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gastric carcinoma

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This is a very important tumour because it is associated with high mortality (1,2)

In the UK:

  • stomach cancer patients with a known stage are most commonly diagnosed at stage IV (46-57%).
  • more patients with a known stage are diagnosed at a late stage (69-75% are diagnosed at stage III or IV), than an early stage (25-31% are diagnosed at stage I or II)
  • stomach cancer incidence is strongly related to age, with the highest incidence rates being in older people. In the UK in 2013-2015, on average each year around half (51%) of new cases were in people aged 75 and over
  • age-specific incidence rates rise steadily from around age 45-49 and more steeply from around age 65-69
    • highest rates are in the 85 to 89 age group for males and females
  • incidence rates are significantly higher in males than females in a number of (mainly older) age groups. The gap is widest at age 65 to 69, when the age-specific incidence rate is 2.6 times higher in males than females
  • 50% reduction in stomach cancer incidence rates since the early 1990s
  • accounts for 2% of total cancer cases
  • trends in the incidence and mortality of stomach cancer show a decline in many countries including the UK. The UK age-standardised incidence rate for stomach cancer has steadily decreased since the early 1990s, from 23.4 per 100,000 in 1993 to 10.3 per 100,000 in 2017 (3,4)

Fortunately, it is becoming less common.

Gastric adenocarcinoma is particularly common in Japan, the Scandinavian countries, and Iceland.

There are a number of factors which are known to increase the risk of developing stomach cancer.

The presence of the bacterium Heliobactor pylori (H.pylori) has been identified as the most important risk for developing stomach cancer (5)

  • the chronic inflammation in the stomach due to the presence of H.pylori induces cell changes in the stomach mucosa; a precursor to the development of the condition. Diagnosis and treatment of people with H.pylori since the 1990’s is thought to beinstrumental in an overall decline in the incidence of stomach cancer seen in many countries including the UK (5)
  • other important population characteristics that increase the risk of gastric adenocarcinoma are age, sex, social deprivation and ethnic origin. Incidence rates rise steadily from around age 45-49 years with the highest rates in the 85 to 89 age group(3)
  • males have a higher incidence of gastric adenocarcinoma than females accounting for 65% of all new cases in the UK(3). Incidence rates in males are 86% higher and in females 93% higher in the most deprived areas compared with the least deprived (3)

A report by the National Cancer Intelligence Network in 2009 reported that people of Caucasian ethnicity were more likely to develop stomach cancer compared to people of Asian origin but less likely to develop the condition than those of a Black African or Caribbean origin (6)

  • the International Agency for Research on Cancer (IARC) have listed the particular environmental factors where there is convincing evidence that exposure increases the risk of developing gastric adenocarcinoma (7)
    • these include tobacco smoking, obesity, occupations involving rubber production and exposure to X-radiation or gamma radiation. Environmental factors with limited or probable evidence of increasing the risk of gastric adenocarcinoma include; asbestos; Epstein-Barr virus (a common virus in humans also known as glandular fever); inorganic lead compounds; nitrate or nitrite; traditional Asian pickled vegetables; processed meat; alcohol; and foods preserved by salting.

Notes (1)

  • there are around 13,000 new cases of oesophago-gastric cancer diagnosed in England each year
    • mortality rates are high, with over 10,000 deaths annually, and over the last 30 years the incidence of these cancers has continued to increase

Reference:

  • NICE (January 2018). Oesophago-gastric cancer: assessment and management in adults
  • CRUK. Stomach cancer statistics (Accessed 29/5/19)
  • Bray F, Ferlay J Soerjomataram I, Siegel R, Torre L, Jemel A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries Cancer J Clin. 2018; 68:394-424
  • Mukaisho K, Nakayama T, Hagiwara T, Hattori T and Sugihara H. Two distinct etiologies of gastric cardia adenocarcinoma: interactions among pH, Helicobacter pylori, and bile acids. Front. Microbiol. 2015: 6:412.
  • Amiri M, Janssen F, Kunst A, The decline in stomach cancer mortality: exploration of future Eur J Epidemiol 2011: 26:23–28.
  • National Cancer Intelligence Network. Cancer incidence and survival by major ethnic group, England, 2002 – 2006. 2009; London UK.
  • IARC.  Monographs on the Identification of Carcinogenic Hazards to Humans; Agents Classified by the IARC Monographs, Volumes 1–127 https://monographs.iarc.fr/agents-classified-by-the-iarc/ June 2020. Accessed August 2020.

Last edited 11/2020

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