Endoscopic, clinicopathological features and prognosis of very young patients with gastric cancer

Emerging trends in early-onset gastric cancer

ABSTRACT

The incidence of early-onset gastric cancer (EOGC) is consistently increasing, and its etiology is notably complex. This increase may be attributed to distinctive factors that differ from those associated with late-onset gastric cancer (LOGC), including genetic predispositions, dietary factors, gastric microbiota dysbiosis, and screening of high-risk cases. These factors collectively contribute to the onset of cancer. EOGC significantly differs from LOGC in terms of clinicopathological and molecular characteristics. Moreover, multiple differences in prognosis and clinical management also exist. This study aimed to systematically review the latest research advancements in the epidemiological characteristics, etiological factors, clinicopathological and molecular features, prognosis, and treatment modalities of EOGC.

Comparison of incidence and prognosis between young and old gastric cancer patient in North-Western China: A retrospective cohort study

Gastric cancer (GC) is the fourth most common cancer in the world and the second most common cancer in China. In this study, we compared the clinicopathological features and prognosis of GC between young and old patients after curative resection. Six hundred and eighty-six patients with GC resected were divided two groups according to patient age: Younger GC patients ≤40 years of age (YGC, n = 52) and older GC patients >40 years of age (OGC, n = 634). The YGC group had 52 (7.6%) patients in total 686 GC patients. YGC patients was predominant in women (53.8% vs 26.5%) compared with OGC patients. 5-year overall survival exhibited differences in tumor sites, tumor sizes, macroscopic types, T staging, N staging, rate of N staging (rN), tumor node metastasis staging, scope of gastrectomy, radical degree, and lymphatic vascular invasion within each of YGC and OGC group. Univariate analysis of the clinical factors affecting overall survival in YGC group revealed the significant differences in tumor size, macroscopic types (except Borrmann), T staging (except T2), N staging (N3a and N3b), rN, tumor node metastasis staging (III), scope of gastrectomy, radical degree, and lymphatic vascular invasion. Gender, N staging, rN, radical degrees were the independent prognostic factors of younger patients with GC. Similar results were found in the OGC groups. The significant differences in radical degree and lymphatic vascular invasion were found between male and female patients in YGC group. Similar results were found in the OGC groups. Our results showed that YGC patients differ from OGC patients in predominance of women. Gender, N staging, rN, radical degrees were independent risk factors for the prognosis in YGC patients.

Screening and surveillance for gastric cancer: Does family history play an important role in shaping our strategy?

Family history is an important risk factor of gastric cancer. No guidelines have been developed that target gastric cancer with a family history; only hereditary familial gastric cancer is targeted. We review the available evidence regarding the familial aggregation mechanisms of gastric cancer and a strategy of screening and surveillance for gastric cancer in individuals with a positive family history of the disease. As there is a synergic effect of Helicobacter pylori infection and family history on the increased risk of gastric cancer, Helicobacter pylori eradication should be considered in all infected individuals with a family history of gastric cancer. Currently, there is weak evidence indicating that suitable timing to initiate eradication therapy is at the age of 20, when precancerous lesions, including significant gastric atrophy and intestinal metaplasia, have not been established. Reasonable timing to initiate screening for gastric cancer in individuals with a family history of gastric cancer is 10 years prior to the age of onset of gastric cancer in affected relatives. A 2-year surveillance interval, instead of the 3-year interval recommended in the present guidelines, may be better to detect early gastric cancer in those individuals who have already developed precancerous gastric lesions.

Prevalence of gastric cancer precursors in gastroscopy-screened adults by family history of gastric cancer and of cancers other than gastric

Background

People are at a high risk of gastric cancer if their first-degree relatives suffered from atrophic gastritis (AG), intestinal metaplasia (IM), intraepithelial neoplasia (IEN), dysplasia (DYS), or gastric cancer (GC). This study was performed to analyse the association between FDR-GC and GC precursors.

Methods

A cross-sectional study was performed to screen the prevalence of GC precursors from November 2016 to September 2019. A total of 1329 participants with FDR-GC, 193 participants with a family history of non-gastric cancer in FDRs (FDR-nGC), and 860 participants without a family history of cancer in FDRs (FDR-nC) were recruited in this study. The logistic regression model was used in this study.

