Article Text

Download PDFPDF

Chronicles of a cancer foretold: 35 years of gastric cancer risk assessment
  1. Massimo Rugge1,2,
  2. Robert M Genta3,4,
  3. David Y Graham5,
  4. Francesco Di Mario6,
  5. Luiz Gonzaga Vaz Coelho7,
  6. Nayoung Kim8,
  7. Peter Malfertheiner9,
  8. Kentaro Sugano10,
  9. Vladislav Tsukanov11,
  10. Pelayo Correa12
  1. 1Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy
  2. 2Tumor Registry of the Veneto Region, Padova, Italy
  3. 3Miraca Life Sciences Research Institute, Irving, Texas, USA
  4. 4University of Texas Southwestern Medical School, Dallas, Texas, USA
  5. 5Department of Medicine, Michael E. De Bakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas, USA
  6. 6Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
  7. 7Institute Alfa of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  8. 8Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, South Korea
  9. 9Department of Gastroenterology, Hepatology & Infectious Diseases, Otto-von-Guericke University, University Medical Center of Magdeburg, Magdeburg, Germany
  10. 10Department of Medicine, Jichi Medical University, Tochigi, Japan
  11. 11State Scientific Medical Research Institute for Northern Problems of Siberian Division of Russian Academy of Medical Sciences, Krasnoyarsk, Russia
  12. 12Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Massimo Rugge MD FACG, Surgical Pathology & Cytopathology Unit, Department of Medicine DIMED, University of Padova, Via A. Gabelli, 61, Padova 35121, Italy; massimo.rugge{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


In 1980, an international group of pathologists and clinicians led by Basil Morson published a critical review entitled Precancerous Conditions and Epithelial Dysplasia in the Stomach.1 This seminal article attempted to merge Eastern and Western pathological experiences in the evaluation of preneoplastic conditions into a systematic approach to the evaluation of gastric precancerous conditions. Thirty-five years after its publication, we pay homage to Professor Morson's team by revisiting their positions in light of the dramatic advances of our understanding of gastric disease that have occurred during this time. To this end, we have selected from the original article those statements that warranted reappraisal and, after reproducing them verbatim, have provided our comments.IntroductionWhen considering problems of pre-malignancy, it is essential to define exactly what is meant by this term. A distinction can be made between a precancerous condition and a precancerous lesion. The former is best regarded as a clinical state associated with a significantly increased risk of cancer, whereas a precancerous lesion is a histopathological abnormality in which cancer is more likely to occur than in its apparently normal counterpart. In many clinical conditions with an increased risk of cancer, there is also an identifiable precancerous lesion, but this is not invariably so.

Studies carried out in the last three decades have supported the multifactorial aetiology of sporadic gastric cancer and have led to the concept of a progressive ‘cascade’ of phenotypic and molecular changes that may eventually result in neoplasia.2 In 1994, Helicobacter pylori was added to the cascade, providing the hitherto missing crucial aetiological element that initiates the entire process.3 ,4 While the distinction between precancerous condition and lesion remains useful, the current understanding of gastric oncogenesis (including its early molecular disarrangements) begs an expansion of the concept of ‘lesion’, …

View Full Text