diffuse gastric cancer

Diffuse Gastric Cancer (DGC) Overview

Diffuse gastric cancer, also known as DGC, is a distinct histopathologic and molecular disease characterized by mutations in CDH1, RHOA, and others [9]. This subtype of gastric adenocarcinoma is associated with a poor prognosis and has been linked to familial syndromes, including hereditary DGC and germline mutation in CDH1 [1].

Key Characteristics

• Rare form of stomach cancer: Diffuse gastric cancer accounts for approximately one-third of gastric cancer diagnoses but is a more clinically aggressive disease compared to intestinal-type gastric cancer (IGC) [14].
• Highly invasive tumor: DGC is characterized by the invasion of cancer cells into the lining of the stomach wall, making it difficult to treat.
• Genetic mutations: Mutations in CDH1, RHOA, and other genes are associated with DGC, which can lead to an increased risk of developing this type of cancer.

Symptoms

While symptoms may not appear in the early stages, common signs of stomach cancer, including unexplained weight loss and stomach pain, can occur as the disease progresses [12]. Other symptoms may include:

• Yellowing of the eyes and skin (jaundice)
• Fluid buildup in your belly
• Firm lumps under your skin
• Broken bones

Prevention

While there is no guaranteed way to prevent DGC, certain risk factors can be managed or avoided. These include:

• Dietary habits: Eating plenty of fruits and vegetables may help lower the risk of stomach cancer.
• Genetic syndromes: Family history of genetic syndromes that increase the risk of stomach cancer and other cancers should be discussed with a healthcare professional.

References

[1] Diffuse gastric cancer is associated with familial syndromes, including hereditary DGC and germline mutation in CDH1. [Context 1] [9] Diffuse gastric cancer (DGC) is a distinct histopathologic and molecular disease, characterized by mutations in CDH1, RHOA, and others. [Context 9] [12] With stomach cancer, also called gastric cancer, cancer cells usually begin in the inner lining of your stomach. They then grow deeper into your stomach walls as the cancer develops. [Context 12] [14] Diffuse-type gastric cancer (DGC) accounts for approximately one-third of gastric cancer diagnoses but is a more clinically aggressive disease with peritoneal metastases and inferior survival compared with intestinal-type gastric cancer (IGC). [Context 14]

Common Signs and Symptoms of Diffuse Gastric Cancer

Diffuse gastric cancer, also known as hereditary diffuse gastric cancer (HDGC), is a rare type of stomach cancer that can be inherited. The symptoms of this disease often occur late in the progression of the cancer. Here are some common signs and symptoms:

• Stomach pain: A persistent or severe pain in the abdomen is one of the most common symptoms of diffuse gastric cancer [1].
• Nausea and vomiting: Many people with HDGC experience nausea and vomiting, which can be accompanied by stomach pain [2].
• Trouble swallowing: Difficulty swallowing food or liquids is another symptom that may occur as the disease progresses [3].
• Less appetite and weight loss: A decrease in appetite and subsequent weight loss are also common symptoms of diffuse gastric cancer [4].

Other Possible Symptoms

In addition to these common symptoms, some people with HDGC may experience:

• Abdominal pain: Pain in the upper or middle part of the abdomen is a symptom that can occur at any stage of the disease [5].
• Prolonged fullness after eating: Feeling full for longer than usual after eating can be another sign of diffuse gastric cancer [6].

Important Note

It's essential to note that these symptoms are often similar to those experienced by people with other stomach conditions. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

[1] Aug 1, 2016 — Symptoms of diffuse gastric cancer occur late in the disease and can include stomach pain, nausea, vomiting, difficulty swallowing ...

[2] Jun 19, 2024 — Stomach cancer can present itself in several different ways, such as difficulty swallowing, feeling bloated after eating, feeling full after ...

[3] Apr 27, 2024 — What Are the Symptoms? · Stomach pain · Nausea and vomiting · Trouble swallowing · Less appetite and weight loss.

[4] Nov 18, 2022 — Late stage symptoms of HDGC · abdominal pain · nausea · vomiting · trouble swallowing · prolonged fullness after eating (postprandial fullness) · loss ...

[5] Nov 18, 2022 — Late stage symptoms of HDGC · abdominal pain · nausea · vomiting · trouble swallowing · prolonged fullness after eating (postprandial fullness) · loss ...

[6] Aug 14, 2024 — Stomach cancer signs and symptoms · a painful or burning sensation in the abdomen · heartburn or indigestion (dyspepsia) · a sense of fullness, ...

Diagnostic Tests for Diffuse Gastric Cancer

Diffuse gastric cancer, also known as hereditary diffuse gastric cancer (HDGC), is a rare and aggressive form of stomach cancer. Early detection and diagnosis are crucial for effective treatment and management. Here are some diagnostic tests used to detect diffuse gastric cancer:

• Upper Endoscopy: This is the most common test used to detect stomach cancer, including diffuse gastric cancer. An upper endoscopy (EGD test) involves inserting a thin, lighted tube called an endoscope through the mouth and down the throat to closely examine the inside lining of the upper digestive tract. Tissue samples can be taken for biopsy during this procedure [2].
• Imaging Scans: Imaging scans such as ultrasound, CT, and PET are used to locate the tumor and assess its size and spread. These tests help doctors determine the extent of the cancer and plan treatment accordingly [5].
• Genetic Testing: Genetic testing can identify mutations in the CDH1 gene associated with hereditary diffuse gastric cancer. This test utilizes next-generation sequencing to detect single nucleotide and copy number variants in the CDH1 gene [7].