Results

The prevalence of normal, Non-AG, AG/IM, IEN/DYS, and GC was 31.91, 44.21, 13.81, 8.73, and 1.34%, respectively. The prevalence of IEN/DYS was higher in people with FDR-GC and FDR-nGC (FDR-GC: odds ratio (OR) = 1.655; 95%CI, 1.153–2.376; FDR-nGC: OR = 1.984; 95%CI, 1.122–3.506) than those with FDR-nC. The younger the age at which FDRs were diagnosed with GC, the more likely the participants were to develop AG/IM (P_trend = 0.019). The risk of precursors to GC was higher in participants whose FDR-GC was the mother than in those whose FDR-GC was the father or sibling (OR, non-AG: 1.312 vs. 1.007, 1.274; AG/IM: 1.430 vs. 1.296, 1.378; IEN/DYS: 1.988 vs. 1.573, 1.542). There was no statistically significant difference in non-AG (OR = 1.700; 95%CI, 0.940–3.074), AG/IM (OR = 1.291; 95%CI, 0.579–2.877), and IEN/DYS (OR = 1.265; 95%CI, 0.517–3.096) between participants with one or more FDR-GC.

Conclusion

People with FDR-GC and FDR-nGC are at a high risk of IEN/DYS. When an FDR was diagnosed at a younger age, the risk of AG/IM was higher. The risk of GC precursors was higher in people whose FDR-GC was the mother.

A validated survival nomogram for early-onset diffuse gastric cancer

This study aimed to establish and independently validate a prognostic nomogram for individual risk prediction in patients with early-onset diffuse gastric cancer (EODGC). Data for 794 patients with EODGC from the SEER database were randomly assigned to training (N=558) and internal validation (N=236) sets, and data for 82 patients from the Renmin Hospital of Wuhan University (RMHWHU) were used as an independent validation cohort. Our LASSO regression analyses of the training set yielded five clinicopathological features (race, AJCC stage, surgery for primary site, chemotherapy and tumor size), which were used to create a survival nomogram. Our survival nomogram achieved better predictive performance than the AJCC staging system, the current standard. Additionally, the calibration curves of the prognostic nomogram revealed good agreement between the predicted survival probabilities and the ground truth values. Indeed, our nomogram, which estimates individualized survival probabilities for patients with EODGC, shows good predictive accuracy and calibration ability for both the SEER and RMHWHU cohorts. These results suggest that a survival nomogram may be better at predicting OS for EODGC patients than the AJCC staging system.

Different Incidence of Early-Onset Gastric Carcinoma Depending on Ethnicity: Preliminary Results of a Hospital in Liangshan

Background

In China, the incidence of cancer has significantly decreased over the last two decades. In contrast, the incidence of gastric carcinoma (GC) has risen in young patients.

Methods

We reevaluated the histopathological results of 4,353 endoscopic gastroscopies from the Department of Pathology at No 1 Hospital of Liangshan. The ethnic groups Han and Yi were almost equally distributed in this cohort. Over a five-year period, 1407 GC were diagnosed.

Results

In 171 of these cases (12%), the patients were ≤40 years old (early-onset GC, EOGC). Out of this cohort, 9 patients were aged ≤25 years. 54% of these patients were male and showed marked predominance (92%) of the Yi-minority. Using the classification of Lauren, 103 GC (60%) were of diffuse type, 27 (16%) of intestinal type, and 41 (24%) of mixed type. In the remaining 1,236 cases of patients ≥41 years (88%), 1,014 patients (82%) belonged to the Yi-minority. Helicobacter pylori (HP) were found in 46% of all cases. Familial clustering was found in 14 patients (18%; in first degree relatives, 12%, and in second degree relatives, 6%). Follow-up was not possible.

Conclusion

This study demonstrates the unequal manifestation of EOGC within the two ethnic groups of Han and Yi. However, familial clustering was infrequent. Further investigations are necessary to discover relevant risk factors apart from hereditary predisposition.

