Early clinical and pathophysiological manifestations of gastric cancer at the outpatient clinic stage (The “RADIUS” study)

Objective. To study the early clinical and pathophysiological manifestations of gastric cancer in the outpatient phasefor early diagnosis disease.
Methods. A total of 300 outpatient cards of patients treated in Smolensk Oncology Hospital with gastric cancer were analyzed during 2016-2019. Data collection included filling out a questionnaire consisting of 32 questions aimed at clarifying demographic data, diagnosing the symptoms of the disease and their duration, identifying the warning signs, precancerous lesion of the gastric mucosa, previous diagnosis and treatment of H. pylori. The study included patients with gastric cancer aged 31 to 88 years. The mean age of patients was 65.12±9.92 years, the median age was 65.5 years. Among 300 patients, 153 (51%) were male and 147 (49%) were female.
Results. 2.7% (n=8) of diagnosed patients account for young people. 32.7% (n=98) of patients were diagnosed with the stage II cancer, 32.3% (n=97) — with the stage III cancer. The most common symptoms of the disease were epigastric pain — 57% (n=171), dysphagia — 19.3% (n=58), nausea — 15% (n=45), unmotivated weight loss — 12% (n=36) and epigastric burning — 7% (n=21). These symptoms bothered patients up to 6 months in 32.7% (n=98) of cases. Biochemical blood tests (80%, n=192/240), accelerated ESR (76%, n=183/241), decreased hemoglobin (69%, n=178/258), and leukocytosis (48%, n=120/248) were identified as the most common “warning” signs. 24.7% (n=74) of patients had atrophic gastritis preceded the development of gastric cancer, 24% (n=72) — gastric ulcer, 12% (n=36) — polyps of the stomach. The previous diagnostics of H. pylori was carried out only in 1.3% (n=4) of patients.
Conclusions. If a patient, including a young patient, has epigastric pain, primary care physicians should recommend esophagogastroduodenoscopy with biopsies to determine precancerous changes in the gastric mucosa and the presence of H. pylori, followed by eradication therapy.

1. Zlokachestvennye novoobrazovaniya v Rossii v 2018 godu (zabolevaemost' i smertnost') Pod red. A. D. Kaprina., V. V. Starinskogo, G. V. Petrovoi. Cancer in Russia in 2018 (incidence and mortality). M.: MNIOI im. P. A. Gertsena - filial FGBU «NMITs radiologii» Minzdrava Rossii, 2019. 250 P. (in Russian)

2. Kratkie algoritmy vedenija pacientov na jetape okaza-nija pervichnoj mediko-sanitarnoj pomoshhi / Pod red. O. M. Drapkinoj. Brief guidelines for outpatient management. M.: VIDOKS, 2019. 20 p. (in Russian)

3. Amorena Muro E., Borda Celaya F., Martrnez-Penuela Virseda J. M. et al. Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer. Journal of Gastroenterology and Hepatology, 2009, V.32, N.1, pp. 2-8.

4. Anderson W.F., Camargo M. C., Fraumeni J. F. Jr. et al. Age-specific trends in incidence of noncardia gastric cancer in US adults. The Journal of the American Medical Association, 2010, V.303, N17, pp. 1723-1728.

5. Bolander-Gouaille C. Focus on homocysteine and the vitamins involved in its metabolism. France: SpringerVerlag, 2002, ISBN2-287-9712-3.

6. Brenner H., Arndt V., Stegmaier C. et al. Is Helicobacter pylori infection a necessary condition for noncardia gastric cancer?. American Journal of Epidemiology, 2004, V.159, N.3, pp. 252-258.

7. Carcas L. P. Gastric cancer review. Journal of carcinogenesis, 2014, V.13, P. 14.

8. Correa P. Human gastric carcinogenesis: a multistep and multifactorial Society Award Lecture on Castric Epidemiology and Prevention. Cancer Research, 1992, Vol. 52, № . 24, pp. 6735-6740.

9. Correa P., Piazuelo M. B. The gastric precancerous cascade. Journal of Digestive Diseases, 2012, V.13, N.1, pp. 2-9.

10. Daibo M., Itabashi M., Hirota T. Malignant transformation of gastric hyperplastic polyps. The American Journal of Gastroenterology, 1987, V.82, pp. 1016-1025.