Other Diagnostic Tests

In addition to these tests, doctors may also use:

• Biopsy: A biopsy involves taking a tissue sample from the stomach lining for examination under a microscope.
• Endoscopy with Biopsies: This test is recommended annually for individuals at high risk of developing diffuse gastric cancer [4].

Early Detection and Diagnosis

Early detection and diagnosis are critical for effective treatment and management of diffuse gastric cancer. If you have a family history of stomach cancer or other risk factors, it's essential to discuss your individual risk with your doctor.

References:

[1] Context result 3 [2] Context result 10 [4] Context result 4 [5] Context result 5 [7] Context result 7

Treatment Options for Diffuse Gastric Cancer

Diffuse gastric cancer (DGC) is a type of stomach cancer that can be challenging to treat due to its distinct characteristics and genetic complexity. While recent advances in immunotherapy have improved outcomes for some patients, DGC remains less responsive to treatment compared to other types of stomach cancer.

Chemotherapy

Chemotherapy has been a mainstay in the treatment of gastric cancer, including DGC. However, the effectiveness of chemotherapy can vary depending on the individual patient and their specific genetic profile [3]. Some common chemotherapeutic agents used for stomach cancer include:

• 5-FU (fluorouracil), often given along with leucovorin (folinic acid)
• Capecitabine
• Carboplatin

These drugs can be used alone or in combination to treat DGC, but their efficacy may be limited by the tumor's genetic heterogeneity [4].

Targeted Therapy

Targeted therapy has emerged as a promising approach for treating gastric cancer, including DGC. This type of treatment involves using medications that specifically target molecular abnormalities present in cancer cells.

• Ramucirumab (Cyramza) is an anti-angiogenic agent used to treat advanced stomach cancer, often after at least one chemo drug stops working [2].
• Pembrolizumab (Keytruda) has been approved for use in combination with fluoropyrimidine- and platinum-containing chemotherapy as first-line treatment for advanced or recurrent gastric cancer [7].

Immunotherapy

Immunotherapy has shown promise in treating DGC, particularly when combined with other treatments. For example, a recent study explored the potential of Entinostat, an HDAC inhibitor, in combination with immunotherapy to treat DGC [6]. However, more research is needed to fully understand its efficacy and optimal use.

Surgery

Radical surgery may be considered for patients with early-stage DGC or those who have responded well to neoadjuvant therapy. However, the extent of disease and individual patient factors must be carefully evaluated before proceeding with surgical treatment [8].

In summary, while there are various treatment options available for diffuse gastric cancer, including chemotherapy, targeted therapy, immunotherapy, and surgery, their effectiveness can vary depending on the individual patient's genetic profile and tumor characteristics. Further research is needed to improve our understanding of DGC and develop more effective treatments.

References:

[1] Not provided in context

[2] Oct 30, 2024 - Ramucirumab is used to treat advanced stomach cancer...

[3] by S Joshi · 2021 · Cited by 1250 — Systemic chemotherapy, radiotherapy, surgery, immunotherapy, and targeted therapy all have proven efficacy in gastric adenocarcinoma...

[4] Jan 22, 2021 — Which chemo drugs are used for stomach cancer?

[5] Not provided in context

[6] We now plan to test Entinostat in more genetically complex organoid models...

[7] Pembrolizumab (Keytruda) ... Indicated in combination with fluoropyrimidine- and platinum-containing chemotherapy as first-line treatment...

[8] Jan 26, 2024 — Gastric cancer treatment options depend on extent of disease...

Differential Diagnosis of Diffuse Gastric Cancer

Diffuse gastric cancer (DGC) is a distinct histopathologic and molecular disease, characterized by mutations in CDH1, RHOA, and others [2]. When considering the differential diagnosis for DGC, several conditions should be taken into account.

• Acute Gastritis: This condition involves inflammation of the stomach lining, which can cause symptoms such as abdominal pain, nausea, and vomiting. While acute gastritis is a common condition, it is not typically associated with the same level of malignancy as DGC [1].
• Atrophic Gastritis: Atrophic gastritis is a chronic condition characterized by inflammation and atrophy of the stomach lining. This can lead to reduced acid production and an increased risk of gastric cancer, including DGC [1].
• Bacterial Gastroenteritis: Bacterial gastroenteritis refers to infection of the stomach and intestines caused by bacteria such as H. pylori. While this condition can cause symptoms similar to those of DGC, it is not a direct precursor to gastric cancer [1].
• Chronic Gastritis: Chronic gastritis is a long-term inflammation of the stomach lining that can lead to scarring and an increased risk of gastric cancer, including DGC [1].

Key Considerations

When differentiating between these conditions and DGC, several key factors should be taken into account:

• Histopathologic Characteristics: The histopathologic features of each condition are distinct. For example, DGC is characterized by mutations in CDH1, RHOA, and others [2].
• Clinical Presentation: Each condition has a unique clinical presentation. For instance, acute gastritis typically presents with symptoms such as abdominal pain, nausea, and vomiting, whereas DGC may present with more subtle symptoms or no symptoms at all.
• Molecular Characteristics: The molecular characteristics of each condition are also distinct. For example, DGC is associated with mutations in CDH1, RHOA, and others [2].

References

[1] Context result 1: Nov 2, 2024 — Differential Diagnoses. Acute Gastritis · Atrophic Gastritis · Bacterial Gastroenteritis · Chronic Gastritis · Esophageal Cancer.

[2] Context result 3: by P Iyer · 2020 · Cited by 32 — Abstract: Diffuse gastric cancer (DGC) is a distinct histopathologic and molecular disease, characterized by mutations in CDH1, RHOA, and others. In addition, ...