Phenotypic and genotypic events in gastric carcinogenesis.

Two main histological variants of gastric carcinoma have been identified: intestinal and diffuse types. The former is preceded by a sequential chain of events characterized as chronic gastritis, atrophy, intestinal metaplasia, dysplasia, intramucosal carcinoma, and invasive neoplasia. The second type (diffuse) lacks well-recognized precursor changes. Genotypic events in the gastric precancerous process are described, but a clear model of their sequence and relevance is lacking. Cadherins may play a role in determining which type of carcinoma develops. Translocated promoter region-MET rearrangements have been identified since early stages of the process. p53 alterations are reported beginning with the dysplasia stage utilizing immunohistochemical techniques. Single-strand conformation polymorphism and sequencing analysis show alterations in early stages, especially G:C to A:T transitions.