New research from Rhode Island Hospital may help predict outcomes for stomach cancer patients

July 17, 2008

Study identifies possible markers for cancer prognosis

PROVIDENCE, R.I. - Researchers at Rhode Island Hospital have identified two potential molecular markers that may predict outcomes for patients with stomach cancer, one of the most common and fatal cancers worldwide.

According to the study, published in the July 1 issue of Clinical Cancer Research, patients who had poor outcomes following surgery for stomach cancer also had extremely low amounts of two proteins, known as gastrokine 1 and 2 (GKN1 and GKN2), which are produced by normal stomach cells.

The study's findings confirm previous research showing that once stomach cells become cancerous, they manufacture very low amounts of GKN1 and GKN2. However, this is the first known study to link these low protein levels with outcomes following stomach cancer surgery. Researchers say this discovery could eventually help physicians better determine and individualize therapy for stomach cancer, including which patients should be offered chemotherapy and other treatments in addition to surgery.

"Unfortunately, stomach cancer is difficult to cure unless it's discovered early, but because the early stage of the disease has very few symptoms, the cancer is usually advanced by the time it's diagnosed," says lead author Steven Moss, MD, a gastroenterologist with Rhode Island Hospital and an associate professor of medicine at The Warren Alpert Medical School of Brown University.

"That's what makes our findings so significant, because if the potential markers identified in our study can help predict a patient's prognosis, we can decide right away which course of action to take and hopefully help patients live longer and more comfortably," he adds.

According to the National Cancer Institute, approximately 760,000 cases of stomach cancer are diagnosed worldwide each year. Microscopically, stomach cancers can be subdivided into those which appear "diffuse" (a more aggressive form of cancer that can occur throughout the stomach and is more likely to spread) or "intestinal" (resembling the cells normally found only in the small or large intestines). Stomach cancers of both types are often triggered by a chronic infection brought on by Helicobacter pylori (H. pylori), a common bacterium that causes stomach inflammation and ulcers. Surgery is the most common treatment for stomach cancer and can include partial or full removal of the stomach. The five-year relative survival rate of patients with stomach cancer is 24 percent.

Moss, an expert on H.pylori, and colleagues initially set out to learn more about what the bacterium does to normal stomach cells. They focused on GKN1 and GKN2 because these proteins are also suppressed by stomach infections caused by H. pylori.

After looking at tissue samples from more than 150 stomach cancer patients who underwent surgery, the researchers discovered a near total suppression of GKN1 and GKN2 in the majority of patients. This was particularly evident in those patients with the diffuse variant of stomach cancer. More than three-quarters of these patients had extremely low levels of GKN1 and 85 percent had nearly nonexistent levels of GKN2.

Furthermore, in those patients with the intestinal variant of stomach cancer, very low levels of GKN 1 or GKN 2 at the time of surgery were associated with a significantly worse outcome. The median survival was about two years in these patients compared to a survival of more than 10 years for patients with normal levels of GKN1 or GKN2.

Researchers do not yet know the exact function of GKN1 and GKN2. They say further studies are needed to demonstrate the mechanisms responsible for the loss of GKN1 and GKN2 in this patient popoulation as well as the clinical biomarker potential of these two proteins.

The study included tissue samples from 155 patients with stomach cancer (81 men and 74 women) who underwent surgery at Rhode Island Hospital and The Miriam Hospital, both in Providence, R.I. The average age at surgery was 72 years. All four stages of cancer were represented in the study, including 37 patients with Stage I, 44 patients with Stage II, 34 patients with Stage III, and 40 patients with Stage IV. More than 61 patients were being treated for the intestinal variant of stomach cancer while 90 patients had the diffuse variant.