Analysis of clinicopathologic characteristics of gastric cancer in patients ≤40 and ≥40 years of age

Objectives: Gastric cancer (GC) in young patients is a troubling clinical problem. The aim of this study was to analyze whether patients ≤40 years of age with GC differ from patients (age >40 years) in terms of clinicopathological and selected genetic factors.Materials and methods: Between 1984 and 2011, data were collected for 840 GC patients diagnosed and treated for GC at the Department of Gastroenterology at Pomeranian Medical University. The following clinicopathological features were compared between two age groups: sex, symptom duration, family history of cancer, tumor site, stage (early vs. advanced), blood group, histology, Helicobacter pylori infection and BRCA2 C572T silent mutation status.Results: A total of 65 (7.7%) patients were age 40 years or younger. GC was predominant in women in the younger group (p < .001). Patients (≤40 years) more frequently reported a positive family history of cancer (p = .01) and a diffuse tumor type was more common in this group (p < .001). The two age groups did not differ significantly regarding symptom duration, tumor location or stage, H. pylori infection, blood group, or BRCA2 C572T silent mutation status. A comparison of male and female patients aged 40 years or less did not reveal sex-based differences in any analyzed features.Conclusion: Patients ≤40 years of age with GC differ from patient >40 years of age in having a predominance of women, diffuse tumor type, and positive family history of cancer. These results offer openings for further investigation of the relevance of these differences.

Common Locations of Gastric Cancer: Review of Research from the Endoscopic Submucosal Dissection Era

Detection of early-stage gastric cancer improves the prognosis of patients. Endoscopic submucosal dissection (ESD) is a curative and stomach-preserving treatment for early gastric cancer (EGC) associated with a low risk of lymph node metastasis. However, several studies have reported missed diagnosis of gastric cancer. Therefore, endoscopists are required to learn accurate diagnostic skills to eliminate endoscopic blind spots. A systematic screening protocol to map the entire stomach without blind spots reduces the risk of missed lesions. Knowledge of the features of EGC or dysplasia is essential to identify suspicious lesion. Information of the common sites of occurrence of EGC can also enable a detailed endoscopic examination to improve detection rates. Previous reports investigating the location of gastric cancers resected by ESD or surgery showed that the antrum and lesser curvature of stomach were predominantly affected. Helicobacter pylori-induced atrophic changes advance from the antrum to the corpus along the lesser curvature, predominantly affecting these areas. Gastric cancers in the antrum and the lower corpus are also commonly missed during screening examination. Therefore, a careful examination of the lower third stomach is warranted to avoid missing synchronous and metachronous gastric lesions. Knowledge of the location of EGC enables accurate endoscopic examination and detection of EGC in early stage.

More attention should be paid to adult gastric cancer patients younger than 35 years old: extremely poor prognosis was found

Purpose: Several studies have reported controversial results about prognosis of gastric cancer in young age patients. The difference may partially result from variable definitions of young age. The aim of this study was to find out the relation between age and prognosis of gastric cancer patients, and to analyze the clinicopathological features and prognostic factors in young gastric cancer patients.

Methods: Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 1973 to 2014. Gastric cancer patients (N=79,505) diagnosed with an age≥18 were included. By combining patients with similar prognosis, we figured out 3 cutoff values of age, 35 years old, 65 years old and 75 years old. We divided patients into 4 groups: young age patients: 18-34 years; middle-age patients: 35-64 years; elderly patients: 65-74 years; extremely elderly patients: >74 years. GC patients from Sun Yat-sen University Cancer Center (SYSUCC) were used as external validation data.

Results: The clinicopathological features of young age gastric cancer patients included: poor-differentiated, diffuse type of cancer, and advanced stage at diagnosis. The median survival of patients <35 years old was significantly lower than middle-age patients (35-64 years) and elderly patients (65-74 years) (12 months vs. 15 and 16 months, respectively, both p <0.001). Location of tumor, ethnicity, tumor size, surgery and TNM stage were independent prognostic factors by multivariate analysis in young patients. The poor prognosis for young patients remained valid in the SYSUCC database.

Conclusions: Our results demonstrated that gastric cancer patients <35 years old had an extremely poor prognosis. Early detection of gastric cancer is of paramount importance in young age people.

