Helicobacter pylori, a bacterium that infects millions of people, is responsible for most cases of gastric cancer. Experts explain the role of chronic infections, genetics and lifestyles in the increase in gastrointestinal cancers even among the youngest.
For many it is just a burning sensation after dinner. Difficult digestion, a feeling of heaviness, some episodes of reflux that go away with an antacid purchased at the pharmacy. Yet behind apparently trivial symptoms one of the most important may hide oncological risk factors known to modern medicine. Is called Helicobacter pyloriinfects about the 40% of the Italian population and is considered responsible for approximately the 90% of gastric cancer cases in the world. The bacterium colonizes the stomach and can remain silent for years. In many subjects it does not cause any obvious symptoms, but in others it triggers a chronic inflammatory process that can evolve into gastritis, peptic ulcer and gastric carcinoma. Smoking, alcohol, obesity, diet poor in fruit and vegetables and frequent consumption of preserved foods further increase the risk. The problem is that the stomach cancer continues to be diagnosed too late. Every year in Italy approximately 14,500 new cases of gastric cancerbut only one in five patients receives a diagnosis in the initial stages of the disease, when the chances of recovery are much higher. In most cases the tumor is discovered when it already exists locally advanced or metastatic. According to specialists, part of the responsibility is linked to the growing diffusion ofself-medication. Antacids and proton pump inhibitors they are among the drugs most used by Italians and are often taken for long periods without a real diagnostic evaluation. The risk is to mitigate the symptom without identifying its cause. Hence the appeal of the scientific community: Don’t ignore persistent gastric discomfortavoid prolonged use of over-the-counter medicines without medical advice and, when indicated, carry out simple and non-invasive tests to detect Helicobacter pylori before it causes irreversible consequences.
Stomach cancer in young people: the role of Helicobacter, genetics and new therapies
In recent years, oncologists’ attention has focused on an unexpected phenomenon:increase in gastric cancers in under 50s. Although the disease continues to be more frequent in older ages, cases diagnosed under the age of 50 are attracting growing interest from international research. According to the professor Riccardo Rosati, head of Gastroenterological Surgery IRCCS San Raffaele Hospital and professor of Surgery at the Vita-Salute San Raffaele Universitytwo factors emerge with particular force. «The main factors are theHelicobacter pylori infection and the mutation of the CDH1 genewhich are both risk factors for the development of gastric cancer, especially in widespread variantwhich represents the most biologically aggressive form”. Particularly insidious is the mutation of the CDH1 generesponsible for a hereditary form known as Hereditary Diffuse Gastric Cancer (HDGC).
«These situations are often identified starting from a patient who develops cancer before the age of 40. At that point, family members are studied and real family lines carrying the genetic mutation are discovered. In some cases we even get to prophylactic gastrectomy to prevent the onset of the disease.” Prevention, however, does not only come through genetics. Rosati draws attention to the profound differences between East and West. «South Korea, China and Japan have a very high incidence of gastric cancer and for this reason they have introduced screening programs with gastroscopy every two years starting from the age of 40. This allows us to diagnose many more tumors at an early stage and obtain completely different results in terms of survival.” In Western countries the situation is very different. «In Europe and the United States we see most cancers in the form locally advanced or metastatic precisely because, as there is a lower incidence of this neoplasm, there are no structured screening programs like the oriental ones”.
If the early diagnosis remains the most effective weapon, but research is also profoundly changing the treatment of the disease. «In recent years we have witnessed a real revolution thanks to molecular characterizations of the tumor. Today we no longer only have surgery and chemotherapy, but also… immunotherapy and agents directed against specific biological targets.” According to Rosati, around 30-40% of patients presents molecular alterations that can be affected with personalized treatments. Even some patients with limited metastases, who until a few years ago were destined exclusively for palliative care, can now benefit from integrated strategies that combine chemo-immunotherapy and surgery.
