Precancerous lesions may not necessarily develop into gastric cancer

by Specialist

The term cancer-related always causes panic, and so do precancerous lesions. Since it is a precancerous lesion, will it definitely develop into cancer? First, let’s explain what precancerous lesions in the stomach are. In common understanding, the lesions experienced during the development of gastric cancer are not cancerous, but will gradually evolve into cancer if not intervened and treated; in professional terms, the concept of pathological histology, such lesions are more prone to cancer than normal or other gastric mucosal lesions, mainly including atypical hyperplasia and intestinal epithelial metaplasia.

Different precancerous lesions have different risks of progression to cancer

Atypical hyperplasia: moderate to severe as a risk sign for gastric cancer

Atypical hyperplasia, also known as heterogeneous hyperplasia, is a type of lesion in which cells at each site have a fixed morphology and rhythm of growth and development (differentiation), and heterogeneous hyperplasia is a type of lesion in which tissues and cells proliferate abnormally and differentiate poorly, showing morphological and structural changes and a tendency to change to malignancy. The World Health Organization (WHO) proposed in the 1980 symposium on histological criteria for precancerous lesions of the stomach that heterogeneous hyperplasia of the gastric mucosa and its grading criteria be judged by a combination of three aspects: cellular heterogeneity, abnormal differentiation, and structural disorders.

According to the different degrees of gastric mucosal heterogeneous hyperplasia, the Pathology Group of the National Gastric Cancer Collaborative Group (1987) developed a 3-grade scheme for heterogeneous hyperplasia, namely mild, moderate, and severe: mild is a benign lesion; moderate hyperplasia has a more pronounced structural and cellular heterogeneity but is still benign; and all those with very pronounced structural and cellular heterogeneity or difficulty in determining benign and malignant are severe.

According to endoscopic follow-up data, the percentage of carcinomas in mild heterogeneous hyperplasia is 0-5%, in moderate heterogeneous hyperplasia is 4%-38%, and in severe heterogeneous hyperplasia is as high as 60%-81%. Some scholars classify severe heterogeneous hyperplasia as “junctional lesions”. Therefore, when the gastroscopy pathology report contains the words “heterogeneous hyperplasia of the gastric mucosa”, you need to be alert and consult your gastroenterologist, especially if moderate to severe heterogeneous hyperplasia is a risk sign of gastric cancer, and you should follow up regularly to prevent cancer.

Intestinal epithelial metaplasia: unlikely to progress to gastric cancer

Intestinal mucosal metaplasia, also known as intestinal epithelial metaplasia, is called intestinal epithelial metaplasia when normal gastric mucosal epithelial cells are replaced by intestinal-type epithelium; in mild cases, only a few intestinal epithelial cells are seen, and in severe cases, intestinal villi may appear as in the small intestine. Intestinal epithelial metaplasia is a relatively common lesion in gastritis and occurs in almost all atrophic gastritis, and its appearance is associated with gastric mucosal injury and inability to fully regenerate and repair it.

According to the secretion of mucus by intestinal epithelial metaplasia and the nature of the mucus, intestinal epithelial metaplasia can be divided into four types: complete small bowel metaplasia, incomplete small bowel metaplasia, complete colon metaplasia, and incomplete colon metaplasia, of which, incomplete colon metaplasia can be considered a precancerous lesion of gastric cancer and is closely related to intestinal-type gastric cancer. However, the results of a large-scale study in the Netherlands showed that the percentage of patients with intestinal epithelial hyperplasia who eventually developed gastric cancer was only 0.25%. Therefore, when you see the words “intestinal epithelial hyperplasia” in a gastroscopy pathology report, it is important to carefully distinguish which type it is, and there is no need to be overly nervous, as most of them are caused by inflammation and can be cured with medication.

Gastric precancerous lesions, monitoring and treatment

Referring to the Consensus Opinion on Early Gastric Cancer Screening and Endoscopic Diagnosis and Treatment in China (2016), patients with gastric precancerous lesions should receive regular gastric cancer screening, preferably once a year, with the following screening items:

  • Serological screening, including serum pepsinogen (PG) testing and serum gastrin-17 (G-17) testing;

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Why check pepsinogen and gastrin 17?

  • H. pylori surveillance, detection of serum H. pylori (Hp) antibodies;

  • Serum tumor marker testing, currently in common use, including carcinoembryonic antigen (CEA), glycoantigen 19-9 (CA19-9), glycoantigen 72-4 (CA72-4), and glycoantigen 125 (CA125);

What do these tumor markers mean for gastric cancer diagnosis?

  • Endoscopic screening with electronic gastroscopy screening, magnetic control capsule gastroscopy screening.

Epidemiological surveys have found that gastric precancerous lesions can be completely reversed to normal gastric mucosal cells after reasonable medication. Since H. pylori can induce the development of intestinal epithelial chemosis and atypical hyperplasia and accelerate the rate of gastric precancerous lesions, eradication of H. pylori plays a key role in reversing gastric precancerous lesions, which can usually be done with acid suppressants, bismuth + two antibiotics “quadruple therapy”. Some studies have found that long-term supplementation with antioxidants, vitamins, folic acid and carotenoids has a role in preventing and blocking the progression of gastric mucosal intraepithelial neoplasia. Chinese medicine treatment may also be effective for gastric precancerous lesions, but patients should seek medical advice carefully and should not take them without doctor’s recommendation. The endoscopic intervention of gastric precancerous lesions is still in the research and exploration stage. It is generally believed that simple intestinal epithelial metaplasia and low-grade intraepithelial neoplasia do not require endoscopic treatment, whereas high-grade intraepithelial neoplasia can be reversed by endoscopic treatment.

H. pylori infection, how to deal with it?

After a baptism of knowledge about gastric precancer, it can be found that gastric precancer is actually preventable and controllable. With early detection, early diagnosis, early treatment, and reasonable treatment, gastric precancer will gradually move away from gastric cancer.