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Thursday, May 23, 2013
Risk of Esophageal and/or Stomach Cancer
Hello. I would really appreciate your opinion on some problems I am having. First I want to establish that my Dad died at 40 years of age from stomach and esophagus cancer.
I was diagnosed in April with chronic gastritis and GERD. Also, my EGD showed multiple antral, duodenum, and Esophageal ulcers. Biopsies came back as squamous mucosa with edema and basal cell hyperplasia in esophagus and intestinal metaplasia in the stomach.
Does this place me in a higher risk bracket of developing what my dad died of? He was diagnosed with many of the same things. He was diagnosed in August 1986 at age 39. He died in September, 1987. I have done so much research and unfortunately it all points to cancer. I was told by a doctor that you only get this kind of cancer if you smoke and drink. I am 36 and have never smoked and may have 2-3 drinks per year. Your response would be greatly appreciated. Thank you.
You should first discuss with your gastroenterologist his or her interpretation of the biopsies from your EGD. It does appear that you have some high risk features that suggest you might be at increased risk for gastric cancer. However, bear in mind that these features do not mean that gastric cancer is inevitable. There are now more options available to potentially reduce your chance of developing gastric cancer than may have been available to your father. If your gastroenterologist has not discussed these with you, you may wish to schedule another appointment with him or her and find out whether there are options for you to consider.
We have learned that there are a number of factors that influence whether someone will develop cancer. Among these generally are environmental factors and genetic factors. Smoking and alcohol consumption have been implicated as two environmental factors that significantly increase one's risk to develop gastric cancer. However, we have also learned that chronic gastric infections with Helicobactor pylori (H.pylori) also increase the risk for gastric cancer. In one study, it was reported that of 100 subjects with H.pylori infections, 50 will develop chronic atrophic gastritis, 40 will develop intestinal metaplasia, 8 will develop dysplasia and 1-2 will develop gastric cancer. Overall, the chance to develop gastric cancer, even in individuals with intestinal metaplasia, is not extraordinarily high.
One other thing to consider is that there may be a strongly hereditary component to your father's cancer. It has been found that families with hereditary non-polyposis colorectal cancer susceptibility (HNPCC) have an increased lifetime risk for early onset colon, gastric, uterine and ovarian cancers. A few rare families with hereditary breast and ovarian cancer susceptibility have also been found to have increased risk for gastric cancer. I encourage you to consider meeting with a genetic counselor or a medical geneticist to discuss whether your family history is suggestive of a hereditary form of cancer susceptibility, and to review options for cancer risk reduction. You can find a genetic counselor by visiting the website for the National Society of Genetic Counselors or the National Cancer Institute.
Duane D Culler, PhD, MS
Clinical Instructor of Genetics
School of Medicine
Case Western Reserve University