The Endoscopic and Clinicopathological Characteristics of Early-onset Gastric Cancer in Vietnamese Patients

Aim: To assess the endoscopic and clinicopathological features of early-onset gastric cancer (EOGC) in Vietnamese, a population with intermediate risk of gastric cancer. Patients and methods: Consecutive patients diagnosed with gastric adenocarcinoma were prospectively recruited. The demographic, clinical data in each patient were collected. The location and macroscopic type of all gastric lesions suspected to be malignant were reported according to the Japanese classification. The histologic tumor type of gastric cancer (GC) was classified according to the Lauren classification. Helicobacter pylori (H. pylori) infection were diagnosed by rapid urease test and urinary H. pylori antibody test. The infection was diagnosed when at least one of the two tests was positive. Results: The rate of EOGC (i.e. ≤ 40 years of age) was 16.3% (23/141). The median age of patients with EOGC was 35 (range 28 – 40) years and the male-to-female was 1:1.09. Compared to the older group (i.e. ≥ 50 years of age), the rates of positive family history, H. pylori infection and alarm features in the EOGC group were not significantly different (0.0% vs. 5.4%, p = 0.581; 73.9% vs. 66.3%, p = 0.620; and 60.8% vs. 79.3%, p = 0.100; respectively). The EOGC group had significantly higher rate of tumor extending to entire stomach (21.7% vs. 3.4%, p = 0.003); but the rate of diffuse-type GC between the two groups were not significantly different (87.0% vs. 71.7%, p = 0.181). Conclusions: Vietnamese patients with EOGC had higher rate of tumor extending to entire stomach compared to the older group. But the family history of GC, H. pylori infection and the pathological characteristics were not significantly different between the two groups. Environmental factors which play important roles in the development of EOGC in Vietnam should be investigated in future study.

Gastric cancer in a teenager: a case report

Background Gastric cancer occurs mainly in older patients, with a peak incidence over 60 years of age. It is relatively rare among younger individuals. However, the frequency of gastric cancer in young patients appears to be on the rise worldwide. Case presentation We report the case of a 19-year-old female soldier who, after a considerable diagnostic delay, was diagnosed with gastric adenocarcinoma. She is one of the youngest gastric adenocarcinoma patients ever reported in Israel. Conclusion This case should serve as a reminder that gastric carcinoma is a possible diagnosis even in young patients. It also highlights the critical importance of obtaining a thorough medical history in the process of clinical decision making.

Expression profile of E-cadherin, estrogen receptors, and P53 in early-onset gastric cancers

Early-onset gastric cancer (EOGC) is predominant in females, diffuse histology, and hereditary pattern. Germline mutation of CDH1 and p53 has been reported previously and female dominance was speculated to be associated with estrogen and its receptors. Expression of E-cadherin, estrogen receptor α (ERα), estrogen receptor β (ERβ), and p53 in EOGC remains unclear, which was the focus of this study, to assess clinical significance of their expression in EOGC. The expression of E-cadherin, ERα, ERβ, and p53 in tumors and normal tissues from surgically resected EOGCs was assessed by immunohistochemistry (n = 139) and Western blot (n = 7) methods, respectively. The expression in tumor tissues was significantly higher for ERα, ERβ, and p53, but lower for E-cadherin, compared to uninvolved mucosa. Positive staining of ERβ and p53 was more frequently observed in younger patients with advanced TNM stages. For E-cadherin, significant correlation was observed between the immunopositivity and TNM stages IA+IB. P53-negative patients had significantly better outcomes than p53-positive patients. Significant association between expression of E-cadherin and histologic types was found in familial, but not in sporadic, EOGC. In conclusion, our results demonstrated E-cadherin may have a role in initiation of EOGC and positive ERβ and p53 expression may partially explained early-onset and tumor progression of EOGC.

MiR 21-5p as a predictor of recurrence in young gastric cancer patients

BACKGROUND AND AIM

It is generally assumed that gastric cancer (GC) in young patients has different clinicopathologic characteristics than that of elderly patients. Although recurrence is an important factor in determining prognosis, traditional clinicopathological factors are sometimes inadequate for predicting recurrence in individuals. Therefore, we aimed to identify miRNAs with the potential to predict recurrence in young patients.

METHODS

Young patients (age <40 years) undergoing gastrectomy for potentially curable GC (stage III) at Asan Medical Center participated in this study. A total of 50 GC patients with (n = 28) and without (n = 22) GC recurrence were selected for analysis. miRNA microarrays were analyzed to screen tissue samples (n = 7), and we validated the selected miRNAs by quantitative PCR in validation samples (n = 43).

