The Mexican consensus on the detection and treatment of early gastric cancer

Gastric cancer is one of the most frequent neoplasias in the digestive tract and is the result of premalignant lesion progression in the majority of cases. Opportune detection of those lesions is relevant, given that timely treatment offers the possibility of cure. There is no consensus in Mexico on the early detection of gastric cancer, and therefore, the Asociación Mexicana de Gastroenterología brought together a group of experts and produced the "Mexican consensus on the detection and treatment of early gastric cancer" to establish useful recommendations for the medical community. The Delphi methodology was employed, and 38 recommendations related to early gastric cancer were formulated. The consensus defines early gastric cancer as that which at diagnosis is limited to the mucosa and submucosa, irrespective of lymph node metástasis. In Mexico, as in other parts of the world, factors associated with early gastric cancer include Helicobacter pylori infection, a family history of the disease, smoking, and diet. Chromoendoscopy, magnification endoscopy, and equipment-based image-enhanced endoscopy are recommended for making the diagnosis, and accurate histopathologic diagnosis is invaluable for making therapeutic decisions. The endoscopic treatment of early gastric cancer, whether dissection or resection of the mucosa, should be preferred to surgical management, when similar oncologic cure results can be obtained. Endoscopic surveillance should be individualized.

[Helicobacter pylori. Its relationships and morphological controversies]

After Helicobacter pylori was described in 1984, it has been related to numerous benign and malignant morphological disturbances. The distribution of the gastroduodenal disease, their histological expressions and their controversial topics regarding their relationship with HP are better known today. The aim of this paper is review some of these features.

Histological types of gastric cancer in Mexico

BACKGROUND

Gastric cancer is the second leading cause of malignant tumours in Mexico. The distribution of the histological types of this tumour has not been estimated from a population-based representative sample.

METHODS

The histological types of gastric cancer according to the Lauren classification and selected socio-demographic characteristics for 220 patients from different socioeconomic levels are reported. The study population represents 66% of all new gastric cancer cases during 1989-1990 reported to the Mexico City Cancer Registry. The patients attended four public hospitals, seven social security hospitals and four private hospitals in Mexico City. A second histological diagnosis was performed by one pathologist.

RESULTS

No specific histological type of gastric cancer predominated since the estimated distribution for intestinal gastric cancer was 44.5%, for diffuse gastric cancer 43.2% (and the remaining 12.3% corresponded to indeterminate tumours). The distribution of intestinal and diffuse gastric cancer did not vary significantly according to socioeconomic level or medical care unit and it showed a clear relationship with gender, the intestinal type of gastric cancer being more common among males.

CONCLUSIONS

Mexico may not have been affected by the gastric cancer epidemic at the beginning of the twentieth century but the available information and the results of this study are only useful to demonstrate that, currently, no histological type of gastric cancer (according to Lauren's classification) predominates significantly in this country.