Stomach Cancer: How to Know When to Undergo a Gastroscopy

Obesity, consumption of processed meats and preserved foods, little fruit and vegetables, and also Helicobacter pylori infections, gastric polyps, family history. Several risk factors are known that predispose to the risk of stomach cancer, a disease too often diagnosed only in the late stage and therefore with a low 5-year survival rate (just over 30%). This is why a screening program that includes a gastroscopy could change the history of this neoplasm, especially if targeted to people most at risk of developing the disease.

To find them, a questionnaire like GastroForm could be helpful, part of the “ Gastroscreening ” project by RicerChiAmo Onlus in collaboration with the Municipality and the University of Brescia, and which will soon be validated in a scientific study.

A questionnaire to estimate the risk of disease

The announcement of the start of the study was made in Brescia during the National Conference “Road to Gastroscreening/3”, and is the last phase of a project that began a few years ago and involved several specialists and several facilities. “Many questions - explained Silvano Gallus , head of the Lifestyle Research Laboratory at the Mario Negri Institute in Milan, who took part in the project - focus on personal and family pathological history and lifestyles, such as alcohol consumption, cigarette smoking and physical activity. A large section of the questionnaire is also dedicated to eating habits, investigating the frequency of consumption of foods associated in the literature with a higher risk of developing gastric cancer, such as processed meats or salty foods. Or lower, such as fruit, vegetables and whole grains. This approach allows us to estimate individual risk on the basis of known epidemiological factors, offering a useful tool for orienting early diagnosis strategies”.

Who is gastroscopy useful for?

The idea of ​​a questionnaire to identify those most at risk responds to the need to identify those who can benefit most from a gastroscopy to detect gastric tumors in the early stages, explained Gian Luca Baiocchi , co-founder and scientific director of RicerChiAmo Onlus, director of General Surgery at the Asst of Cremona and full professor of General Surgery at the University of Brescia: "We started from the need to identify a first-level, non-invasive, very low-cost and relatively specific test for this neoplasm, for an initial evaluation of the population at risk, to whom gastroscopy can then be recommended. Only in this way is it possible to increase the number of early diagnoses". Once the questionnaire has been developed, the next step is therefore its validation, with a study at 10 digestive endoscopy centers throughout Italy, where it will be administered to people who have already had an indication for gastroscopy.

Risk factors: from gastric reflux to chronic gastritis, to Nin

“The primary objective is, in patients at risk, the identification of a group of pre-tumor lesions - continued Baiocchi - They are represented by Barrett's esophagus, caused by gastroesophageal reflux, by chronic atrophic gastritis with intestinal metaplasia, a type of gastritis at risk of developing cancer, and by Nin ( noninvasive neoplasia ), that is, the modification of cells that can lead to cancer. Patients who present these lesions must undergo frequent checks.

Today, about 8% of these pre-neoplastic lesions are identified with gastroscopy. Thanks to GastroFORM, we can reach a percentage of 40%. An effective comparison is the intestinal polyps identified during colonoscopy and eliminated thanks to this test, before they become tumors”.

Biopsies can also be performed during gastroscopy, as Roberto Grassia , head of Gastroenterology and Digestive Endoscopy at the Asst of Cremona, recalled: “Gastroscopy performed during screening must be a 'quality' exam that includes preparation and sedation of the patient, the use of high-definition instruments that allow the identification of very small changes in the gastric mucosa, a minimum observation time, equal to 7 minutes according to oriental literature, the possibility of performing biopsies, an adequate histological evaluation and, obviously, the experience of the operator”.

A tool to support screening

In Italy, in 2024, there were more than 14,000 diagnoses of stomach cancer. A disease, Baiocchi recalled, that still has a high impact today. “In December 2022, the European Council issued new recommendations on cancer screening, suggesting its extension to lung, prostate and stomach. Our project fits into this context. After the scientific validation of the questionnaire, we will propose GastroFORM to scientific societies and institutions”. Institutions that support the project, as recalled by the Councilor for Education of the Lombardy Region Simona Tironi , who spoke at the conference: “The health institutions of the Lombardy Region look with great interest at scientific studies that aim to improve public health through screening policies. For stomach cancer, unlike other tumor diseases, we are far from having found a good solution for early diagnosis”.