RESULTS

Two miRNAs (hsa-miR-21-5p and hsa-miR-451a) identified in the microarray analysis were evaluated in the validation samples. Among the validation samples containing intratumoral stroma ≥ 70 (n = 35), hsa-miR-21-5p was more highly expressed in the recurrence group than in the nonrecurrence group (fold change 1.82, P = 0.03). In the validation samples with intratumoral stroma ≥ 70, the ΔCt of hsa-miR-21-5p, which was >3.35, had a sensitivity and specificity of 86.7% and 65.5%, respectively, for predicting recurrence, with an area under the ROC curve of 0.723.

CONCLUSIONS

miR-21-5p may be useful as a predictor of recurrence in young GC patients whose tumors contain a high proportion of intratumoral stroma. The combination of this miRNA with conventional clinicopathological factors should allow patient prognoses to be more accurately predicted.

Gastric Carcinomas in Young (Younger than 40 Years) Chinese Patients: Clinicopathology, Family History, and Postresection Survival

Little is known about clinicopathological characteristics of gastric carcinoma (GC) in young (≤40 years) Chinese patients. We aimed in this study to analyze those features along with family history and prognostic factors after resection. We retrospectively reviewed all 4671 GC resections (surgical and endoscopic) performed at our center from 2004 to 2014 and identified 152 (3.2%) consecutive young patients. Patient demographics, clinical results, family history, and endoscopic-pathological findings were analyzed along with the older (>41 years) GC controls recruited in the same study period. Clinicopathological factors related to postresection outcomes were assessed statistically. The trend of GC resections in young patients was not changed over the study period. Compared to old GCs, the young GC cohort was predominant in women, positive family history, middle gastric location, the diffuse histology type, shorter duration of symptoms, and advanced stage (pIII+pIV, 53.3%). Radical resection was carried out in 90.1% (n = 137) with a better 5-year survival rate (70.3%) than palliative surgery (0%, n = 15). There was no significant difference in clinicopathological characteristics between familial GC (FGC, n = 38) and sporadic GC (SGC, n = 114) groups. Very young patients (≤ 30 years, n = 38) showed lower Helicobacter pylori (Hp) infection and significantly higher perineural invasion rates, compared to older (31-40 years) patients. Hp infection was more commonly seen in the Lauren's intestinal type and early pT stages (T1+T2). Independent prognostic factors for worse outcomes included higher serum CA 72-4, CA 125 levels, positive resection margin, and stage pIII-pIV tumors. The 5-year survival rate was significantly higher in patients with radical resection than those without. GCs in young Chinese patients were prevalent in women with advanced stages but showed no significant differences in clinicopathology between FGC and SGC groups. High serum CA 72-4 and CA 125 levels may help identify patients with worse outcomes. Radical resection improved postresection survival.

Laparoscopic radical gastrectomy versus traditional open surgery in elderly patients with gastric cancer: Benefits and complications

This study was conducted to compare the therapeutic effect and complications of laparoscopic radical gastrectomy (LRG) with those of traditional open surgery in elderly patients with gastric cancer (GC). We conducted a retrospective comparison of therapeutic efficacy and complications between elderly patients with GC (defined as those aged ≥70 years) who received laparoscopic gastrectomy and those who underwent gastrectomy by open surgery. A total of 108 patients who either underwent laparoscopic surgery (n=54) or traditional open surgery (n=54) at the General Hospital of Lanzhou Military Region between June, 2008 and March, 2009 were analyzed. Compared to traditional open surgery, LRG exhibited several advantages, such as being less invasive, with less intraoperative blood loss, shorter bedbound time, less intubation time, low frequency of fever, less time to normal diet, shorter hospital stay and a low overall incidence of complications. No significant difference was observed between laparoscopic and open surgery in terms of operative time and number of lymph nodes dissected. The 3-year cancer recurrence and mortality rates were similar in the two groups. In conclusion, LRG is a safe and effective procedure for the management of GC in elderly patients and was found to be superior to traditional open surgery regarding the short-term curative effect. Therefore, LRG represents a feasible and safe surgical approach for elderly patients with GC.

