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News

Researchers find distinct etiologies of gastric cardia cancer

Combination of gastric atrophy, reflux symptoms and histological subtype indicates distinct etiologies of gastric cardia cancer, finds March's issue of Gut.

News image

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Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-esophageal reflux disease for esophageal adenocarcinoma.

The role of atrophic gastritis and gastro-esophageal reflux disease in the etiology of adenocarcinoma of the cardia remains unclear.

55% of non-cardia cancers were intestinal subtype
Gut

Professor McColl and colleagues from the United Kingdom investigated the association between adenocarcinoma of the different regions of the upper gastrointestinal tract, and atrophic gastritis and gastro-esophageal reflux disease symptoms.

The team studied 138 patients with upper GI adenocarcinoma, and age- and sex-matched controls.

Serum pepsinogen I/II was used as a marker of atrophic gastritis, and patients were categorized to 5 quintiles.

The team incorporated history of gastro-esophageal reflux disease symptoms, smoking and H pylori infection in logistic regression analysis.

Lauren classification of gastric cancer was used to subtype gastric and esophageal adenocarcinoma.

The researchers found that non-cardia cancer was associated with atrophic gastritis but not with gastro-esophageal reflux disease symptoms.

The research team noted that 55% of non-cardia cancers were intestinal subtype.

The team observed that esophageal adenocarcinoma was associated with gastro-esophageal reflux disease symptoms, but not with atrophic gastritis.

About 84% of these cancers were intestinal subtype.

Cardia cancer was positively associated with both severe gastric atrophy, and with frequent gastro-esophageal reflux disease symptoms.

Frequent gastro-esophageal reflux disease symptoms were only apparent in the non-atrophic subgroup, and in the intestinal subtype.

The team found the association of cardia cancer with atrophy was stronger for the diffuse versus intestinal subtype.

The research team noted that this was the converse of the association observed with non-cardia cancer.

Professor McColl's team concluded, "These findings indicate 2 distinct etiologies of cardia cancer."

"One arises from severe atrophic gastritis, and of intestinal or diffuse subtype similar to non-cardia cancer."

"The other is related to gastro-esophageal reflux disease and intestinal in subtype, similar to esophageal adenocarcinoma."

"Gastric atrophy, gastro-esophageal reflux disease symptoms and histological subtype may distinguish between gastric versus esophageal origin of cardia cancer."

Gut 2008: 57(3): 298-305
18 February 2008

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