Precancerous Lesions of Stomach
- Written by Los Angeles Colonoscopy
Pre-Malignant Conditions of Stomach in High Risk Population
Stomach cancer is the second most frequent cancer worldwide. For example, according to one survey, among all cancers affecting Koreans, nearly 1/4 of all cancers are due to stomach cancer. In fact, the overall life-time risk of developing stomach cancer for Koreans is thought to be as high as 6-7%. Recent change in diet, improvement in hygiene, and the treatment of Helicobacter pylori infection are expected to reduce the overall incidence of stomach cancer. However, despite rapid advances in modern medicine, 7 out of 10 individuals diagnosed with stomach cancer still do not survive beyond 5 years, as most cancers are diagnosed at a relatively late stage. Thus, early diagnosis of stomach cancer remains urgent health issue for those affected.
The gold standard in the diagnosis of stomach cancer remains the upper endoscopy examination. It allows a complete visual evaluation of the inner lining of stomach. If necessary, endoscopy also permits biopsy study for further evaluation of the stomach lining under the scrutiny of microscope. In cases where the diagnosis of stomach cancer is excluded by a so-called a normal upper endoscopy examination, the risk of eventual development of cancer may not be entirely excluded. In fact, there are certain distinct but subtle endoscopic features or findings that would prompt endoscopist to take biopsy samples, even if a frank cancer is not suspected. When these biopsy specimen do reveal pre-malignant microscopic feastures such as atrophic gastritis and intestinal metaplasia, a careful follow-up becomes paramount, particularlly in high risk individuals.The finding of gastric intestinal metaplasia indicate that the gastric lining has undergone transformation from normal gastric cell type to those that resemble "intestine." This finding of intestinal metaplasia from the biopsy of gastric lining indicates an increased potential for eventually developing stomach cancer in affected individuals. In fact, according to one study, the risk of developing stomach cancer in patients with intestinal metaplasia may be as high as 0.5% to 1.0% per year among the high risk population. The finding of dysplasia portend even higher risk of eventually developing stomach cancer.
In general, because of the potential risk of developing stomach cancer, individuals of high-risk ethnic background are advised to undergo biennial endoscopic surveillance starting at the age of 40. For patients with the endoscopic finding of pre-malignant condtions, such as intestinal metaplasia of stomach, decreasing this interval to yearly frequency may be advisable. When more ominous findings such as dysplasia is detected, even more frequent follow-up examination may be necessary. A careful endoscopic follow-up evaluation is expected to help establish the diagnosis of stomach cancer at an earlier stage, and help extend the lives of those who are unfortunately affected by this deadly disease.