Pathogenesis and prevention of gastric cancer

Background: Gastric cancer still has a high worldwide incidence as well as a dramatically poor prognosis. Although genome-wide transcript analyses and sequencing projects have enabled a better phenotypic description, this could not yet be translated into clinical benefit. Objective: The aim of this article is to give an overview of the current biological understanding of gastric cancer and the possibilities for prevention. Materials and methods: A comprehensive literature research within PubMed®/MEDLINE® (U.S. National Library of Medicine®, Bethesda, MD, USA) was undertaken. Results: The integration of multiple data levels into new classification systems has been a focus of the biological characterisation of gastric adenocarcinomas in recent years. The Cancer Genome Atlas (TCGA) consortium introduced a model of 4 phenotypes, demonstrating that oesophageal adenocarcinomas also correspond phenotypically to gastric cancer. The possibility of transfer into clinical application has yet to be confirmed. Apart from the increasing relevance of Epstein–Barr virus infection, Helicobacter pylori remains the most important risk factor for gastric cancer. Eradication for prophylaxis of gastric cancer can still have an effect even in cases of more advanced mucosal transformation, although development of intestinal metaplasia seems to be the milestone marking the point of no return. Conclusion: The TCGA classification has imparted important new knowledge on gastric cancer biology. However, the histopathological classification by Laurén still remains the clinical standard. Eradication of Helicobacter pylori is the most important target of global prevention strategies.