Lifespan

---

---

	John Hopkins Patients' Guide to Cancer of the Stomach and Esophagus (Johns Hopkins Patients' Guide) by Mark D. Duncan (Author) Johns Hopkins Patients' Guide to Cancer of the Stomach and Esophagus is a concise, easy-to-follow how to guide that puts you on a path to wellness by explaining stomach and liver cancer treatment from start to finish. It guides you through the overwhelming maze of treatment decisions, simplifies the complicated schedule that lies ahead, and performs the task of putting together your plan of care in everyday terms. Empower yourself with accurate, understandable information that will give you the ability to confidently participate in the decision making about your care and treatment.
	100 Q&A About Gastric Cancer (100 Questions & Answers about . . .) by Manish A. Shah (Author) About 21,700 Americans are diagnosed with stomach cancer each year and it occurs most often in people in their 60s and 70s. Whether you're a newly diagnosed patient with gastric cancer or a friend or relative of someone with cancer, this book offers help. This book is an invaluable resource for anyone coping with the physical and emotional turmoil of this disease. The author Dr. Shah is from Memorial Sloan-Kettering Cancer Center, one of the few National Cancer Institute-designated cancer centers with a specific program in treating cancers of the upper gastrointestinal tract and has made many of the major advances in the treatment of these diseases.
	Stomach Cancer: Your Way Forward by Abaco Publishing You will never cure anything if you don’t do something about the underlying cause. This applies to every illness including stomach cancer. In my book ‘Stomach Cancer – Your Way Forward’ I explain why it may have developed, giving you something to do to change the underlying causes and bring things under control. It is almost definitely associated with the organism Helicobacter pylori, associated with bad eating habits, a poor immune system, infections, too many antibiotics, toxic chemicals, geopathic stress and certainly stresses of everyday life affecting your emotions. When cancer declares itself, it could have been developing for ten or fifteen years. All of this is explained to you in detail as though you are with me in my consulting room. I then give ideas on how to change...
	What You Always Wanted To Know About Stomach Cancer by Jazzybee Publishing "What You Always Wanted To Know About..." are fully researched, straight-to-the-point, easily understandable and most comprehensive medical ebooks and guides for everybody. Whether you are just interested in the topic of the book or you are directly affected by it, these books can really help you with the information you need. All books including interactive tables-of-contents, this is your step toward new insights and informations. The contents of this book: General Information About Stomach (Gastric) Cancer Stages of Gastric Cancer Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV Recurrent Gastric Cancer Treatment Option Overview Surgery Chemotherapy Radiation...
	Breast Cancer and Iodine : How to Prevent and How to Survive Breast Cancer by Ph.D. Dr. David Derry M.D. (Author) This book is about cause, prevention and treatment of breast cancer. Breast cancer has two phases. The first one, from abnormal cells up to carcinoma in situ reverses with iodine. The second phase, invasion, is controlled by connective tissue thyroid hormone.
	Advances in Surgical Pathology: Gastric Cancer by Dongfeng Tan (Editor), Gregory Lauwers (Editor) Advances in Surgical Pathology: Gastric Cancer provides a concise, updated review of the pathological characteristics of gastric cancer, with an emphasis on exploring practical issues and recent developments. The book features current and emerging concepts in the field of gastric cancer, a disease whose management requires a multidisciplinary approach in which pathology plays a key role. Its six sections cover the essential histopathology of gastric cancer as well as related topics such as imaging evaluation, molecular diagnosis, and personalized treatment, among other areas of interest. Individual chapters written by international experts in the fields of pathology, gastrointestinal medical oncology, cancer epidemiology, and gastrointestinal radiology, address the fundamental issues...
	Gastric Cancer (Contemporary Issues in Cancer Imaging) by Richard M. Gore (Editor) Gastric adenocarcinoma is the second most common cancer worldwide. It is usually diagnosed at a late stage and prognosis is poor; even with modern diagnostic and treatment methods the 5-year survival is only 10%. Improvements in overall patient survival can only be achieved by earlier diagnosis and by tailored therapeutic strategies based on tumor type, location and stage at presentation. This volume provides a state-of-the-art, integrated diagnostic and therapeutic approach to patient management. The role of the upper GI series, endoscopy, endoscopic ultrasound, MDCT, MRI, and PET/CT in the diagnosis, staging and follow-up of patients with gastric cancer is emphasized. The relative strengths and limitations of these diagnostic examinations will be presented in context with the most...
	Stomach Cancer - Enhanced Edition: Learn What Is Cause, Risk Factors, Symptoms, Diagnosis, Treatment and Health Care (Annotated and Illustrated) by MedHealth Stomach Cancer - Enhanced Edition: Learn What Is Cause, Risk Factors, Symptoms, Diagnosis, Treatment and Health Care (Annotated and Illustrated) provides you overall information about brain tumor. This book was written by Medical Professionals from National Cancer Institute with scientific details. You will learn the cause, risk factors, symptoms, treatments, etc that will helpful for both readers who are interesred in health and whoever have a member in family suffer from cancer. Moreover, this edition of the book includes; - Eating Hints: Before, During, and After Cancer Treatment - Follow-up Care After Cancer Treatment - How To Find a Doctor or Treatment Facility If You Have Cancer - Facing Forward: Life After Cancer Treatment -...
	The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee (Author) The Emperor of All Maladies is a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence. Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with—and perished from—for more than five thousand years. The story of cancer is a story of human ingenuity, resilience, and perseverance, but also of hubris, paternalism, and misperception. Mukherjee recounts centuries of...
	Dx/Rx: Upper GI Cancer by Manish A. Shah (Author) Tightly Organized Into A Super-Condensed, Outline Bulleted Format, This Handy, Pocket-Sized Manual Details Precise, Up-To-Date Information For Diagnosis And Treatment Of Esophageal And, Gastric Cancers. Comprehensive And Concise, The Book Covers Epidemiology, Diagnosis, Staging, Treatment, And Complications. Throughout The Handbook, Tables And Figures Summarize Important Clinical Data And Current Professional Society Recommendations, While Salient References Direct Readers To Additional Information. Current, Quick, And Concise, For Instant Access On Ward Or In The Clinic!