title: Hereditary diffuse gastric cancer: diagnosis and management.
abstract: Hereditary diffuse gastric cancer (HDGC) is a familial cancer syndrome defined by germline mutation of the E-cadherin gene (CDH-1). The cumulative risk for advanced gastric cancer in HDGC is 67% in men and 83% in women by 80 years of age. Early HDGC is characterized by multiple microscopic foci of intramucosal signet-ring cell carcinoma. The time to progression of these foci appears to be variable and currently is not predictable--the carcinoma foci may remain confined to the mucosa for many years. The management options for mutation carriers include prophylactic gastrectomy or surveillance gastroscopy. The only extensive published surveillance experience used chromogastroscopy, which detected early HDGC foci not visible on white-light endoscopy. The use of new techniques such as confocal microscopy, spectroscopy, or autofluorescence may prove useful, but have not been studied in HDGC. In patients up to 20 years of age, the risk for gastric cancer is less than 1%; this risk is outweighed by the mortality and morbidity associated with total gastrectomy. It is therefore recommended that genetic testing should occur at 16 years of age and that annual surveillance chromogastroscopy also should begin at age 16 in identified CDH-1 mutation carriers. After 20 years of age, delaying prophylactic gastrectomy carries significant risk, particularly if the alternative is surveillance by white-light gastroscopy. Surveillance chromogastroscopy (Congo red/methylene blue technique) should be considered for individuals younger than 20 years and patients unwilling to undergo prophylactic gastrectomy. Sufficient evidence for an increased risk for lobular breast cancer in CDH-1 carriers exists to justify breast screening in female carriers older than 35 years of age, however, evidence is insufficient to recommend prophylactic mastectomy.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand. vblair@auckland.ac.nz
authors.forename: Vanessa
authors.initials: V
authors.lastname: Blair
authors.forename: Iain
authors.initials: I
authors.lastname: Martin
authors.forename: David
authors.initials: D
authors.lastname: Shaw
authors.forename: Ingrid
authors.initials: I
authors.lastname: Winship
authors.forename: Dale
authors.initials: D
authors.lastname: Kerr
authors.forename: Julie
authors.initials: J
authors.lastname: Arnold
authors.forename: Pauline
authors.initials: P
authors.lastname: Harawira
authors.forename: Maybelle
authors.initials: M
authors.lastname: McLeod
authors.forename: Susan
authors.initials: S
authors.lastname: Parry
authors.forename: Amanda
authors.initials: A
authors.lastname: Charlton
authors.forename: Michael
authors.initials: M
authors.lastname: Findlay
authors.forename: Brian
authors.initials: B
authors.lastname: Cox
authors.forename: Bostjan
authors.initials: B
authors.lastname: Humar
authors.forename: Helen
authors.initials: H
authors.lastname: More
authors.forename: Parry
authors.initials: P
authors.lastname: Guilford
mesh_terms: D015820:Cadherins / Q000235:genetics; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*; D003663:Decision Trees; D018095:Germ-Line Mutation; D006801:Humans; D009386:Neoplastic Syndromes, Hereditary; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*
chemical_list: D015820:Cadherins