Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2012; 4(7): 156-169
Published online Jul 15, 2012. doi: 10.4251/wjgo.v4.i7.156
Carcinoma of the stomach: A review of epidemiology, pathogenesis, molecular genetics and chemoprevention
Siddavaram Nagini
Siddavaram Nagini, Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
Author contributions: Nagini S solely contributed to this paper.
Supported by A Grant from the Department of Biotechnology, New Delhi, India under the 7th FP of the Indo-EU Joint Collaborative Project on “FUNCFOOD”
Correspondence to: Siddavaram Nagini, Professor, Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India. snlabau@gmail.com
Telephone: +91-4144-239842 Fax: +91-4144-238145
Received: November 11, 2011
Revised: June 4, 2012
Accepted: June 12, 2012
Published online: July 15, 2012

Carcinoma of the stomach is still the second most common cause of cancer death worldwide, although the incidence and mortality have fallen dramatically over the last 50 years in many regions. The incidence of gastric cancer varies in different parts of the world and among various ethnic groups. Despite advances in diagnosis and treatment, the 5-year survival rate of stomach cancer is only 20 per cent. Stomach cancer can be classified into intestinal and diffuse types based on epidemiological and clinicopathological features. The etiology of gastric cancer is multifactorial and includes both dietary and nondietary factors. The major diet-related risk factors implicated in stomach cancer development include high content of nitrates and high salt intake. Accumulating evidence has implicated the role of Helicobacter pylori (H. pylori) infection in the pathogenesis of gastric cancer. The development of gastric cancer is a complex, multistep process involving multiple genetic and epigenetic alterations of oncogenes, tumor suppressor genes, DNA repair genes, cell cycle regulators, and signaling molecules. A plausible program for gastric cancer prevention involves intake of a balanced diet containing fruits and vegetables, improved sanitation and hygiene, screening and treatment of H. pylori infection, and follow-up of precancerous lesions. The fact that diet plays an important role in the etiology of gastric cancer offers scope for nutritional chemoprevention. Animal models have been extensively used to analyze the stepwise evolution of gastric carcinogenesis and to test dietary chemopreventive agents. Development of multitargeted preventive and therapeutic strategies for gastric cancer is a major challenge for the future.

Keywords: Chemoprevention, Diet, Epidemiology, Epigenetic changes, Gastric cancer, Genetic alterations, Helicobacter pylori, Risk factors