Al-Samawi & Aulaqi Histopathology of gastric cancer in Yemen: A 7 years retrospective analysis

© Sudan JMS Vol. 7, No.4. December 2012 95 Helicobacter pylori are the most common suspects in gastric carcinogenesis. Asakaet al has been shown a clear association between gastric adenocarcinoma and Helicobacter Pylori. The prevalence of infection with the bacteria in dyspeptic patients in Yemen appears high. Therefore, it is suggested that infection by this bacteria may play a role in the development of gastric carcinoma in our patients. Fresh vegetables and fruits, starch natural unprocessed wheat products are the major constituents of traditional Yemeni food. However, during the last decades Yemen, like other Arabian countries, has experienced a rapid change in the diet habit with dominant of animal proteins, canned food, hot spices and fermented food. These types of food have been implicated as risk factors for GC in many studies. Another risk factor is the organophosphorous compounds which used in agriculture especially Qat (Catha Edulis) as fertilizer, pesticides and insecticides and may have increased the magnitude of cancer. Improvements in diet habits and storage, public health education, reducing tobacco and Khat usage and control of H pylori infection are likely to offer great potential for the prevention of GC in this area. In Western countries NHL represented only 2% to 5% of GC while it represented 7.4% of our series, which was similar to the 8% figure from Jordan, but different from the 14% and 22% figures reported from neighboring Saudi Arabia. During the past three decades the site of primary gastric lymphomas in the Middle East has changed. Small intestinal involvement become less common and gastric involvement more frequent, this varying pattern seemed to be environmental in origin. There was a slight male predominance in all types of gastric malignancies (Table 1) and comprising 334 (65%) with (p value=0.12). However, the male preponderance seen in our result is consistent with the fact that gastric cancer is more common in males as reported repeatedly in the literatures. In the neighboring gulf countries, the incidence of stomach cancer in males was approximately twice that of females; a similar two-fold difference in risk has been documented in many other countries. Also we found that the male to female ratio was 1.8:1 which is very much comparable to the finding of many literatures. The peak frequency of gastric carcinoma was at the age group of 51-70 years (56%) with median age of 65 years for males and 60 years for females.It appears to occur a decade earlier than in developed countries. A similar to this finding was documented in some Middle Eastern countries. Forty eight (11.2 %) patients were under the age of 41 years and this is lower than the 18.2% reported by Al-Radi AO et al from Saudi Arabia and 20.9% by Alsir K et al from Sudan and fairly comparable with that reported from Jordan and Iran. In developed countries lower than this percentage (3.7%) was reported by Su-Shun LO et al. So, our finding reveals mild inconsistency with those countries having similar anthropologic and demographic profiles. The causes for this variation are not understood and the late diagnoses of disease can explain part of the reasons. In general GC occurring below 45 years of age is called early onset gastric cancer. It has a higher genetic component than GC occurring in the 45 and above group, which is initiated more by the environmental risk factors.