The Danger of ‘Young’ Stomach Cancer

Why do we need to be concerned about stomach (gastric) cancer, even though the occurrence is so low in the US population? Gastric cancer ranks 16th most common cancer in the United States, but 2nd in causing the most cancer deaths in the world. It is one of the deadliest cancers in the Asian population, but generally has a low occurrence among white people.

There is an alarming trend of increased gastric cancer incidence in individuals younger than 40 years in some countries, including Sweden, Ecuador, and the UK. In the US, the number of Americans in their 30s to 50s with gastric cancer has doubled since 1995, based on a 2019 Mayo Clinic study. The study reviewed 75,225 gastric cancer cases from 1973 to 2015.

Gastric cancer in younger patients (generally defined as below 40 years old) is “genetically and clinically” distinct from the gastric cancer traditionally seen in older patients. The early-onset gastric cancer tends to be caused by a more aggressive adenocarcinoma made up of signet ring cells. These cells are highly malignant, leading to a worse prognosiis.

“Younger patients also tend to present late [be diagnosed later] with more advanced disease because of a lower self-perceived risk of the cancer”, says Professor Martin Chi-sang Wong, a specialist in Family Medicine and researcher of cancer screening from The Chinese University of Hong Kong.

“There is very little known about why there is currently a rise in gastric cancer in this group,” says Dr Yanghee Woo in an interview, an oncologist and associate professor at the City of Hope Cancer Treatment and Research Center.

In a 2021 paper, Dr Woo and her team found that young Hispanics (under 40) have an increased chance of getting gastric cancer. Young patients also tend to have a poorer outcome with aggressive cancer tumors that are more likely to metastasize or spread to a lymph node.

Notably in 2022, Mike Mora, the husband of ‘Milkshake’ singer Kelis, died after a seven-month long battle with Stage 4 gastric cancer. For many, this served as a reminder of how the disease can act quickly, especially if not caught early in young people.

In Mora’s case, the deceased was diagnosed with “gastric adenocarcinoma with diffuse type/signet ring cell features”. In diffuse gastric cancer, or sometimes called “signet ring cell gastric cancer”, the cancer often affects more than one area of the stomach.

Read more: Kelis's Husband's Fight with Stage 4 Gastric Cancer at Age 37

The diffuse type is difficult to detect through upper endoscopy, the gold standard for gastric cancer detection. At an early stage, diffuse gastric cancer is not visible on the endoscopy. Instead, genetic screening has been advocated for those with familial diffuse gastric cancer (hereditary mutation in CDH1 gene). Individuals with the CDH1 mutation may be advised by their doctors to have their stomach surgically removed, as a preventative measure.

Even if gastric cancer is removed by surgery, patients still face a relatively high risk of recurrence such as spread to the membrane lining of the abdominal cavity (also known as peritoneal dissemination). Therefore, it is desirable to develop novel strategies in order to conquer this gastric cancer. Currently, therapies that target Claudin 18.2 (e.g. zolbetuximab) are quite promising.

Read more: Claudin 18.2

Finally, while gastric cancer in younger people may usually be detected later, early screening upon discovering potential symptoms could help cases be addressed earlier.