Prevention and Early Diagnosis of Gastric Cancer

  • Zhiyun Wang
  • Ya Li Clinical laboratory center, Xi’an People’s Hospital
Keywords: Gastric Cancer; Prevention; Early Diagnosis; Serological Examination; Tumor Markers; Endoscopy


Gastric cancer is one of the most common malignant tumors, posing a serious threat to people’s life and health. Therefore, prevention and early diagnosis are crucial for managing gastric cancer. This article provides an overview of the research progress in gastric cancer prevention, as well as related serological examinations, tumor markers, and endoscopic techniques.Serological tests and tumor markers are convenient, rapid, and easily accessible screening tools for gastric cancer. However, their sensitivity and specificity are not yet satisfactory and require further improvement. Endoscopic technology offers the advantage of directly observing lesion sites with a high detection rate. When combined with pathologic tissue biopsy, endoscopy serves as a means to confirm the diagnosis of gastric cancer. Nevertheless, it is important to note that endoscopy can be a cumbersome procedure with its detection rate depending on the level of experience of the examiner. Despite these advantages, due to its invasiveness to patients’ digestive tracts and potential discomfort during examination procedures leading to patient intolerance towards pain; endoscopy has not been widely adopted as a screening tool for early gastric cancer.


Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians, 71(3), 209–249.

Song, Z., Wu, Y., Yang, J., Yang, D., & Fang, X. (2017). Progress in the treatment of advanced gastric cancer. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine, 39(7), 1010428317714626.

Dong, J., & Thrift, A. P. (2017). Alcohol, smoking and risk of oesophago-gastric cancer. Best practice & research. Clinical gastroenterology, 31(5), 509–517.

Butt, J., Varga, M. G., Wang, T., Tsugane, S., Shimazu, T., Zheng, W., Abnet, C. C., Yoo, K. Y., Park, S. K., Kim, J., Jee, S. H., Qiao, Y. L., Shu, X. O., Waterboer, T., Pawlita, M., & Epplein, M. (2019). Smoking, Helicobacter Pylori Serology, and Gastric Cancer

Risk in Prospective Studies from China, Japan, and Korea. Cancer prevention research (Philadelphia, Pa.), 12(10), 667–674.

Moy, K. A., Fan, Y., Wang, R., Gao, Y. T., Yu, M. C., & Yuan, J. M. (2010). Alcohol and tobacco use in relation to gastric cancer: a prospective study of men in Shanghai, China. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(9), 2287–2297.

Bouras, E., Tsilidis, K. K., Triggi, M., Siargkas, A., Chourdakis, M., & Haidich, A. B. (2022). Diet and Risk of Gastric Cancer: An Umbrella Review. Nutrients, 14(9), 1764.

Wu, B., Yang, D., Yang, S., & Zhang, G. (2021). Dietary Salt Intake and Gastric Cancer Risk: A Systematic Review and Meta-Analysis. Frontiers in nutrition, 8, 801228.

Li, Y., Eshak, E. S., Shirai, K., Liu, K., Dong, J. Y., Iso, H., Tamakoshi, A., & JACC Study Group (2021). Alcohol Consumption and Risk of Gastric Cancer: The Japan Collaborative Cohort Study. Journal of epidemiology, 31(1), 30–36.

Camilo, V., Sugiyama, T., & Touati, E. (2017). Pathogenesis of Helicobacter pylori infection. Helicobacter, 22 Suppl 1, 10.1111/hel.12405.

Cai X , Carlson J , Stoicov C ,et al.Helicobacter felis eradication restores normal architecture and inhibits gastric cancer progression in C57BL/6 mice.[J].Gastroenterology, 2005, 128(7):1937-1952.DOI:10.1053/j.gastro.2005.02.066.

Sugano K .Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis[J]. Gastric Cancer, 2019, 22(3):435-445.DOI:10.1007/s10120-018-0876-0.

Trivanovic, D., Plestina, S., Honovic, L., Dobrila-Dintinjana, R., Vlasic Tanaskovic, J., & Vrbanec, D. (2022). Gastric cancer detection using the serum pepsinogen test method. Tumori, 108(4), 386–391.

Lin, Z., Bian, H., Chen, C., Chen, W., & Li, Q. (2021). Application of serum pepsinogen and carbohydrate antigen 72-4 (CA72-4) combined with gastrin-17 (G-17) detection in the screening, diagnosis, and evaluation of early gastric cancer. Journal of gastrointestinaloncology, 12(3), 1042–1048.

Gong, X., & Zhang, H. (2020). Diagnostic and prognostic values of anti-helicobacter pylori antibody combined with serum CA724, CA19-9, and CEA for young patients with early gastric cancer. Journal of clinical laboratory analysis, 34(7), e23268. https://doi. org/10.1002/jcla.23268

Yu, J., & Zheng, W. (2018). An Alternative Method for Screening Gastric Cancer Based on Serum Levels of CEA, CA19-9, and CA72-4. Journal of gastrointestinal cancer, 49(1), 57–62.

