3 Clearly, Japan’s earlier stage of diagnosis and superior 5-year survival highlight the need for earlier recognition and treatment to overcome this bleak prognosis. 3 6 The UK all-stage average 5-year survival rate is 18%, compared with an 80% average 5-year survival for stage 1A. 1–3 Importantly, with the exception of Japan and South Korea, the majority of gastric cancers worldwide are diagnosed at a late stage, resulting in poor prognosis with a 29% average 5-year survival. At present within the UK, gastric cancer is the 16th most common cancer, within Europe it is the sixth most common cancer, and worldwide it is the fifth most common.
4 5 These studies may suggest that historically declining gastric adenocarcinoma incidence rates may alter. Although there has been a decline in the incidence over the past 50 years, studies have demonstrated an increasing incidence of gastric adenocarcinoma among young white people in the USA, alongside a Swedish study demonstrating an increasing incidence of premalignant gastric lesions among adults aged 35–44 years. 1–3 In the UK in 2016, there were 5314 cases of gastric cancer, which has been declining gradually with the incidence of H. pylori infection. Gastric adenocarcinoma is a major cause of cancer mortality worldwide.
DR MATTHEW BANKS GASTROENTEROLOGIST SERIES
We followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Ī series of statements, recommendations and suggestions are proposed to ensure that there is consistency of practice, such that patients with gastric premalignant and early gastric malignant lesions are provided with optimal care. The target users include gastroenterologists, GI surgeons, pathologists, endoscopists and general practitioners. The principal patient group are those found to have GA, GIM, gastric epithelial dysplasia or early gastric adenocarcinoma limited to the mucosal or superficial submucosal layers. The British Society of Gastroenterology (BSG) endoscopy committee agreed to create a guideline to provide statements and recommendations on the prevalence, risks, diagnosis, treatment, surveillance and screening of gastric premalignant and early gastric malignant lesions. The key to having a significant impact on the prognosis of gastric adenocarcinoma and its economic burden is to accurately identify individuals at greatest risk and intervene with recognised efficacious treatments, including endoscopic resection, before cancer is established. These conditions are principally caused by Helicobacter pylori infection and less commonly by autoimmune gastritis. The most common stages in the progression to gastric adenocarcinoma are gastric atrophy (GA) and gastric intestinal metaplasia (GIM), which are collectively known as chronic atrophic gastritis (CAG). Gastric adenocarcinoma continues to be a frequent cause of death in the world and is the 16th most common cancer in the UK. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM.
DR MATTHEW BANKS GASTROENTEROLOGIST FULL
High-quality endoscopy with full mucosal visualisation is an important part of improving early detection.
However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. Risk factors include Helicobacter pylori infection, family history of gastric cancer-in particular, hereditary diffuse gastric cancer and pernicious anaemia. Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis.
0 kommentar(er)
