Tumor Classification Should Be Based on Biology and Not Consensus: Re-Defining Tumors Based on Biology May Accelerate Progress, An Experience of Gastric Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Tumorigenesis/Carcinogenesis
1.2. Classification of Tumors and Cell of Origin
1.3. The Distinction between Adenocarcinomas and Neuroendocrine Carcinomas
1.4. The ECL Cell
1.5. Gastric Physiology with Relevance to Gastric Cancer
2. Conclusions
Funding
Conflicts of Interest
References
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• Gastric carcinomas should be located to the three different mucosae (cardiac, oxyntic, and antral) and not as being proximal (cardiac) and distal (oxyntic and antral). |
• The central role of metaplasia in gastric carcinogenesis according to Correa should be replaced by oxyntic atrophy. Metaplasia may just be a marker of advanced longstanding atrophy. |
• Lauren’s classification represents biological differences with an intestinal type probably originating from the stem cell and a diffuse type from the ECL cell. |
• The percentage of tumor cells expressing a marker depends on the sensitivity of the method used. Setting a certain figure to differentiate between, for instance, adenocarcinomas and neuroendocrine carcinomas, is not logical. |
• PAS/Alcian-blue positivity is not specific for mucin and thus does not imply exocrine origin. |
• Gastrin is central in gastric carcinogenesis whether due to Helicobacter pylori or autoimmune atrophic gastritis as well as profound acid inhibition. Gastrin is a complete carcinogen for the oxyntic mucosa. |
• The wisdom of subclassification of gastric NETs due to hypergastrinemia into two types is challenged. |
• The gastrin receptor is localized on the ECL cell and possibly on the stem cell. |
• The two-hit theory for carcinogenesis by Knudson is useful for understanding some congenital cancers, but in general, cancer may develop due to a single mutation affecting a central function of the cell, although most cancers occur due to multiple mutations, which together move the cell into malignancy. |
• Hormones are complete carcinogens by their stimulation of proliferation causing an increased rate of mutations. |
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Waldum, H. Tumor Classification Should Be Based on Biology and Not Consensus: Re-Defining Tumors Based on Biology May Accelerate Progress, An Experience of Gastric Cancer. Cancers 2021, 13, 3159. https://doi.org/10.3390/cancers13133159
Waldum H. Tumor Classification Should Be Based on Biology and Not Consensus: Re-Defining Tumors Based on Biology May Accelerate Progress, An Experience of Gastric Cancer. Cancers. 2021; 13(13):3159. https://doi.org/10.3390/cancers13133159
Chicago/Turabian StyleWaldum, Helge. 2021. "Tumor Classification Should Be Based on Biology and Not Consensus: Re-Defining Tumors Based on Biology May Accelerate Progress, An Experience of Gastric Cancer" Cancers 13, no. 13: 3159. https://doi.org/10.3390/cancers13133159