rugge M, Cassaro M, Di Mario, et al. The long term outcome of gastric non-invasive neoplasia. Gut 2003; 52:1111–1116.

    Article  CAS  PubMed  Google Scholar 

  86. Lansdown M, Quirke P, Dixon MF, et al. High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut 1990; 31: 977–983.

    Article  CAS  PubMed  Google Scholar 

  87. Stalnikowicz R, Benbassat J. Risk of gastric cancer after gastric surgery for benign disorders. Arch Intern Med 1990; 150:2022–2026.

    Article  CAS  PubMed  Google Scholar 

  88. Greene FL. Gastroscopic screening of the post-gastrectomy stomach. Relationship of dysplasia to remnant cancer. Am Surg 1989; 55:12–15.

    CAS  PubMed  Google Scholar 

  89. Greene FL. Management of gastric remnant carcinoma based on the results of a 15 year endoscopic screening program. Annals of Surgery 1996; 223:701–708.

    Article  CAS  PubMed  Google Scholar 

  90. Pointner R, Welscher G, Gadenstatter M, et al. Gastric remnant cancer has a better prognosis than primary gastric cancer. Arch Surg 1994; 126:615–619.

    Google Scholar 

  91. Lacaine F, Houry S, Huguier M. Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports. Hepatogastroenterology 1992; 39:4–8.

    CAS  PubMed  Google Scholar 

  92. Gannon CJ, Engbrecht B, Napolitano LM, et al. Gastric remnant carcinoma. Reevaluation of screening endoscopy. Surg Endosc 2001; 15:1488–1490.

    Article  CAS  PubMed  Google Scholar 

  93. Schafer LW, Larson DE, Melton LJ, et al. The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population based study in Olmsted County, Minnesota. N Engl J Med 1983; 309:1210–1213.

    Article  CAS  PubMed  Google Scholar 

  94. Ross AH, Smith MA, Anderson JR, et al. Late mortality after surgery for peptic ulcer. N Engl J Med 1982; 307:519–522.

    Article  CAS  PubMed  Google Scholar 

  95. Stockbrugger RW, Menon GG, Beilby JOW, et al. Gastroscopic screening in 80 patients with pernicious anemia. Gut 1983; 24:1141–1147.

    Article  CAS  PubMed  Google Scholar 

  96. Borch K. Epidemiologic, clinicopathologic and economic aspects of gastroscopic screening of patients with pernicious anemia. Scand J Gastroenterol 1986; 21:21–30.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA

    Omid A. Shaye MD & Andrew Ippoliti MD

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  1. Omid A. Shaye MD
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Editors and Affiliations

  1. Oregon Health and Science University, Portland, OR

    Douglas O. Faigel MD, FACG, FASGE (Associate Professor of Medicine, Director of Endoscopy) (Associate Professor of Medicine, Director of Endoscopy)

  2. Hospital of the University of Pennsylvania, Philadelphia, PA

    Michael L. Kochman MD, FACP, FASGE (Professor of Medicine and Surgery, Co-Director Gastrointestinal Oncology) (Professor of Medicine and Surgery, Co-Director Gastrointestinal Oncology)

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Shaye, O.A., Ippoliti, A. (2006). Premalignant Lesions of the Stomach. In: Faigel, D.O., Kochman, M.L. (eds) Endoscopic Oncology. Humana Press. https://doi.org/10.1007/978-1-59745-172-7_9

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