Precancerous conditions of the stomach

Precancerous conditions of the stomach are changes to stomach cells that make them more likely to develop into cancer. These conditions are not yet cancer. But if they aren’t treated, there is a chance that these abnormal changes may become stomach cancer.

Gastric epithelial dysplasia

Gastric epithelial dysplasia occurs when the cells of the stomach lining (called the mucosa) change and become abnormal. These abnormal cells may eventually become adenocarcinoma, the most common type of stomach cancer.

Gastric epithelial dysplasia can be divided into 2 types:

• low-grade dysplasia – The abnormal cells change and grow slowly. It has a low risk of becoming cancer and may change back to normal (regress).
• high-grade dysplasia – The abnormal cells change and grow quickly. It has a high risk of becoming cancer.

Risk factors

The following risk factors increase your chance of developing gastric epithelial dysplasia:

• H. pylori (Helicobacter pylori) infection
• chronic atrophic gastritis – the lining of the stomach becomes thin, or atrophies, due to long-term inflammation of the stomach, called gastritis
• intestinal metaplasia – the lining of the stomach is replaced by tissue that is normally found in the lining of the small and large intestines
• pernicious anemia

Each of these conditions causes changes in the stomach lining that can lead to the development of abnormal cells and dysplasia.

Signs and symptoms

Gastric epithelial dysplasia does not cause any signs or symptoms.

Diagnosis

Gastric epithelial dysplasia is often found during stomach tests, such as an upper gastrointestinal endoscopy, done for other health reasons. Tests used to diagnose gastric epithelial dysplasia may include:

• upper gastrointestinal endoscopy
• endoscopic biopsy 
• chromoendoscopy (a special stain or pigment is used during an endoscopy to help identify the area of gastric epithelial dysplasia)
• endoscopic ultrasound

Treatments

Treatment options for gastric epithelial dysplasia will depend on the grade of dysplasia.

Low-grade dysplasia

Surgery is not usually needed to treat low-grade dysplasia. The doctor will closely monitor you and do an upper gastrointestinal endoscopy and a biopsy once a year.

High-grade dysplasia

Treatment for high-grade dysplasia may include:

• endoscopic mucosal resection (removal of the area during an endoscopy)
• limited surgical resection (removal of the area along with a section of healthy tissue)

Gastric adenoma

Gastric adenoma (adenomatous gastric polyp) is a type of polyp made up of abnormal (atypical) glandular cells from the stomach lining. They are found in areas of the stomach where the normal tissue has been changed by chronic inflammation. If left untreated, a gastric adenoma could develop into adenocarcinoma, the most common type of stomach cancer.

Gastric adenoma is usually found in the antrum of the stomach. It may grow as a slightly elevated area on the lining of the stomach (sessile) or outward from the surface with a head and stalk (pedunculated). A gastric adenoma usually measures less than 2 cm in size. Gastric adenomas are more likely to become cancerous if they:

• are larger than 2 cm
• have high-grade dysplasia
• grow with tiny, finger-like projections (villous)
• are ulcerated (have the appearance of an open sore)

Risk factors

The following risk factors increase your chance of developing gastric adenoma:

• familial adenomatous polyposis (FAP) – an inherited condition that causes hundreds to thousands of polyps to develop on the lining of the colon and rectum as early as adolescence
• chronic atrophic gastritis – the lining of the stomach becomes thin, or atrophies, due to long-term inflammation of the stomach, called gastritis
• intestinal metaplasia

Signs and symptoms

Small gastric adenomas do not cause any signs or symptoms. Signs and symptoms may appear if the gastric adenoma grows larger and causes a blockage (obstruction) in the stomach. They may include:

• mild, vague upper abdominal discomfort
• digestive problems such as nausea, vomiting, feeling full after a small meal (early satiety) or difficulty swallowing
• bleeding
• anemia

Diagnosis

If you have symptoms or your doctor thinks you might have gastric adenoma, you will be sent for tests. Tests used to diagnose gastric adenoma may include:

• physical exam
• ultrasound
• upper gastrointestinal endoscopy
• endoscopic biopsy

Treatments

Treatment options for gastric adenoma include:

• endoscopic removal of the polyp (used for single polyps that are 2 cm or smaller)
• endoscopic mucosal resection
• gastrostomy (uses an incision, or a surgical cut, in the stomach wall to remove polyps larger than 5 cm, many polyps or a sessile polyp)
• partial gastrectomy (removes part of the stomach in people who cannot have a gastrostomy)