Keywords: Assessment, Contributing factors, Gastric Carcinoma.
Introduction
Stomach cancer refers to any malignant neoplasm that arises from the region extending between the gastro-esophageal junction and the pylorus. Approximately 95 per cent of stomach tumors are epithelial in origin and designated as adenocarcinomas. Adeno-squamous, squamous, and undifferentiated carcinomas are however rare (1).Stomach cancer is characterized by a growth of cancer cells within the lining of the stomach, Stomach cancer tend to develop slowly over many years, before a true cancer develops, pre-cancerous change often occurs in the inner lining (mucosa) of the stomach.(2) These early changes rarely cause symptoms and there often go untreated. Stomach cancer can spread (metastasize) in different ways. They can grow through the wall of stomach and invade nearby organs; they can also spread to the lymph vessels and nearby lymph nodes. Lymph nodes are bean sized structures that help fight infection, the stomach has a very rich network of lymph vessels and nodes, as the stomach cancer become more advanced it can travel through the blood stream and spread to organs such as the liver, lungs and bones.(3) The development of gastric cancer is a multifactorial process and many conditions influence the likelihood of occurrence, of them, family history of gastric cancer, Helicobacter pylori infection (a common bacteria that can also cause stomach ulcers), history of an adenomatous gastric polyp larger than 2 centimeters, history of chronic atrophic gastritis, history of pernicious anemia, obesity, alcohol, smoking, red meat and low socioeconomic status are all believed to be important. (4)
Helicobacter pylori infection is an important and well-established a etiologic factor for stomach cancer in all populations worldwide, and the infected individuals by H. pylori show about (3 to 6) fold increased risk of developing stomach cancer. (5) Other risk factors for gastric cancer include chronic gastritis; older age; male sex; a diet high in salted, smoked, or poorly preserved foods and low in fruits and vegetables; tobacco smoking; pernicious anemia; a history of stomach surgery for benign conditions; and a family history of stomach cancer. (6)
Methodology
Design of the study: Descriptive design of study was carried out for the period of First of October, 2016 until the end of May, 2016 to assess the contributing factors of patients with gastric carcinoma.
Setting of the Study: The present study is carried out at Baghdad Teaching Hospital.
Setting No. of samples
Digestive system teaching hospital 15
AL-Emamain AL-Kadimain medical city 8
AL-kendi teaching hospital 5
Baghdad teaching hospital 2
Total 30
Sample of the Study: A purposive sample was applied consist of (30) patients who diagnosed with gastric carcinoma after endoscopy procedure.
Instrument: the Questionnaire format of study consists of two parts:
Part I: The demographic data of the sample of the study & which consist of (8) items which included the clients characteristic, such as age, gender, level of education, marital status, and employment.
Part II: Include the risk factors, which consist of (13) items.
Validity and Reliability: The instrument of the study was constructed by the researcher, by reviewing related books & literature to initiate the instrument format, then it was presented to the panel of experts from college of nursing at Baghdad University for the validity ,and all the comments was considered.
Statistical Analysis: The data have been analyzed through the application of: descriptive frequency, percentages; mean of scores; and the inferential analysis that include: Analysis of variance and the researcher used the SPSS version 20 to analysis of data.
Data Collection: The date have been collected through the utilization of the self-administrative questionnaire as a mean of data collection, the date were collected through the utilization of structured interviewing of subjects. Self-administrative questionnaire and participate in the study, all of the respondent were cooperative with the investigators. Filling the questionnaire takes approximately 20-30 min.