More and more gastrointestinal cancers in the under 50s: the alarm of specialists and the challenge of prevention
If stomach cancer represents one of the most worrying aspects of the problem, the phenomenon actually concerns the whole digestive system. The data coming from Dana-Farber Cancer Institute and from other important international centers show an increase in early-onset gastrointestinal tumors in people born after 1990. For Antonino Spinelli, director of the Colon and Rectal Surgery Unit at Humanitas Research Hospital and Full Professor of Surgery at Humanitas Universitythe explanation cannot be traced back to a single cause. «The answer, as often happens in medicine, is not to be found in a single factor, but in the complex interaction of multiple elements. On the one hand we observe increasingly westernized lifestylescharacterized by diets low in fiber and rich in ultra-processed foodssugars and red meat, sedentary lifestyle, obesity and alterations of intestinal microbiome. On the other hand, we are understanding that these early-onset tumors may have specific biological characteristics and, in some cases, be more aggressive.” According to the specialist, the challenge of the future will be to build one personalized prevention. «We are identifying disease subgroups driven by specific molecular mechanisms. The objective is to combine primary prevention, based on lifestyle, with a increasingly targeted secondary prevention». Particularly important is the theme of colorectal cancer screening. «In the United States the age for starting screening has already been lowered to 45 years oldbut this is not enough. Only one in five adults between the ages of 45 and 49 participates in prevention programs. We must overcome the idea that these tumors only affect the elderly.” Spinelli also draws attention to the symptoms not to be underestimated. «Blood in the stool, persistent bowel changes, abdominal pain, involuntary weight loss, sensation of incomplete evacuation and iron deficiency anemia These are signs that always deserve further investigation.” Another problem is represented by theself-medication. «Taking laxatives, anti-diarrheals or painkillers without having clarified the cause of the symptom is like turning off the oil light in your car because it bothers you. The symptom is a message and must be interpreted.” Alongside prevention, treatments are also experiencing a radical transformation. There minimally invasive and robotic surgery Today it allows for increasingly precise and less traumatic interventions. “There robotic surgery it’s not just a matter of smaller incisions. It allows you to operate with millimeter precision in extremely complex anatomical spaces.” To these innovations are added intraoperative imaging And artificial intelligence in surgery. “We are developing a sort of digital co-pilot that helps identify critical anatomical structures and tumor margins, further increasing precision and safety.” The future, concludes Spinelli, will be increasingly oriented towards one precision medicine.
The real weapon remains to arrive before the tumor
Between chronic infectionsgenetic predispositions, increasingly unfavorable lifestyles and diagnoses that still arrive too late, the gastric cancer and the others gastrointestinal tumors they are sending a message that medicine can no longer afford to ignore. The good news is that today we have increasingly effective tools: testing for Helicobacter pylori, surveillance of at-risk subjects, immunotherapy, personalized therapies and robotic surgery. But no innovation will really be enough if we continue to consider persistent heartburn, a change in the intestine or unexplained weight loss as small ailments to be tolerated or silenced with an over-the-counter drug. Because the real enemy is not just the tumor: it is the time we give it to grow undisturbed. And perhaps the most important lesson that comes from oncologists is precisely this: the stomach cancer It doesn’t start when a visible mass appears on a CT scan, but much earlier, when the body starts sending signals that we choose not to listen to. Ignoring them can cost years of your life. Recognizing them early can make all the difference between a treatable disease and a discovery too late.
A new hope against treatment-resistant cancer
Alongside prevention and early diagnosis, research is looking for new strategies to deal with it resistance to therapies in metastatic colorectal cancer. An important study coordinated byIRCCS of Candiolo and published in the scientific journal EMBO Molecular Medicine has identified a possible vulnerability of tumor cells that stop responding to anti-EGFR drugs, which have been a mainstay of the treatment of many patients for years. “The tumor is a sort of intelligent entity: under the pressure of drugs it learns to evolve and escape treatment, becoming resistant over time in most cases,” he explains Sabrina Arenahead of the Translational Cancer Genetics laboratory at the Candiolo Institute. The researchers found that these cells, despite appearing more aggressive, accumulate high levels of DNA damage and they survive thanks to the action of a protein called WEE1which works as a real cellular emergency system. By blocking this protein, the researchers explain, the tumor loses the ability to repair its genetic errors and is pushed towards a sort of “biological collapse”. «By inhibiting WEE1, the tumor cell is forced to divide without control, bringing with it all its genetic errors until it undergoes cell death», underlines Arena. In experimental models, the combination between WEE1 inhibitors and chemotherapy has shown particularly promising results, especially in patients who have already exhausted available treatment options. Although clinical studies are needed to confirm these results, the discovery opens a new perspective in the fight against this tumor.
