Precancerous conditions of the stomach

Precancerous conditions of the stomach are changes to stomach cells that make them more likely to develop into cancer. These conditions are not yet cancer. But if they aren’t treated, there is a chance that these abnormal changes may become stomach cancer.

Gastric epithelial dysplasia occurs when the cells of the stomach lining (called the mucosa) change and become abnormal. These abnormal cells may eventually become adenocarcinoma, the most common type of stomach cancer.

Gastric epithelial dysplasia can be divided into 2 types:

• low-grade dysplasia – The abnormal cells change and grow slowly. This type has a low risk of becoming cancer and may change back to normal (regress).
• high-grade dysplasia – The abnormal cells change and grow quickly. This type has a high risk of becoming cancer

The following risks increase your chance of developing gastric epithelial dysplasia:

• Helicobacter pylori (H. pylori) infection
• chronic atrophic gastritis – The lining of the stomach becomes thin from long-term inflammation. It is commonly caused by H. pylori or an autoimmune disease.
• intestinal metaplasia – The lining of the stomach is replaced by tissue that is normally found in the lining of the intestine. It often happens with chronic atrophic gastritis.
• pernicious anemia.

Each of these conditions causes changes in the stomach lining that can lead to the development of abnormal cells and dysplasia.

Gastric epithelial dysplasia does not cause any symptoms.

Gastric epithelial dysplasia is often found during stomach tests done for other health reasons. Tests used to diagnose gastric epithelial dysplasia may include:

• upper gastrointestinal (GI) endoscopy
• an endoscopic biopsy
• a chromoendoscopy – a special stain or pigment is used during an endoscopy to help identify the area of gastric epithelial dysplasia

Treatment options for gastric epithelial dysplasia will depend on the grade of dysplasia.

Surgery is not usually needed to treat low-grade dysplasia. The doctor will monitor you closely and do an upper gastrointestinal endoscopy and a biopsy once a year.

Treatment for high-grade dysplasia may include:

• an endoscopic resection (ER) – removing a tumour from the stomach using an endoscope and surgical tools
• a limited surgical resection – removing the section of the stomach wall that contains the abnormal area along with an area of healthy tissue (called the surgical margin)

A gastric adenoma (adenomatous gastric polyp) is a type of polyp made up of abnormal (atypical) gland cells from the stomach lining. They are often found in areas of the stomach where the normal tissue has been changed by chronic inflammation. If left untreated, a gastric adenoma could develop into adenocarcinoma, the most common type of stomach cancer.

A gastric adenoma is usually found in the lower part of the stomach (antrum). It may grow as a slightly raised area on the lining of the stomach (called a sessile polyp) or outward from the surface with a head and stalk (called a pedunculated polyp). A gastric adenoma is usually smaller than 2 cm.

Gastric adenomas are more likely to become cancerous if they:

• are larger than 2 cm
• have high-grade dysplasia
• grow with tiny, finger-like projections (villous)
• are ulcerated (an open wound)

The following risks increase your chance of developing a gastric adenoma:

• familial adenomatous polyposis (FAP)
• chronic atrophic gastritis
• intestinal metaplasia

Small gastric adenomas do not cause any signs or symptoms. Signs and symptoms may appear if the gastric adenoma grows larger and causes a blockage (obstruction) in the stomach. They may include:

• mild or vague discomfort in the upper abdomen
• digestive problems, such as nausea, vomiting, or feeling full after a small meal (early satiety)
• bleeding
• anemia

If you have symptoms or your doctor thinks you might have gastric adenoma, you will be sent for tests. Tests used to diagnose a gastric adenoma may include:

• an upper gastrointestinal endoscopy
• an endoscopic biopsy

Treatment options for gastric adenoma include:

• endoscopic removal of single polyps that are 2 cm or smaller
• an endoscopic resection (ER)
• a gastrostomy – making a cut (incision) in the stomach wall to remove polyps larger than 5 cm, many polyps or a sessile polyp
• a subtotal gastrectomy – removing part of the stomach