ESMO PRECEPTORSHIP ON Gastric Cancer: Epidemiology (including GE - PowerPoint PPT Presentation

ESMO PRECEPTORSHIP ON Gastric Cancer: Epidemiology (including GE junction) and clinical presentation Dr Yong Wei Peng National University Cancer Institute, Singapore 20 Nov 2019

DISCLOSURES Advisory board: Abbie, Amgen, Aslan pharmaceutic, BMS, Boston scientific, Ipsen, Novartis, Taiho Speaker bureau: BMS, Easai, Taiho Travel support: Eli Lilly

INCIDENCES OF GC WORLDWIDE GLOBOCAN 2018 (IARC)

GLOBOCAN 2018 (IARC)

TRENDS IN INCIDENCES OF GC

CAUSES FOR REDUCTION IN INCIDENCE AND MORTALITY Improved food preservation practices Early cancer detection • use of refrigeration • less pickling of vegetables • less smoking and processing of meat Surgical and oncologic advances • greater availability of fresh fruits and vegetables Reduction in H Pylori infection

CARDIA CANCER

RISK FACTORS FOR GC

RISK FACTORS FOR GC

H. Pylori infection

PATHOGENESIS OF GASTRIC CANCER

CAG - A IS A MAJOR VIRULENCE FACTOR OF H.PYLORI

H.PYLORI IN WESTERN AND EAST ASIAN ISOLATES

EBV INFECTION

FAMILIAR GASTRIC CANCER SYNDROME

FAMILIAR GASTRIC CANCER SYNDROME 10% of gastric cancers show familial clustering Hereditary Diffuse Gastric Cancer (E-cadherin mutation): Elevated risk of lobular breast cancer and possibly colorectal cancer. Histologically, gastric tumors are highly invasive, poorly differentiated, and display occasional signet ring cells. The lifetime penetrance of HDGC is about 65%, Age of onset shows from 14 years upward with a median age in the late thirties. ESMO Clinical Practice Guidelines: If a familial cancer syndrome such as hereditary diffuse GC (HDGC) is suspected, ideally, referral to a geneticist for assessment is recommended based on international clinical guidelines.

LYNCH’S SYNDROME

AETIOLOGY AND MOLECULAR CLASSIFICATION OF AGC AND EC

CLINICAL PRESENTATION

DIAGNOSIS & STAGING ESMO guideline recommendation: Diagnosis should be made from a gastroscopic or surgical biopsy reviewed by an experienced pathologist, and histology should be reported according to the World Health Organisation (WHO) criteria. https://oncologypro.esmo.org/Guidelines/Clinical-Practice-Guidelines/Gastrointestinal-Cancers/Gastric-Cancer

CONCLUSIONS

NATIONAL UNIVERSITY CANCER INSTITUTE, SINGAPORE