11. Deppisch L.M., Rona V. T. Gastric epithelial polyps. A 10-year study. Journal of Clinical Gastroenterology, 1989, V.11, pp. 110-115.

12. Dicken B.J., Bigam D. L., Cass C. et al. Gastric adenocarcinoma: review and considerations for future directions. Annals of Surgery, 2005, V.241, pp. 27-39.

13. Dinis-Ribeiro M., Areia M., de Vries A. C. et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy, 2012, V.44, pp. 74-94.

14. Ferlay J., Colombet M., Soerjomataram I. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International Journal of Cancer, 2019, V.144, N.8, pp. 1941-1953.

15. Graham D. Y. Helicobacter pylori Update: gastric cancer, reliable therapy, and possible benefits. Gastroenterology, 2015, V.148, N.4, pp. 719-731.

16. Hamashima C., Ogoshi K., Okamoto M. et al. A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. Public Library of Science one. 2013, V.8, N.11, Е. 79088.

17. Hanada K., Grahm D. Y. Helicobacter pylori and the molecular pathogenesis of intestinal-type gastric carcinoma. Expert Review of Anticancer Therapy, 2014, V.14, N.8, pp. 974-954.

18. Hizawa K., Fuchigami T., Iida M. et al. Possible neoplastic transformation within gastric hyperplastic polyp. Application of endoscopic polypectomy. Surgical Endoscopy, 1995, V.9, pp. 714-718.

19. Ferlay J., Ervik M., Lam F. et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer, 08.05.20. https://gco.iarc.fr/today.

20. Lawrence W., Herman R., Menck I. et al. The national cancer data base report for gastric cancer. Cancer, 1995, V.75, N.7, pp. 1734-1744.

21. Lv S.X., Gan J. H., Ma X. G. et al. Biopsy from the base and edge of gastric ulcer healing or complete healing may lead to detection of gastric cancer earlier: an 8 years endoscopic follow-up study. Hepatogastroenterology, 2012, V.59, pp. 947-950.

22. Miyahara R., Niwa Y., Matsuura T. et al. Prevalence and prognosis of gastric cancer detected by screening in a large Japanese population: data from a single institute over 30 years. Journal of Gastroenterology and Hepatology, 2007, V.22. N.9, pp. 1435-1442.

23. Orlowska J., Jarosz D., Pachlewski J., Butruk E. Malignant transformation of benign epithelial gastric polyps. The America Journal of Gastroenterology, 1995, V.90. N.12, pp. 2152-2159.

24. Pimanov S.I., Makarenko E. V., Voropaeva A. V. et al. Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer years. Journal of Gastroenterology and Hepatology, 2008, V.23. N.11, pp. 1666-1671.

25. Plummer M., de Martel C., Vignat J. et al. Global burden of cancers attributable to infections in 2012: A synthetic analysis. The Lancet Global Health, 2016, V.4, N.9, pp. e609-e616.

26. Rokkas T., Pistiolas D., Sechopoulos P. et al. The longterm impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis. Helicobacter, 2007, V.23. N.s2, pp. 32-38.

27. Seifert E., Gail K., Weismuller J. Gastric polypectomy. Long-term results (survey of 23 centres in Germany). Endoscopy, 1983, V.15. N.1, pp. 8-11.

28. Sipponen P., Maaroos H. I. Chronic gastritis. Scandinavian Journal of Gastroenterology, 2015, V.50, N.6, pp. 657-667.

29. Sipponen P., Laxen F., Huotari K. et al. Prevalence of low vitamin B12 and high homocysteine in serum in an elderly male population: association with atrophic gastritis and Helicobacter pylori infection. Scandinavian Journal of Gastroenterology, 2003, V.38, N.12, pp. 1209-1216.

30. Snover D. C. Benign epithelial polyps of the stomach. Pathology Annual, 1985, V.20, N.1, pp. 303-329.

31. Sugano K. Tack J., Kuipers E. J. et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut, 2015, V.64, N.9, pp. 1-15.

32. Van Cutsem E., Sagaert X., Topal B. et al. Gastric cancer. Lancet, 2016, V.338. N.10060, pp. 2654-2664.

33. Wang J., Xu L., Shi R. et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis. Digestion, 2011, V.83, N.4, pp. 253-260.

34. Zea-Iriarte W.L., Sekine I., Itsuno M. et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Digestive Diseases and Sciences, 1996, V.41, N.2, pp. 377-386.