Screening &early Screening &early detection of detection of

gastric cancersgastric cancers

Prepared by Rasha MahmoudRasha Mahmoud

Faculty of medicine –Benha university

Epidemiology Epidemiology &incidence&incidence

Gastric cancer remains the second leading cause of cancer death worldwide.

It is more common in Japan, China, Japan, China, and South and Central America and South and Central America..

It is adisease of elderly and more It is adisease of elderly and more in male(2:1)in male(2:1)

In EgyptIn Egypt:Gastric tumors formed 2.12% of the total malignancy and 14.72 of all digestive system tumors

Adenocarcinoma was the most common type(Mokhtar,etal,2007)

What are the risk factors for stomach

cancer?

11--Helicobacter pylori infectionHelicobacter pylori infection..22 - -Age&SexAge&Sex..

33 - -DietDiet..44 - -Tobacco useTobacco use..

55--ObesityObesity..66 - -Previous stomach surgeryPrevious stomach surgery..

7 -Menetrier disease (hypertrophic gastropathy

88--Hereditary gastric cancerHereditary gastric cancer..88 - -Pernicious anemiaPernicious anemia..

99 - -Some types of stomach polypsSome types of stomach polyps . . 1010 - -Epstein-Barr virus infectionEpstein-Barr virus infection . .

1111--Occuptional exposureOccuptional exposure..

Helicobacter pylori infection&Gastric Helicobacter pylori infection&Gastric cancerscancers:

Long-term infection of the stomach

chronic atrophic gastritis pre-cancerous lesions(Intestinal metaplasia& dysplasia)

Gastric carcinomaH pylori infection is also linked to MALT

lymphoma of the stomach .

Diet &gastric cancersDiet &gastric cancersSmoked foods, salted fish and meat .

Nitrates and nitrites are substances commonly found in cured meats .

On the other hand, eating fresh fruits and vegetables that contain antioxidants appears to lower the risk of stomach cancer.

Tobacco useTobacco use::Smoking increases stomach cancer risk, particularly for cancers of the upper portion of the stomach.

ObesityObesity::

Being very overweight or obese is a possible cause of cancers of

the cardia.

Previous stomach surgeryPrevious stomach surgery::As partial gastrectomy;

more nitrite-producing bacteria to be present &

Less acid production &

may be reflux (backup) of bile from the small intestine into

the stomach .

Inherited cancer syndromes:

11 - -Familial adenomatous polyposis (FAPFamilial adenomatous polyposis (FAP):):. People . People with this syndrome are at greatly increased risk of with this syndrome are at greatly increased risk of getting colorectal cancer and have a slightly getting colorectal cancer and have a slightly increased risk of getting stomach cancer. It is increased risk of getting stomach cancer. It is

caused by mutations in the gene caused by mutations in the gene APCAPC..

22--Hereditary non-polyposis colorectal cancerHereditary non-polyposis colorectal cancer::. In . In most cases, this disorder is caused by a defect in most cases, this disorder is caused by a defect in either the gene either the gene MLH1MLH1 or the gene or the gene MSH2MSH2, but at least , but at least 5 other genes can cause HNPCC: 5 other genes can cause HNPCC: MLH3MLH3, , MSH6MSH6, , TGBR2TGBR2, , PMS1PMS1, and , and PMS2PMS2..

33--Hereditary diffuse gastric cancerHereditary diffuse gastric cancer:: This condition This condition is quite rare, but the lifetime stomach cancer risk is quite rare, but the lifetime stomach cancer risk

among affected people is about 70% to 80%among affected people is about 70% to 80% . .

44--BRCA1 and BRCA2 mutationsBRCA1 and BRCA2 mutations..

Stomach polyps and gastric cancers

Most types of polyps (such as hyperplastic polyps or inflammatory polyps) do not seem to increase a person's risk of stomach cancer, but adenomatous polyps( adenomas) can sometimes develop into cancer..

Occupational exposure and Occupational exposure and gastric cancergastric cancer::

Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer.

Signs and symptoms Signs and symptoms of stomach cancersof stomach cancers::

1-Poor appetite2-Weight loss

3-Abdominal (belly) pain4-Vague discomfort in the abdomen

5-A sense of fullness in the upper abdomen after eating a small meal

6-Heartburn, indigestion, or ulcer-type symptoms

7-Nausea8-Vomiting, with or without blood9-Swelling or fluid build-up in the

abdomen

Early detection Early detection &Screening&Screening

IndicationsIndications::1 -In patients suffering from

dyspepsia not responding to antacid drugs.

2-In patients with any of the risk factors e.g. Helicobacter infection.

3 -In countries with increased incidence e.g. Japan

MethodsOnly systematic mass systematic mass screening by endoscopyscreening by endoscopy as practiced in Japan and Korea has been shown to improve early

detection .

Advantages of early Advantages of early detectiondetectionGastric cancers are tumors of bad prognosis

,if diagnosed at an early stage,they can be curedIn the absence of screening, patients present with advanced disease, and prognosis is poor

But it can be cured if diagnosed at an early stage .

In the absence of screening, patients present with advanced

disease, and prognosis is poor .

Screening &early detection

Early diagnosis

Good eradication & treatment

Good prognosis and survival

PU.1 is a member of the Ets (E-twenty six) family of transcription factors and plays critical roles in the development of hemaopoietic cells such as macrophages and B cells

.Some studies revealed that in contrast to nodular lymphovyte predominant Hodgkin"lymphoma, Pu1 is consistently absent in all cases of classic Hodgkin" lymphoma

Lymphomas (Hodgkin and non-Hodgkin) are common malignancies seen in our practice. So we wanted to test the utility of Fascin and PU.1 in distinguishing between Hodgkin lymphomas and morphologically closely related forms of non-Hodgkin lymphomas such as diffuse large B cell lymphoma and anaplastic large cell lymphoma in difficult cases. If found useful, these antibodies could help in reaching a correct diagnosis in difficult cases and allow appropriate patient management.

Aim of the Work

1-Histopatholgical study of Hodgkin , anaplastic large, and diffuse large B- cell lymphomas.

2-Immunohistochemical study of Fascin expression in Hodgkin, anaplastic large, and diffuse large B-cell lymphomas.

3-Immunohistochemical study of PU.1 expression in Hodgkin, anaplastic large, and diffuse large B-cell lymphomas

4-Showing to what extent Fascin and PU.1 can be used in the differential diagnosis between Hodgkin lymphomas and non Hodgkin lymphomas.

Materials and Methods

This retrospective study is carried upon different types of lymphoid neoplastic lesions.The material include consecutive archival formalin-fixed paraffin-embedded blocks of lymph nodes and available decalcified bone marrow biopsies processed during the years 2007 to 2010. These blocks were obtained from the departments of Pathology of faculty of medicine ,Banha university and International Medical Center. From each block several adjacent sections

were prepared and stained by :

1- The Hematoxylin and Eosin for histopathological study.

2-Routinly used Immunohistochemical staining panel using antibodies against CD45, kappa & lamda light chains, CD30, CD15, CD20, CD79a and CD3 to establish clonality, differerentiate Hodgkin from non Hodgkin lymphomas and for subtyping .

3- Fascin using Immunohistochemical staining.

4-PU.1 using Immunohistochemical staining .