Gastric Carcinomas Localized to the Cardia

Karin E Bakkelund,Ivar S Nordrum,Reidar Fossmark,Helge L Waldum

doi:10.1155/2012/457831

Abstract

Objectives. Gastric adenocarcinomas localized to the cardia are increasing. Enterochromaffin-like (ECL) cells play a role in gastric carcinogenesis in hypergastrinemia, and the use of proton pump inhibitors (PPI) leading to hypergastrinemia has increased considerably during the last decades. We have examined cardia cancers for neuroendocrine and ECL cell differentiation. Methods. Thirty-two cardia cancers were examined by immunohistochemical labelling of chromogranin A (CgA), synaptophysin, serotonin, and histidine decarboxylase (HDC). Information about PPI use was collected from the patient records. Results. In 15 of 32 tumours, there were positive signs for one or several neuroendocrine markers. Five cases were CgA and serotonin positive; three of these carcinomas were also positive for HDC. Three patients were long-term users of PPI, and two of these were immunoreactive for neuroendocrine markers. Conclusions. A high proportion of cardia cancers expressed neuroendocrine markers, but only few patients with cardia cancers were using PPI.

Highlights

Gastric adenocarcinoma has shown a marked decline in the last decades [1]
Gastric carcinomas in the cardiac region have shown an unexplained increase in frequency [2,3,4,5,6], and it was of interest to see if this increase could be related to use of pump inhibitors (PPI)
Carcinomas developing in hypergastrinemic patients are immunoreactive for neuroendocrine markers, and we examined cardia cancers for such markers

Summary

Introduction

Gastric adenocarcinoma has shown a marked decline in the last decades [1]. There seems to be an increase in carcinomas localized to the cardia [2,3,4,5], especially in younger women and older men [6]. Little is known about the mechanisms for the development of cardia cancers. Adenocarcinomas of the esophagus and cardia share some epidemiological features, including incidence trends and sex distribution [9], but could have different risk factors. Oesophageal carcinoma is associated with reflux disease, obesity, hiatal hernia, and smoking, but these factors may have weak or no association with cardia cancer [10,11,12,13]

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Conclusion