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THE INTESTINAL TYPE OF THE STOMACH CANCER: HIGH RISK GROUP OF IT’S DEVELOPMENT

THE INTESTINAL TYPE OF THE STOMACH CANCER: HIGH RISK GROUP OF IT’S DEVELOPMENT
Anna Donscaia, doctor of medicine, associate professor

Lorena Mednicov, ph.d. of medicine

National Oncologic Institute, Moldova

Ion Mereutsa, doctor of medicine, full professor

Nicolae Ghidirim, doctor of medicine, full professor

Nicolae Testemitanu State University of Medicine and Pharmacy, Moldova

Conference participant

Stomach cancer represents a serious health problem worldwide. It is the second leading cause of cancer – related death.

From 1965 (Lauren) stomach cancer has been divided in two types: intestinal and diffuse. The first type is associated with Helicobacter pylori (H.p.) contamination and mucous membrane modifications.

The main goal of this study was to elaborate the criterions for high risk group in intestinal type stomach cancer developing.

The H.p. contamination, H.p antibodies level and mucous membrane state have been studied in 113 patients with chronic stomach diseases and 96 stomach cancer patients.

 H.p. contamination was confirmed in 61, 8% patients with chronical stomach diseases. In stomach cancer patient’s earlier H.p. contamination was confirmed with H.p. antibodies presence. Lack of modifications in mucous membrane has been observed  in 11,1% in patients with H.p. contamination.

Mucous membrane modifications out of the tumor have been observed In 87, 5% cases of intestinal type and in 23,6% cases of diffuse gastric cancer type (p<0,001).

H.p. contamination and mucous membrane modifications are the criterions of high risk intestinal type cancer developing in chronical atrophy gastritis patients.

KeywordsStomach cancer, intestinal type, high risk groups in developing.

 

Stomach cancer represents a serious health problem worldwide. In spite of decreasing incidence level in the developed countries, it remains too high in some regions, such as Eastern Europe, inclusive, in Moldova Republic.

Stomach cancer is the second leading cause of cancer-related death worldwide.

Lauren [1] has divided stomach cancer into types: intestinal type and diffuse type. New multicenter investigations "The Cancer Genome Atlas Project" (2010-2014) allow researchers to elaborate a molecular classification, dividing stomach cancer into four subtypes: tumors positive for Epstein-Barr virus; genomic stable tumors; microsatellite unstable tumors and tumors with chromosomal instability. [5]

The well-known Lauren’s types differ essential in their clinical characteristics, histological data and presention of the preceded diseases such as atrophic gastritis, which evaluate from intestinal metaplastic to severe dysplastic modifications, after all to cancer.

The scientific researches of the pathogenesis ways in diffuse and intestinal type’s stomach cancer developing have been demonstrated different expression of the adhesive molecules, apoptosis p 53 protein and other markers. These data confirms the phenotype differences in stomach cancer types.

The intestinal type of stomach cancer is developing on chronically stomach lesions. It’s well known that the inflammatory modifications of the mucous membrane stimulated the cell mitosis activity, but permanent stimulation results in atrophy modifications.

Data on stomach canceration in intestinal type have corroborated that this type of stomach cancer is developing durable and depends on a lot of factors [6]. The modification of mucous membrane started from active gastritis, to chronical atrophy gastritis with intestinal metaplasy. When severe dysplasia modifications are observed, the possibility of cancer developing is increasing considerably.

The intestinal type of stomach cancer is often registered in old patients, its evolution is lengthy and in majority cases the preceding chronical diseases have been mentioned.

The histopathology data presented the high differentiated adenocarcinom.

Data from a number of studies have demonstrated an increased likelihood of Helicobacter pylori infection [3, 4]

Helicobacter pylori has been registered by International Agency of Cancer Research as a cancerigen factor, class I H.p. contamination has been registered worldwide, in special, in middle and low developed countries.

H.p. contamination and stomach mucous membrane modifications are well-documented factors that result in of stomach cancer developing starting [6].

So, the particularities of the intestinal type of stomach cancer: its lengthy developing, the H.p contamination role and mucous membrane modifications make us to elaborate criterions of high risk group in stomach cancer developing. 

Methods. Study is based on data from 209 patients: 113 patients with chronical stomach diseases and 96 stomach cancer patients. It is a retrospective non-randomized, two centers study. Data collection was performed at the gastrological department of National Oncologic Institute, Moldova Republic and from Medical Diagnostic Center. Patients with chronical stomach diseases have been investigated for mucous membrane status appreciation, H.p. contamination.

Results and discussion

Data from a number of studies have demonstrated an increased likelihood of Helicobacter pillory infection in patients with stomach cancer [3,4].

Helicobacter pillory has been registered by International Agency of Cancer Study as a cancerigen factor class I, so the role of H.p. in stomach cancer pathogenesis was confirmed.

We started from H.p. contamination study in some chronical gastric diseases in comparation with stomach cancer patients. The tests on H.p. antibodies were performed only in stomach cancer patients.

Our data on H.p. contamination in chronic stomach diseases patients are presented in table 1.

Table 1.

The H.p. contamination level in chronic stomach diseases patients

Pathology of stomach

Total

H.p.

positive

negative

Chronic atrophy gastritis

34

21

13

Stomach ulcer

71

36

35

Stomach polyps

8

3

5

Stomach cancer

96

40

56

 

209

100

109

The obtained data denote H.p. contamination in 61,8% patients with chronic atrophy gastritis. Test on H.p. antibodies was positive in 83,2% cases of stomach cancer patients. These data confirm H.p. contamination earlier presence. The data on stomach mucous membrane modifications in stomach chronic diseases patients and stomach cancer patients are presented in tables 2, 3.

Table 2.

