1. ELIAS Ca stomach Risk factors

2. Gastric cancers show two morphologic types Intestinal; Arise from gastric mucous cells that have undergone intestinal metaplasia following chronic gastritis. Well differentiated More common type in high-risk populations Diffuse; Arises de novo from native gastric mucous cells not associated with chronic gastritis Poorly differentiated

3. Pathogenesis of ca stomach Risk is high in individuals with chronic gastritis Gastritis leads to gastric atrophy and intestinal metaplasia This leads by dysplasia and cancer. Chronic inflammation by H. pylori causes of release reactive oxygen species, which cause DNA damage leading to an imbalance between cell proliferation and apoptosis, in areas of tissue repair.

4. Gender: Stomach cancer is more common in men than in women. Estrogen is thought to be protective from chronic gastric inflammation that can lead to cancer Difference in lifestyle such as smoking, diet

5. Race stomach cancer is more common in Hispanic Americans, African Americans, and Asian Pacific Islanders than it is in non-Hispanic whites.

6. Age: Risk increases with age. Average age of people when they are diagnosed is 55years About 6 of every 10 people with stomach cancer each year are 65 years or older

7. Region: Worldwide, stomach cancer is more common in  Japan,  China  korea  Southern and  Eastern Europe  South and Central America. Less common in Northern and Western Africa, South Central Asia, and North America.

8. Infection with Helicobacter pylori major risk factor for gastric carcinoma. H. pylori is associated with a two to sixfold increase in the risk of developing Gastric Cancer. Other infections; Epstain Barr Virus – found in the cancer cells of about 5- 10%of people with stoamch cancer

9. Diet: Nitrates and nitrites found in  Salted  smoked  and dried foods lead to atrophic Gastritis which in turn leads to Gastric Cancer. The risk is lowered by eating lots of fresh fruits and vegetables

10. Tobacco use Smoking increases the risk by 50% to 60% Smoking tobacco is responsible for 11% of all Stomach Cancers worldwide. Decreases the levels of Carotenoids and Vitamin C which are protective Associated with H. pylori infection which leads to Atrophic Gastritis.

11. Pernicious anemia Impaired absorption of vitamin B12 in the terminal ileum due deficient production of intrinsic factor in the stomach People with pernicious aneamia have increased occurrence of gastirc polyps which increase the risk of gastric cancer

12. Menetrier disease Gross hypertrophy of the gastric mucosal folds, mucus production and hypochlorhydria. The condition is pre-malignant and may present with hypoproteinaemia and anaemia. Treatment; gastrectomy.

13. occupation: Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer.

14. Family history People with close family members (parents, siblings, and children) who have had stomach cancer are more likely to get this disease. Attributed to genetic inherited mutations

15. genetics BRAC1 and BRAC2 E- cadherin/CDH1 Lynch syndrome Familial adenomatous polyposis(FAP)

16. Earlier stomach surgery people who have had previous stomach surgery for other pathology like ulcers have a higher risk of stomach cancer.

17. stomach polyp stomach polyps; denomatous or adenoma transform into cancer.

18. Others Type A blood Certain inherited cancer syndromes Common variable immunodeficiency; the immune system can’t make enough antibodies in response to germs Being overweight or obese

19. So can we prevent gastric cancer Smoking avoidance or cessation. Diets rich in fruit, vegetables and fiber. Avoidance of salted, smoked and poorly preserved foods. Erradication of H. pylori Mass screening in high risk populations. In Japan gas-contrast Stomach Fluorography is done in the mass population Those considered abnormal (about 13%) will undergo further studies, including endoscopy and biopsy