Early-onset gastric cancer: A distinct reality with significant implications

In recent years, epidemiological studies found a notable change in the occurrence and prevalence of certain types of digestive system malignancies. Specifically, there is a shift in these cancers being diagnosed at a younger age, which is commonly referred to as “early-onset cancer.” This is especially noticeable in colorectal cancer and to a lesser extent in other malignant digestive tumors, primarily in the gastric and to a lesser extent in the pancreas and biliary tract.¹ In this issue, Tran² et al described the clinical and endoscopic characteristics of this group of individuals from a Vietnamese population. Nine percent of the study population were categorized as early-onset gastric cancer (EOGC), with a diagnosis occurring before the age of 40.

Approximately 90% of gastric cancer is attributable to Helicobacter pylori (H. pylori) infection, and the global incidence of gastric cancer declined in both male and female individuals globally, like the declining trend of H. pylori prevalence.³ However, the incidence of EOGC increased and now comprises 30% of gastric cancer^{4, 5} in the United States. Only a minority of them are being associated with a genetic disease such as the hereditary diffuse gastric cancer or the Lynch syndromes and the remaining majority being sporadic.⁶ Higher prevalence of alcohol drinking and unhealthy dietary habits but not smoking are associated with higher prevalence of EOCG.⁷ EOGC is predominantly found in the stomach body and is more prone to manifesting as a diffuse infiltrative pattern.² A higher proportion of early-onset gastric cancers were associated with an unfavorable tumor biology and advanced stage at presentation compared with those that occur later in life.^{2, 5, 6}

The identification of gastric cancer in young adults poses a considerable difficulty from both personal and societal viewpoints, especially due to the unfavorable prognosis linked to this ailment. The absence of recommendations for screening for these younger population hinders early detection.⁸ Screening endoscopy is the main technique employed for early detection and curative resection of gastric cancer.^{9, 10} A trained endoscopist must thoroughly prepare the endoscope by employing defoamers and mucolytics and examine the stomach body to identify any infrequently overlooked anomalies, such as pale or depressed patches.²

In conclusion, EOGC presents unique challenges due to its nonspecific symptoms and rapid disease progression.² Prior research has demonstrated that eliminating H. pylori infection reduces the occurrence and death rate of gastric cancer.¹¹ Further investigation is required to identify the population at high risk of developing EOGC so that an effective screening and treatment strategy can be developed for this group.

The author declares no conflicts of interest.