Results
Table 1: The Distribution of the Sample according to their Socio-demographic Characteristics
No. Characteristics
F %
1 Gender:
Male 20 66.7
Female 10 33.3
Total 30 100
2 Age:
40 ��� 49 year 8 26.7
50 ��� 59 year 16 53.3
60 ��� year 6 20
Total 30 100
3 Marital status:
Married 17 56.7
Single 5 16.7
Widowed 7 23.3
Divorced 1 3.3
Total 30 100
4 Educational level: Primary 11 36.7
Intermediate 11 36.7
Secondary 3 10
College 5 16.7
Total 30 100
5 Chronic disease: Heart disease (yes: no) (9:21) (30:70)
Diabetes mellitus (yes: no) (12:18) (40:60)
Hypertension (yes: no) (21:9) (70:30)
Cancer (yes: no) (3:27) (10:90)
Total 30 100
6 Family history of gastric cancer: None 21 70
Father 5 16.7
Mother 2 6.7
Other 2 6.7
Total 30 100
7 Blood group: A 8 26.7
B 7 23.3
AB 4 13.3
O 11 36.7
Total 30 100
8 Smoking:
Yes 22 73.3
No 8 26.3
Total 30 100
9 No. of smoked packet/day None 7 23.3
1 ��� 2 18 60
Three and more 5 16.7
Total 30 100
10 No. of smoked cigarette/ day: None 7 23.3
10 ��� 19 6 20
20 ��� 29 10 33.3
30 ��� 7 23.3
Total 30 100
11 Duration of Smoking: None 7 23.3
��� 10 12 40
11 ��� 20 6 20
21- 30 5 16.7
Total 30 100
No: Number, F: Frequency, %: Percentage
This table indicated that more than half of the sample was male (66.7%), their age group was 50 ��� 59 year old (53.3%), 56.7% of them were married. 36.7% of them were having primary and intermediate educational level. The more frequently chronic diseases were hypertension (70%), diabetes mellitus (40, heart disease (30%), and cancer (10%). 70% of the patients have no family history of gastric cancer. 36.7% of the patients were with O blood group type while 13.3% of them were with type AB. More of the patients were smokers (73.3%) who are smoke 1-2 packet/ day (60%), 20 -29 cigarette/day (33.3%). 40% of them are smoking for the period of ten years or less.
Table 2: Risk Factors among Patients with Gastric Cancer (N=30)
No. Factor Yes No M.S Severity
1 Frequent use of anti-inflammatory drugs 23 7 0.77 H
2 Frequent infections of H-pylori bacteria 11 19 0.37 M
3 Exposure to radiation 8 22 0.27 M
4 Working with chemicals in health hazards related places such as rubber and coal��� 6 24 0.20 L
5 Gastric ulcer 26 4 0.87 H
6 Suffering from stress and anxiety 30 0 1.00 H
7 Suffering from overweight 6 24 0.20 L
8 Consume alcohol 8 22 0.27 L
9 Consume salty food 17 13 0.57 M
10 Consume spicy food 24 6 0.80 H
11 Consume fast food 24 6 0.80 H
Total 0.55 M
No: Number, L: Low (0-0.33), M: Moderate (0.34-0.67), H: High (0.68-1.00)
This table indicated that patients having moderate risk factors (M.S= 0.55). The analysis shows that factors (1, 5, 6, 10, and 11) were highly risk while factors (4, 7, and 8) were low risk.
Table 3: Association of Risk Factors with Some of Socio-demographic Characteristics of the patients
Risk factors
Characteristics Chi-square d.f P-Value
��� 0.05 Significance
Gender 2.932 5 0.710 N.S
Age 5.241 10 0.874 N.S
Marital status 12.336 15 0.653 N.S
Educational level 15.680 15 0.404 N.S
Chronic diseases 6.324 10 0.787 N.S
Family history of gastric cancer 17.419 15 0.294 N.S
Blood group 7.832 15 0.930 N.S
Smoking 5.320 10 0.869 N.S
d.f: degree of freedom, P: Probability, N.S: Not significant
This table indicated that there are no significant association between risk factors and socio-demographic characteristics of patients with gastric cancer at p-value= 0.05.