Gastric cancer in the young: is it a different clinical entity? A retrospective cohort study

Background. The rate of gastric cancer in young patients has increased over the past few decades. The aim of this study was to search for independent risk factors related to patients of younger age. Methods. From January 1996 to December 2012, a series of 179 consecutive patients were admitted to our surgical department because of a gastric cancer. We carried out a retrospective cohort study in 20 patients younger than 50 and in 112 patients aged 50 and older treated by curative gastrectomy. The comparison involved the evaluation of patient and tumor characteristics. Results. Younger patients had significantly less comorbidities and a more favorable American Society of Anesthesiology score; they had significantly less preoperative weight loss and a significantly longer duration of symptoms; Helicobacter pylori infection and diffuse histological type were significantly associated with younger age. There was no statistically significant difference regarding overall and cancer-related 5-year survival; advanced cancer stage and diffuse histological type were the independent negative prognostic factors influencing cancer-related survival. Conclusions. We do not have sufficient evidence to consider gastric cancer in younger patients as a different clinical entity. Further studies are needed to understand carcinogenesis in younger patients and to improve gastric cancer classification.

Musashi-1 expression and clinicopathological significance in young gastric cancer patients: a matched case-control study

Musashi-1 (Msi-1) is proposed to be a marker of progenitor cells in the human gastric mucosa. We examined Msi-1 expression and localization in surgical specimens of gastric cancer in young patients using immunohistochemistry and tested associations of Msi-1 expression with clinicopathological features. Patients (n=611) with gastric cancer who underwent radical gastrectomy were included in the present study. To minimize confounding effects, we matched 26 gastric cancer patients 30 years of age or younger (age ≤30) with 26 patients 60 years of age or older (age ≥60). The groups were matched by gender, tumor histological type and tumor stage. Gastric cancer in the younger patients was significantly associated with female gender and with diffuse histological type, compared with 585 gastric cancer patients older than 31 years. Msi-1 expression was more frequently upregulated in gastric cancer in young patients than in patients older than 60 years. Msi-1 expression was significantly associated with diffuse histological type, depth of tumor invasion, lymph node metastasis and tumor stage in the 26 young patients with gastric cancer. Univariate Kaplan-Meier survival analysis identified Msi-1 expression as a significantly negative factor in the survival of young gastric cancer patients. However, Msi-1 expression was not significantly associated with survival in the 26 matched older patients. According to mucin phenotype, the gastric foveolar type predominated in Msi-1-positive gastric cancers. Our principal findings included a significantly higher level of Msi-1 expression in younger gastric cancer patients compared to older ones, and a probable association of tumor Msi-1 expression in young gastric cancer patients with more aggressive tumor type.

Frequency-risk and duration-risk relationships between aspirin use and gastric cancer: a systematic review and meta-analysis

Background

Although previous meta-analyses have suggested an association between aspirin use and risk of gastric cancer, current evidence is inconsistent. Additionally, it remains unclear whether there are frequency-risk and duration-risk relationships and if a threshold of effect exists.

Methods

We identified studies by searching MEDLINE and PUBMED databases and reviewing relevant articles. We derived the summary risk estimates using fixed-effects or random-effects model based on homogeneity analysis. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression. Potential heterogeneity was tested using the Q statistic and quantified with the I² statistic. Subgroup analyses and Galbraith plots were used to explore the potential sources of heterogeneity. Publication bias was evaluated with funnel plots and quantified by the Begg's and Egger's test.

Results

Fifteen studies were included in this meta-analysis. There was an overall 29% reduced risk of gastric cancer corresponding to aspirin use (RR  = 0.71, 95% CI 0.60–0.82). We found there are nonlinear frequency-risk and linear duration-risk relations between aspirin use and gastric cancer. A monotonically decreasing relation was observed only for low-frequency (≤4.5 times/week) aspirin intake (10% decreased risk for once/week, 19% for twice/week and 29% for 4.5 times/week), and the frequency threshold of aspirin use is 4.5 times per week. Regarding those with duration of aspirin use, there was a tendency towards stronger risk reduction of gastric cancer for longer aspirin use (10% decreased risk for 4 years, 19% for 8 years and 28% for 12 years), and no duration threshold was observed.

Conclusion

Our findings suggest that long-term (≥4 years) and low-frequency (1–4.5 times per week) aspirin use is associated with a statistically significant, dose-dependent reduction in the risk of gastric cancer.

That dyspepsia in the young could be cancer

Malignant tumour of the stomach is not common in young adults. When it does occur, it is associated with a high morbidity and mortality. The objective of this report is to document our experience with three cases of gastric adenocarcinoma in young adult Nigerians seen over a period of 18 months in our centre.