Our Summary

The research paper is about a type of stomach cancer that is directly linked to a genetic mutation, known as CDH1. This type of cancer, hereditary diffuse gastric cancers (HDGC), accounts for 1 to 3% of all stomach cancers. In France, the recommendation for people with this mutation is to have a preventative surgery to remove the entire stomach between the ages of 20 and 30. This surgery should also remove all the stomach lining at both ends of the stomach.

When they examined the stomachs removed from people with this mutation who did not have any symptoms, they found small areas of cancer in 90 to 100% of the cases. But, it was very rare to find cancer in the lymph nodes or blood vessels, so they suggest only a limited removal of lymph nodes during surgery.

The paper suggests that a minimally invasive surgical approach might be best, as long as it is done in expert medical centers. The results of this type of surgery seem to be similar to results from surgeries for actual cancer. The paper emphasizes that preventative removal of the entire stomach is key in managing this genetic mutation, along with regular check-ups and monitoring for breast cancer in women.

FAQs

  1. What is the recommended procedure for individuals with a CDH1 gene mutation?
  2. What do histopathological examinations reveal in asymptomatic CDH1-mutated patients who have undergone a prophylactic total gastrectomy?
  3. What is the significance of prophylactic total gastrectomy in the management of CGDH?

Doctor’s Tip

A helpful tip a doctor might tell a patient about gastrectomy is to follow a multidisciplinary follow-up plan after the surgery. This may include regular check-ups, screenings, and monitoring for any potential complications or new developments. It is important to communicate openly with your healthcare team and adhere to their recommendations for long-term care to ensure the best possible outcomes.

Suitable For

Patients who are typically recommended gastrectomy include those with hereditary diffuse gastric cancer caused by CDH1 gene mutations. Prophylactic total gastrectomy is recommended for these patients between the ages of 20 and 30 to remove all the gastric mucosa and reduce the risk of developing gastric cancer. It is important for these patients to undergo regular follow-up and surveillance to monitor for any signs of cancer recurrence. In expert centers, a minimally invasive approach may be preferred for gastrectomy, with similar surgical outcomes to traditional open surgery. Overall, prophylactic total gastrectomy is the cornerstone of management for CDH1-mutated patients and is essential for reducing the risk of developing gastric cancer.

Timeline

  • Genetic testing reveals CDH1 gene mutation
  • Recommendation for prophylactic total gastrectomy between 20-30 years old
  • Preoperative preparation and counseling
  • Minimally invasive gastrectomy performed by expert surgeons
  • Postoperative recovery and monitoring
  • Multidisciplinary follow-up and surveillance for other cancers
  • Long-term management and support for patient and family members

What to Ask Your Doctor

  1. What is the purpose of a prophylactic total gastrectomy in CDH1-mutated patients?
  2. What are the potential risks and benefits of undergoing a prophylactic total gastrectomy?
  3. What is the recommended age range for undergoing a prophylactic total gastrectomy in CDH1-mutated patients?
  4. What type of lymphadenectomy is typically performed during a prophylactic total gastrectomy?
  5. What is the likelihood of finding microscopic foci of diffuse-type cancer in asymptomatic CDH1-mutated patients undergoing a prophylactic total gastrectomy?
  6. What is the recommended follow-up care after undergoing a prophylactic total gastrectomy for CDH1 gene mutation?
  7. How does the minimally invasive approach compare to traditional open surgery for a prophylactic total gastrectomy?
  8. What are the long-term implications of living without a stomach after a prophylactic total gastrectomy?
  9. How does the risk of developing gastric cancer compare for CDH1-mutated patients who undergo a prophylactic total gastrectomy versus those who do not?
  10. Are there any lifestyle changes or dietary restrictions that should be followed after a prophylactic total gastrectomy?

Reference

Authors: Côme P, Rochefort P, De Crignis L, Dupré A. Journal: Bull Cancer. 2025 Mar;112(3):259-262. doi: 10.1016/j.bulcan.2024.04.003. Epub 2024 May 15. PMID: 38755036