The mucous membrane modifications in stomach chronic diseases patients

Cytological data

Total

Test la H.p.

positive

negative

Lack of modifications

72

8

64

Intestinal metaplastic modifications

12

9

3

Dysplastic modifications

8

5

3

Hyperplastic modifications

21

11

10

 

113

33

80

 

Table 3.

The mucous membrane modifications in stomach cancer patients out of tumor

Modifications

Total

Cancer type

intestinal

diffuse

Lack of mucous membrane modifications

32

6

26

Intestinal metaplastic modifications

44

42

2

Dysplastic modifications

20

14

6

 

96

62

34

 

The obtained data have demonstrated that the intestinal type of the stomach cancer is associated with H.p. contamination and mucous membrane modifications out of tumor in 87, 5% cases, when in diffuse type modifications in mucous membrane out of tumors have been registered only in 23, 6% cases (p<0,001).

Received results saved a base for high stomach cancer risk developing criterions elaboration.

The elaborated criterions of high risk stomach developing were:

  • 1.    Chronical atrophy gastritis.
  • 2.    H.p. contamination presence.
  • 3.    Stomach mucous membrane modifications such as dysplastic modification.

The algorithm of high risk patient’s investigations included endoscopy control with biopsy annually, H.p. contaminations study as well, by cytology methods as by H.p. antibodies test.

Conclusions:

In summary, intestinal type of stomach cancer develops on mucous membrane modifications from chronic atrophy gastritis through intestinal metaplastic and dysplastic modifications. The H.p. contamination is one of the risk factors that lead to mucous membrane atrophy and following modifications.

Therefore we have elaborated the monitoring algorithm of patients with chronic atrophy gastritis. This algorithm will result in increasing stomach cancer patient’s early diagnostics.

 

References:

  • 1. Lauren. The two histological main types of gastric carcinoma: diffuse and so-called intestinal type carcinoma. Acta Pathol, microbial. Scand., 64 1965, pp. 31-49.
  • 2. WHO Classification of Tumors of the Digestive System. 4 edt. IARC, 2010.
  • 3. Uemura N. et al Helicobacter Pylori infection and the development of gastric cancer N.Engl.  I med, 345, 2001, pp. 784-789.
  • 4. Masci E., Viale E., Freschi M. et. al. Precancerous gastric lesions and H.p. Hepatogastrology, 2001; 115; 780-782.
  • 5. Comprehensive molecular characterization of gastric adenocarcinoma. The Cancer Genome Atlas Research Network Nature. 513, 2014, pp. 202-209.
  • 6. Correa P. Human gastric cancer genesis a multifactorial process. – Cancer Res., 1992, 52, 6735-6740. 
Comments: 4

Tegza Alexandra

Уважаемые авторы, доктор Анна Донская, доктор Мереуца Ион доктор Николай Гидирим и Рh.D. медицинских наук Лорена Медников, dами проведены актуальные исследования по разработке критериев для группы высокого риска развития кишечного типа рака желудка. Фундаментальные исследования требуют поистине колоссальных вложений сил и времени!! Желаю Вам успехов, значимых результатов, которые послужат основой для дальнейших исследований в области онкологии. С уважением профессор Александра Тегза

Anna Donscaia

Хотелось бы поблагодарить ув.госпожу Григоренко и ув. госпожу Вачева за комментарии к нашей статье

Vacheva Danelina

Уважаемые Коллеги, я прочитала с интересом Вашей статья. Разработанный Вами алгоритм для отслеживания пациентов с хроническим гастритом имеет большое практическое значение для ранней диагностики рака желудка. Я желаю успехов в Ваших будущих клинических испытаний, чтобы помочь пациентам. доц. Д. Вачева

Hryhorenko Liubov Victorovna

Шановна пані Анна та співавтори! Ваша доповідь є інноваційною у галузі онкології. У чому полягає розроблений Вами алгоритм виявлення на ранніх стадіях кишкової форми раку шлунку? В роботі представлені лише результати обєктивного дослідження. Чим саме Ваш алгоритм відрізняється від існуючих чинних офіційних стандартів ранньої діагностики цієї патології? Яке Ви плануєте впровадження на державному рівні? З повагою, Григоренко Любов)
Comments: 4

Tegza Alexandra

Уважаемые авторы, доктор Анна Донская, доктор Мереуца Ион доктор Николай Гидирим и Рh.D. медицинских наук Лорена Медников, dами проведены актуальные исследования по разработке критериев для группы высокого риска развития кишечного типа рака желудка. Фундаментальные исследования требуют поистине колоссальных вложений сил и времени!! Желаю Вам успехов, значимых результатов, которые послужат основой для дальнейших исследований в области онкологии. С уважением профессор Александра Тегза

Anna Donscaia

Хотелось бы поблагодарить ув.госпожу Григоренко и ув. госпожу Вачева за комментарии к нашей статье

Vacheva Danelina

Уважаемые Коллеги, я прочитала с интересом Вашей статья. Разработанный Вами алгоритм для отслеживания пациентов с хроническим гастритом имеет большое практическое значение для ранней диагностики рака желудка. Я желаю успехов в Ваших будущих клинических испытаний, чтобы помочь пациентам. доц. Д. Вачева

Hryhorenko Liubov Victorovna

Шановна пані Анна та співавтори! Ваша доповідь є інноваційною у галузі онкології. У чому полягає розроблений Вами алгоритм виявлення на ранніх стадіях кишкової форми раку шлунку? В роботі представлені лише результати обєктивного дослідження. Чим саме Ваш алгоритм відрізняється від існуючих чинних офіційних стандартів ранньої діагностики цієї патології? Яке Ви плануєте впровадження на державному рівні? З повагою, Григоренко Любов)
PARTNERS
 
 
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