Chen, X., Ba, Y., Ma, L., Cai, X., Yin, Y., Wang, K., Guo, J., Zhang, Y., Chen, J., Guo, X., Li, Q., Li, X., Wang, W., Zhang, Y., Wang, J., Jiang, X., Xiang, Y., Xu, C., Zheng, P., Zhang, J., … Zhang, C. Y. (2008). Characterization of microRNAs in serum: a novel class of biomarkers for diagnosis of cancer and other diseases. Cell research, 18(10), 997–1006.

Mitchell, P. S., Parkin, R. K., Kroh, E. M., Fritz, B. R., Wyman, S. K., Pogosova-Agadjanyan, E. L., Peterson, A., Noteboom, J., O’Briant, K. C., Allen, A., Lin, D. W., Urban, N., Drescher, C. W., Knudsen, B. S., Stirewalt, D. L., Gentleman, R., Vessella, R. L., Nelson, P. S., Martin, D. B., & Tewari, M. (2008). Circulating microRNAs as stable blood-based markers for cancer detection. Proceedings of the National Academy of Sciences of the United States of America, 105(30), 10513–10518.

Guo, F. , Yao, W. , Dai, X. , Wang, C. , & Yuan, Y. . (2014). Study on serum mirnas as biomarkers for early diagnosis of gastric cancer. Chinese Journal of Gastroenterology, 19(4), 198-202.

Huang, Y., Zhu, J., Li, W., Zhang, Z., Xiong, P., Wang, H., & Zhang, J. (2018). Serum microRNA panel excavated by machine learning as a potential biomarker for the detection of gastric cancer. Oncology reports, 39(3), 1338–1346.

So, J. B. Y., Kapoor, R., Zhu, F., Koh, C., Zhou, L., Zou, R., Tang, Y. C., Goo, P. C. K., Rha, S. Y., Chung, H. C., Yoong, J., Yap, C. T., Rao, J., Chia, C. K., Tsao, S., Shabbir, A., Lee, J., Lam, K. P., Hartman, M., Yong, W. P., … Yeoh, K. G. (2021). Development and validation of a serum microRNA biomarker panel for detecting gastric cancer in a high-risk population. Gut, 70(5), 829–837.

Wang, J., Sun, J., Wang, J., Song, Y., Gao, P., Shi, J., Chen, P., & Wang, Z. (2016). Long noncoding RNAs in gastric cancer: functions and clinical applications. OncoTargets and therapy, 9, 681–697.

Zhou, X., Yin, C., Dang, Y., Ye, F., & Zhang, G. (2015). Identification of the long non-coding RNA H19 in plasma as a novel biomarker for diagnosis of gastric cancer. Scientific reports, 5, 11516.

Yörüker, E. E., Keskin, M., Kulle, C. B., Holdenrieder, S., & Gezer, U. (2018). Diagnostic and prognostic value of circulating lncRNA H19 in gastric cancer. Biomedical reports, 9(2), 181–186.

Qian, C., Ju, S., Qi, J., Zhao, J., Shen, X., Jing, R., Yu, J., Li, L., Shi, Y., Zhang, L., Wang, Z., & Cong, H. (2016). Alu-based cell free DNA: a novel biomarker for screening of gastric cancer. Oncotarget, 8(33), 54037–54045.

Park, J. L., Kim, H. J., Choi, B. Y., Lee, H. C., Jang, H. R., Song, K. S., Noh, S. M., Kim, S. Y., Han, D. S., & Kim, Y. S. (2012). Quantitative analysis of cell-free DNA in the plasma of gastric cancer patients. Oncology letters, 3(4), 921–926.

Kojima, T., Yao, K., Ohtsu, K., Kuan, C., Tanabe, H., Imamura, K., Kanemitsu, T., Miyaoka, M., Nagahama, T., Ueki, T., & Iwashita, A. (2022). A comparative study of demarcation line diagnostic performance between non-magnifying observation with white light and non-magnifying observation with narrow-band light for early gastric cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 25(4), 761–769.

Muto, M., Yao, K., Kaise, M., Kato, M., Uedo, N., Yagi, K., & Tajiri, H. (2016). Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 28(4), 379–393.

Khazaaleh, S., Alomari, M., Rashid, M. U., Castaneda, D., & Castro, F. J. (2024). Gastric intestinal metaplasia and gastric cancer prevention: Watchful waiting. Cleveland Clinic journal of medicine, 91(1), 33–39.

Vu, N. T. H., Quach, D. T., Dang, N. L. B., Le, Q. D., Nguyen, D. T. N., Le, H. M., Le, N. Q., & Hiyama, T. (2022). Performance of chromoendoscopy and narrow-band imaging in the diagnosis of gastric intestinal metaplasia. Scandinavian journal of gastroenterology, 57(8), 1005–1010.

