Unique Clinicopathology of Proximal Gastric Carcinoma: A Critical Review

Abstract

Background: Gastric cancer is a heterogeneous disease with respect to its molecular and histopathological features. Proximal gastric carcinoma (PGC) and distal gastric carcinoma (DGC) are two distinct clinical entities, suggesting the existence of different pathogenic mechanisms. PGC arises in a narrow region of the proximal stomach below the gastroesophageal junction. It accounts for around half of gastric cancers in men, with an increasing incidence worldwide and a predominance in elderly males. Summary: At present, the pathogenic mechanisms involved in the onset of PGC remain unknown. This mini-review presents the most recent findings on the pathology and natural history of this widespread and frequently fatal cancer. Key Message: PGC has unique clinicopathological characteristics distinct from esophageal adenocarcinoma and DGC. Practical Implications: Patients with a high risk for PGC, such as elderly obese men, should undergo upper endoscopy for early detection and appropriate endoscopic therapy in the early stages of disease. Once it has progressed, the cancer is more easily spread, although the current staging systems are not perfectly adapted to the disease. PGC should be staged and treated as a gastric cancer. A separate staging system and genomic studies on this cancer are urgently needed for optimal patient management and appropriate disease prevention.