Pathogenesis of Gastric Cancer: Genetics and Molecular Classification

Abstract

Gastric cancer is the fifth most incident and the third most common cause of cancer-related death in the world. Infection with Helicobacter pylori is the major risk factor for this disease. Gastric cancer is the final outcome of a cascade of events that takes decades to occur and results from the accumulation of multiple genetic and epigenetic alterations. These changes are crucial for tumor cells to expedite and sustain the array of pathways involved in the cancer development, such as cell cycle, DNA repair, metabolism, cell-to-cell and cell-to-matrix interactions, apoptosis, angiogenesis, and immune surveillance. Comprehensive molecular analyses of gastric cancer have disclosed the complex heterogeneity of this disease. In particular, these analyses have confirmed that Epstein-Barr virus (EBV)-positive gastric cancer is a distinct entity. The identification of gastric cancer subtypes characterized by recognizable molecular profiles may pave the way for a more personalized clinical management and to the identification of novel therapeutic targets and biomarkers for screening, prognosis, prediction of response to treatment, and monitoring of gastric cancer progression.

Keywords: Chromosomal instability; Epstein–Barr virus; Gastric cancer; Helicobacter pylori; Hereditary gastric cancer; Microsatellite instability.

Fig. 12.1

Current gastric cancer classifications based on comprehensive molecular analyses. The main features of each subtype are highlighted in the boxes below each subtype. (A) TCGA classification (Cancer Genome Atlas Research 2014). (B) ACRG classification (Cristescu et al. 2015).