Pediatric Gastric Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]

General Information About Pediatric Gastric Cancer

Primary gastric tumors in children are rare, and carcinoma of the stomach is even more unusual.[1] In one series, gastric cancer in children younger than 18 years accounted for 0.11% of all gastric cancer cases seen over an 18-year period.[2] In another study that used data from the National Cancer Database, patients younger than 21 years with gastric carcinoma were compared with patients older than 21 years.[3] Of the 129,024 cases identified, only 129 cases (0.1%) occurred in pediatric patients. While pediatric patients presented with more-advanced disease, overall survival for the two groups was similar. A retrospective analysis queried data from the Cerner Health Facts Database. The analysis identified 333 patients with gastric cancer (non-gastrointestinal stromal tumors, nonhematologic) from a base population of 9.6 million children.[4] The male-to-female ratio was 1.15 to 1. The mean age at diagnosis was 11.8 years. Gastric cancer was most prevalent in non-Hispanic White people and less common in Asian and Black people. Symptoms included abdominal pain, vomiting, anemia, diarrhea, and weight loss. Reflux symptoms with or without esophagitis, gastritis (including Helicobacter pylori gastritis), and duodenitis were reported in 10.2% of patients. Obesity, obesity-related comorbidities, tobacco use, and family history of colonic polyps, gastrointestinal cancer, and breast cancer were all more prevalent in this cohort of patients (P < .0001).

Prognosis depends on the extent of the disease at the time of diagnosis and the success of treatment that is appropriate for the clinical situation.[2]

Rare cases of familial diffuse gastric cancer associated with CDH1 germline pathogenic variants have been reported in adolescents.[5]

H. pylori infections may increase the risk of gastric cancer.[2,6] A Chinese study identified 1,015 pediatric patients with H. pylori infections who had endoscopic and histological data available to analyze.[7] The incidence rate of gastric mucosal precancerous lesions in children with H. pylori infections was 4.33% (37 of 854). There were 17 cases of atrophic gastritis, 11 cases of intestinal metaplasia, and 9 cases of dysplasia. For patients without H. pylori, there was only one case of atrophic gastritis (0.62%; 1 of 161 patients; P < .05).

References:

1. Curtis JL, Burns RC, Wang L, et al.: Primary gastric tumors of infancy and childhood: 54-year experience at a single institution. J Pediatr Surg 43 (8): 1487-93, 2008.
2. Subbiah V, Varadhachary G, Herzog CE, et al.: Gastric adenocarcinoma in children and adolescents. Pediatr Blood Cancer 57 (3): 524-7, 2011.
3. Tessler RA, Dellinger M, Richards MK, et al.: Pediatric gastric adenocarcinoma: A National Cancer Data Base review. J Pediatr Surg 54 (5): 1029-1034, 2019.
4. Attard TM, Omar U, Glynn EF, et al.: Gastric cancer in the pediatric population, a multicenter cross-sectional analysis of presentation and coexisting comorbidities. J Cancer Res Clin Oncol 149 (3): 1261-1272, 2023.
5. Guilford P, Hopkins J, Harraway J, et al.: E-cadherin germline mutations in familial gastric cancer. Nature 392 (6674): 402-5, 1998.
6. Saf C, Gulcan EM, Ozkan F, et al.: Assessment of p21, p53 expression, and Ki-67 proliferative activities in the gastric mucosa of children with Helicobacter pylori gastritis. Eur J Gastroenterol Hepatol 27 (2): 155-61, 2015.
7. Yu M, Ma J, Song XX, et al.: Gastric mucosal precancerous lesions in Helicobacter pylori-infected pediatric patients in central China: A single-center, retrospective investigation. World J Gastroenterol 28 (28): 3682-3694, 2022.