Gastric cancer, screening possibilities and proposals for endoscopic and histologic follow-up of premalignant gastric lesions

Gastric cancer is the second largest cause of cancer related deaths worldwide. Gastric cancer is the sixth most common cancer in Slovenia. The known risk factors for gastric cancer are: Helicobacter pylori infection (H. pylori), E-catherin mutation, proinflammatory cytokine polymorphisms, certain foods (salt, nitrosamine, antioxidants), pernicious anemia, 20 years post gastric partial resection, gastric adenoma and hamartoma, male sex and smoking. From 65% to 80% of noncardia gastric cancer are late consequences of H. pylori infection. Half of the World population is infected with H. pylori, but only 1% will develop gastric cancer. Last year, Asian Pacific Cancer Concensus Conference recommended population-based screening and treatment of H. pylori infection in countries with gastric cancer incidence more than 20/100 000. Untill this approach becomes a part of daily clinical practice, endoscopic and histologic surveillance should be done in all patients with premalignant gastric lesions (atrophy, intestinal metaplasia and dysplasia). Histologic caracteristics and recommendations for endoscopic and histologic surveillance are presented.