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The role of inflammation in the occurrence of stomach cancer
Chronic atrophic gastritis and Helicobacter pylori
Intestinal metaplasia of the gastric epithelium (replacement of normal gastric epithelium with absorption and goblet cells) occurs in more than 70% of patients with gastric cancer, but also in the absence of an oncological process. Intestinal cancer of the stomach is closely associated with the presence of intestinal metaplasia and often develops against its background. Atrophic gastritis is observed in 80-90% of patients with gastric cancer. This led to the idea of the same etiology of these diseases. In areas of the world with the highest risk of gastric cancer, atrophic gastritis is extremely widespread among adults. Studies conducted in the Scandinavian countries, Italy, England, showed that about 10% of patients with atrophic gastritis develop stomach cancer within 15 years. In the control group, which included healthy people, or people with superficial gastritis, there were no cases of cancer occurring over 15 years. Therefore, the presence of chronic atrophic gastritis, intestinal metaplasia in any observed group of patients is an indicator of a high risk of cancer. It is usually very difficult to predict the time of the onset of the neoplastic process, because it occurs for a long time. Moreover, only 10% of patients with precancerous changes will develop cancer in the future (observations were carried out for 10 and 20 years). In the United States, in areas at low risk for developing stomach cancer, this figure is even lower.
Atrophic gastritis is a complex disease in which both atrophy of the mucous membrane and hyperproliferation of the cells occur. This disease begins with a superficial inflammatory process of the upper half of the glands of the antrum. Gradually increase both the area and the severity of the inflammatory process. In the end, all the gland is involved in the inflammation, and in the later stages of the development of the disease, there is a decrease in inflammatory infiltrate and atrophy of the mucous membrane. Parietal cells disappear only in the late stage of the disease. Therefore, patients have a normal level of acidity and gastrin in the stomach. A different picture is observed in chronic gastritis, starting in the fundus of the stomach.
With it, the development of antibodies to parietal cells and the destruction of the glands (with the death of parietal and main cells) followed by the development of malignant anemia. Chronic gastritis starting in the antrum of the stomach (type B) is epidemiologically associated with Helicobacter pylori. This type of gastritis is more common in countries with a high risk of gastric cancer and is often accompanied by the formation of ulcers of the antrum. Chronic atrophic gastritis, starting in the fundus of the stomach (type A), has an autoimmune nature and with the same frequency leads to the development of stomach cancer in areas with a high and low risk of disease. In Denmark, where the risk of developing malignant anemia is relatively high, type A gastritis occurs in patients in 2.2% of reported cases of stomach cancer.
For several years, atrophic gastritis can be complicated by intestinal metaplasia, followed by the development of cancer. Helicobacter pylori infection has been shown to be endemic in areas at high risk of developing stomach cancer (Japan, China, South America). A correlation was determined between the socio-economic level of the countries where patients live and the infection of patients with Helicobacter pylori, and diagnosis was carried out by determining antibodies to Helicobacter pylori. Helicobacter pylori infection is combined with both diffuse and intestinal forms of cancer, as well as intestinal metaplasia. The inflammation caused by this pathogen leads to carcinogenesis by DNA damage by the products of neutrophil metabolism. The associated increase in gastrin causes hyperproliferation and, therefore, predisposes to the development of cancer.
But Helicobacter pylori infection alone is not enough for cancer. This infection is often found in young adults in Africa, Costa Rica - areas with a low risk of cancer. Despite the fact that in North America Helicobacter pylori is found in 50% of the adult population, only a small number of people develop cancer. Thus, the development of cancer requires the interaction of a variety of genetic and environmental factors.
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The role of inflammation in the occurrence of stomach cancer
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