Dohi, O., Yagi, N., Yoshida, S., Ono, S., Sanomura, Y., Tanaka, S., Naito, Y., & Kato, M. (2017). Magnifying Blue Laser Imaging versus Magnifying Narrow-Band Imaging for the Diagnosis of Early Gastric Cancer: A Prospective, Multicenter, Comparative Study. Digestion, 96(3), 127–134.

Dohi, O., Yagi, N., Majima, A., Horii, Y., Kitaichi, T., Onozawa, Y., Suzuki, K., Tomie, A., Kimura-Tsuchiya, R., Tsuji, T., Yamada, N., Bito, N., Okayama, T., Yoshida, N., Kamada, K., Katada, K., Uchiyama, K., Ishikawa, T., Takagi, T., Handa, O., … Itoh, Y. (2017). Diagnostic ability of magnifying endoscopy with blue laser imaging for early gastric cancer: a prospective study. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 20(2), 297–303.

Gong, S., Xue, H. B., Ge, Z. Z., Dai, J., Li, X. B., Zhao, Y. J., Zhang, Y., Gao, Y. J., & Song, Y. (2015). Value of Magnifying Endoscopy With Narrow-Band Imaging and Confocal Laser Endomicroscopy in Detecting Gastric Cancerous Lesions. Medicine, 94(44), e1930.

Robles-Medranda, C., Vargas, M., Ospina, J., Puga-Tejada, M., Valero, M., Soria, M., Bravo, G., Robles-Jara, C., & Lukashok, H. P. (2017). Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis. World journal of gastrointestinal endoscopy, 9(8), 389–395.

ASGE Technology Committee, Wang, A., Banerjee, S., Barth, B. A., Bhat, Y. M., Chauhan, S., Gottlieb, K. T., Konda, V., Maple, J. T., Murad, F., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Tokar, J. L., & Rodriguez, S. A. (2013). Wireless capsule endoscopy. Gastrointestinal endoscopy, 78(6), 805–815.

Liao, Z., Hou, X., Lin-Hu, E. Q., Sheng, J. Q., Ge, Z. Z., Jiang, B., Hou, X. H., Liu, J. Y., Li, Z., Huang, Q. Y., Zhao, X. J., Li, N., Gao, Y. J., Zhang, Y., Zhou, J. Q., Wang, X. Y., Liu, J., Xie, X. P., Yang, C. M., Liu, H. L., … Li, Z. S. (2016). Accuracy of Magnetically Controlled Capsule Endoscopy, Compared With Conventional Gastroscopy, in Detection of Gastric Diseases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 14(9), 1266–1273.e1. j.cgh.2016.05.013

Vineis, P., & Wild, C. P. (2014). Global cancer patterns: causes and prevention. Lancet (London, England), 383(9916), 549–557.

Wang, F., Meng, W., Wang, B., & Qiao, L. (2014). Helicobacter pylori-induced gastric inflammation and gastric cancer. Cancer letters, 345(2), 196–202.

Conti, C. B., Agnesi, S., Scaravaglio, M., Masseria, P., Dinelli, M. E., Oldani, M., & Uggeri, F. (2023). Early Gastric Cancer: Update on Prevention, Diagnosis and Treatment. International journal of environmental research and public health, 20(3), 2149.

Mukoubayashi, C., Yanaoka, K., Ohata, H., Arii, K., Tamai, H., Oka, M., & Ichinose, M. (2007). Serum pepsinogen and gastric cancer screening. Internal medicine (Tokyo, Japan), 46(6), 261–266.

Gašenko, E., Bogdanova, I., Sjomina, O., Aleksandraviča, I., Kiršners, A., Ancāns, G., Rudzīte, D., Vangravs, R., Sīviņš, A., Škapars, R., Tzivian, L., Polaka, I., Folkmanis, V., & Leja, M. (2023). Assessing the utility of pepsinogens and gastrin-17 in gastric cancer detection. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP), 32(5), 478–484.

Jelski, W., & Mroczko, B. (2022). Molecular and Circulating Biomarkers of Gastric Cancer. International journal of molecular sciences, 23(14), 7588.

Song, H., Park, J. Y., Kim, J. H., Shin, T. S., Hong, S. A., Huda, M. N., Kim, B. J., & Kim, J. G. (2022). Establishment of Patient-Derived Gastric Cancer Organoid Model From Tissue Obtained by Endoscopic Biopsies. Journal of Korean medical science, 37(28), e220.

Canakis, A., & Kim, R. (2021). Endoscopic Advances for Gastric Neoplasia Detection. Gastrointestinal endoscopy clinics of North America, 31(3), 543–561.

Review Article