Early-onset gastric cancer: Learning lessons from the young

Abstract

There is by no means a clear-cut pattern of mutations contributing to gastric cancers, and gastric cancer research can be hampered by the diversity of factors that can induce gastric cancer, such as Helicobacter pylori infection, diet, ageing and other environmental factors. Tumours are unquestionably riddled with genetic changes yet we are faced with an unsolvable puzzle with respect to a temporal relationship. It is postulated that inherited genetic factors may be more important in early-onset gastric cancer (EOGC) than in gastric cancers found in older patients as they have less exposure to environmental carcinogens. EOGC, therefore, could provide a key to unravelling the genetic changes in gastric carcinogenesis. Gastric cancers occurring in young patients provide an ideal background on which to try and uncover the initiating stages of gastric carcinogenesis. This review summarizes the literature regarding EOGC and also presents evidence that these cancers have a unique molecular-genetic phenotype, distinct from conventional gastric cancer.

Keywords: Early-onset gastric cancer; Gastric cancer; Helicobacter pylori.

Figure 1

This figure summarizes the molecular genetic changes in conventional gastric cancer and emphasizes the lack of a multi-step pathway in gastric cancer, despite extensive research in the field. It highlights the need for a new approach to understanding gastric cancer, such as examining early-onset gastric cancers and hereditary gastric cancers, where we can learn from the young.