Download What are the risk factors for stomach cancer?

Screening &early detection of
gastric cancers
Prepared by
Rasha Mahmoud
Faculty of medicine –Benha university
Epidemiology &incidence
Gastric cancer remains the second leading
cause of cancer death worldwide.
It is more common in Japan, China, and
South and Central America.
It is adisease of elderly and more in
male(2:1)
In Egypt:
Gastric tumors formed 2.12% of the
total malignancy and 14.72 of all
digestive system tumors
Adenocarcinoma was the most
common type(Mokhtar,etal,2007)
What are the risk factors for
stomach cancer?
1-Helicobacter pylori infection.
2- Age&Sex.
3- Diet.
4- Tobacco use.
5-Obesity.
6- Previous stomach surgery.
7- Menetrier disease (hypertrophic gastropathy
8-Hereditary gastric cancer.
8- Pernicious anemia.
9- Some types of stomach polyps .
10- Epstein-Barr virus infection.
11-Occuptional exposure.
Helicobacter pylori infection&Gastric cancers:
Long-term infection of the stomach
chronic atrophic gastritis
pre-cancerous lesions(Intestinal metaplasia&
dysplasia)
Gastric carcinoma
H pylori infection is also linked to MALT lymphoma of the
stomach.
Diet &gastric cancers
Smoked foods, salted fish and meat.
Nitrates and nitrites are substances
commonly found in cured meats.
On the other hand, eating fresh fruits and
vegetables that contain antioxidants
appears to lower the risk of stomach
cancer.
Tobacco use:
Smoking increases stomach cancer risk,
particularly for cancers of the upper
portion of the stomach.
Obesity:
Being very overweight or obese is a
possible cause of cancers of the cardia.
Previous stomach surgery:
As partial gastrectomy;
more nitrite-producing bacteria to be
present
&
Less acid production
&
may be reflux (backup) of bile from the
small intestine into the stomach.
Inherited cancer syndromes:
1- Familial adenomatous polyposis (FAP):. People with this
syndrome are at greatly increased risk of getting colorectal
cancer and have a slightly increased risk of getting stomach
cancer. It is caused by mutations in the gene APC.
2-Hereditary non-polyposis colorectal cancer:. In most cases,
this disorder is caused by a defect in either the gene MLH1 or
the gene MSH2, but at least 5 other genes can cause HNPCC:
MLH3, MSH6, TGBR2, PMS1, and PMS2.
3-Hereditary diffuse gastric cancer: This condition is quite rare,
but the lifetime stomach cancer risk among affected people is
about 70% to 80%.
4-BRCA1 and BRCA2 mutations.
Stomach polyps and gastric cancers
Most types of polyps (such as hyperplastic
polyps or inflammatory polyps) do not
seem to increase a person's risk of
stomach cancer, but adenomatous polyps(
adenomas) can sometimes develop into
cancer.
.
Occupational exposure and gastric
cancer:
Workers in the coal, metal, and rubber
industries seem to have a higher risk
of getting stomach cancer.
Signs and symptoms of
stomach cancers:
1-Poor appetite
2-Weight loss
3-Abdominal (belly) pain
4-Vague discomfort in the abdomen
5-A sense of fullness in the upper abdomen
after eating a small meal
6-Heartburn, indigestion, or ulcer-type
symptoms
7-Nausea
8-Vomiting, with or without blood
9-Swelling or fluid build-up in the abdomen
Early detection &Screening
Indications:
1- In patients suffering from dyspepsia
not responding to antacid drugs.
2-In patients with any of the risk
factors e.g. Helicobacter infection.
3- In countries with increased
incidence e.g. Japan
Methods
Only systematic mass screening by
endoscopy as practiced in Japan and
Korea has been shown to improve early
detection.
Advantages of early
detection
Gastric cancers are tumors
of bad prognosis
,if diagnosed at an early
stage,they can be cured
In the absence of screening, patients
present with advanced disease, and
prognosis is poor
But it can be cured if diagnosed at an
early stage.

In the absence of screening, patients
present with advanced disease, and
prognosis is poor.

Screening &early detection
Early diagnosis
Good eradication & treatment
Good prognosis and survival
PU.1 is a member of the Ets (E-twenty six)
family of transcription factors and plays
critical roles in the development of
hemaopoietic cells such as macrophages
and B cells
. Some studies revealed that in contrast to
nodular lymphovyte predominant
Hodgkin"lymphoma, Pu1 is consistently
absent in all cases of classic Hodgkin"
lymphoma

Lymphomas (Hodgkin and non-Hodgkin) are
common malignancies seen in our practice. So
we wanted to test the utility of Fascin and PU.1
in distinguishing between Hodgkin lymphomas
and morphologically closely related forms of
non-Hodgkin lymphomas such as diffuse large B
cell lymphoma and anaplastic large cell
lymphoma in difficult cases. If found useful, these
antibodies could help in reaching a correct
diagnosis in difficult cases and allow appropriate
patient management.
Aim of the Work
1-Histopatholgical study of Hodgkin , anaplastic
large, and diffuse large B- cell lymphomas.
2-Immunohistochemical study of Fascin
expression in Hodgkin, anaplastic large, and
diffuse large B-cell lymphomas.
3-Immunohistochemical study of PU.1 expression
in Hodgkin, anaplastic large, and diffuse large
B-cell lymphomas
4-Showing to what extent Fascin and PU.1 can be
used in the differential diagnosis between
Hodgkin lymphomas and non Hodgkin
lymphomas.
Materials and Methods
This retrospective study is carried upon 
different types of lymphoid neoplastic
lesions.The material include consecutive
archival formalin-fixed paraffin-embedded blocks
of lymph nodes and available decalcified bone
marrow biopsies processed during the years
2007 to 2010. These blocks were obtained from
the departments of Pathology of faculty of
medicine ,Banha university and International
Medical Center. From each block several
adjacent sections were prepared and stained
by:
1- The Hematoxylin and Eosin for
histopathological study.
2-Routinly used Immunohistochemical staining
panel using antibodies against CD45, kappa &
lamda light chains, CD30, CD15, CD20, CD79a
and CD3 to establish clonality, differerentiate
Hodgkin from non Hodgkin lymphomas and for
subtyping .
3- Fascin using Immunohistochemical staining.
4-PU.1 using Immunohistochemical staining .