Gastric Cancer

  • J. S. Macdonald


Stomach cancer represents a challenging problem in oncology. In 2001 [1], 21,700 people in the United States will develop gastric cancer, and 13,500 will die of this disease. Worldwide it is estimated that 798,000 [2] cases of stomach cancer will occur, making this disease a major international cause of morbidity and mortality. As we enter a new century, it is instructive to look at the history of gastric carcinoma in the 20th century. In the United States, adenocarcinoma of the stomach was the most common cause of cancer-related deaths in 1900 [3] and fell dramatically in the latter half of the century [3]. The gastric cancer incidence rate of roughly 35 per 100,000 in 1930 fell to approximately 3 per 100,000 in the US in the 1970s [4]. There has been no adequate explanation for this change. It is of interest that the fall in gastric cancer has occurred in the socalled endemic or intestinal form [5] of the disease that is usually associated with preexisting intestinal metaplasia. This is the form of gastric cancer seen in high-incidence countries and appears to result from a combination of achlorhydria, migration of small intestinal epithelium into the stomach resulting in intestinal metaplasia, and superinfection with Helicobacter pylori [6]. This combination over time results in chronic gastritis with dysplastic changes and finally the development of the intestinal variant of adenocarcinoma of the stomach, the form of gastric cancer that has decreased significantly in incidence in the United States over the last 70 years.


Gastric Cancer Clin Oncol Gastric Carcinoma Advanced Gastric Cancer Intestinal Metaplasia 
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© Springer-Verlag Berlin Heidelberg 2003

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  • J. S. Macdonald

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