Detection, Surveillance and Treatment of Pre-malignant Gastric Lesions related to Helicobacter pylori Infection

Gastric cancer is the fourth most common cancer and second leading cause of cancer-related death worldwide. The highest incidences are observed in Eastern Asia, Eastern Europe and South America, whereas the incidence in Western countries is much lower. For example, in Japan, the incidence of gastric cancer is approximately 44.1 cases/100 000 persons/year (world standardized rate, WSR). In comparison, in the Netherlands, the incidence of gastric cancer is relatively low with approximately 6.9 cases/100 000 persons/year (WSR). The incidence of gastric cancer is declining, in particular in Western countries. However, the absolute number of new cases per year increases, due to aging of the world population and expansion of the population in developing countries with a high gastric cancer incidence. As symptoms are often absent or non-specific in patients with an early stage of disease, gastric cancer is usually diagnosed at an advanced stage. In advanced gastric cancer, curative options are frequently limited and in these cases only palliative treatment can be offered. During palliative treatment, most responses to chemotherapy are partial and of short duration, rendering a relatively small effect on survival. Consequently, gastric cancer carries a poor prognosis, with an overall five-year survival rate of less than 20 percent. In order to reduce its mortality, detection and intervention in an early stage are essential for gastric cancer prevention. Gastric cancer is a heterogeneous disease with a complex pathogenesis. Proximal gastric carcinomas have probably a mixed etiology, partly related to the etiology of distal esophageal carcinomas and partly to the etiology of distal gastric cancer. The vast majority of distal gastric malignancies are adenocarcinomas, which are commonly divided into intestinal type and diffuse (undifferentiated) type carcinomas. Intestinal type gastric carcinomas account for at least 60 to 75 percent of cancers

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Effective Protection of Fundamental Rights in a pluralist worldCoherent privaatrech

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Effective Protection of Fundamental Rights in a pluralist worl