Table 3: Associated Risk Factors among Patients with Gastric Cancer Regarding their Age Group (N=30)
Risk factors
Age group Low Moderate High Total
40 – 49 year 0 6 2 8
50 – 59 year 0 13 3 16
60 ��� year 0 5 1 6
Total 0 24 6 30
X2= 0.182 d.f=2 p-value= 0.913 Sig.= N.S
X2: Chi-square, d.f: Degree of freedom, P: Probability, Sig.: Significance, NS: Not significant
This table shows that risk factors among patients with gastric cancer are associated more frequently with age group of 50 – 59 years old.
Table 4: Associated Risk Factors among Patients with Gastric Cancer Regarding their Educational Level (N=30)
Risk factors
Education Low Moderate High Total
Primary 0 8 3 11
Intermediate 0 10 1 11
Secondary 0 3 0 3
College 0 3 2 5
Total 0 24 6 30
X2= 3.182 d.f=3 p-value= 0.04 Sig.= S
X2: Chi-square, d.f: Degree of freedom, P: Probability, Sig.: Significance, NS: Not significant
This table shows that risk factors among patients with gastric cancer are associated significantly more frequently with intermediate educational level.
Discussion
*This chapter describes the demographic characteristics of the patients and determines the significant association between risk factors and some of their socio-demographic characteristics.
* This table(1) indicated that more than half of the sample was male (66.7%), their age group was 50 ��� 59 year old (53.3%), 56.7% of them were married. 36.7% of them were having primary and intermediate educational level. The more frequently chronic diseases were hypertension (70%), diabetes mellitus (40, heart disease (30%), and cancer (10%). 70% of the patients have no family history of gastric cancer. 36.7% of the patients were with O blood group type while 13.3% of them were with type AB. More of the patients were smokers (73.3%) who are smoke 1-2 packet/ day (60%), 20 -29 cigarette/day (33.3%). 40% of them are smoking for the period of ten years or less.
Factor:
-Gender: the disease affect men twice than in women
-Age : stomach cancer is found most in people over age 55.
-Smoking: there is evidence linking cigarette smoking to many types of cancer, including stomach cancer , smokers have been found to be at greater risk of developing cancer more than non-smoker
-Genetics: certain gen mutation and some inherited condition are considered stomach cancer risk factor include (BRCA1 and BRCA2, E-cadherin( CDH1), Lynch syndrome (HNPCC) , Familial adenomatous polyposis (FAP)
Hereditary familial:
The study of familial gastric kindred's has led to identification of a germ line mutation of CDH1 gen in one third ���CDH1 encodes E-candheria . acell adhesion molecule that participate in normal differentiation architecture mutation of CDH1 diminish the availability of normal E-cadheria protein thus per tubing normal cell differentiation and cell adhesiveness. Mutation of CDH1 in gastric cancer families may occur any where throughout the gene in contrast to CDH1, mutation occurring almost exclusively in exous 7-9 in individuals with sporadic gastric cancer. Gremlin mutation of CDH1 has 70% pen trance ,increasing the susceptibility to gastric cancer CDH1 is a tumor suppressor gene , since mutation of the second CDH1 allele, perhaps as the result environment influences such as H. pylori infection or diet , is required for full pen trance, affected female family members are higher risk for breast cancer as well as and should be screened accordingly.
-Family history : family history is being looked as a risk factor for stomach cancer. brothers, sisters and children, of people with stomach cancer have an increased risk of getting it themselves. We're not sure whether this genetic, or because they share other risk factors, such as helicobacter pylori infection
-Blood group: people with blood group A may be at a slight increase risk of developing stomach cancer however that risk still small.
-Having other cancers: statistically ,men have slightly increased risk of stomach cancer if they've already had prostate cancer, breast cancer, bladder cancer or testicular cancer. Women have an increased stomach cancer risk if they've had ovarian cancer, breast cancer or cervical cancer. Both sexes have an increased risk if they've had food pipe (esophageal) cancer, non melanoma skin cancer, bowel cancer, non Hodgkin's lymphoma or thyroid cancer (American Cancer Society 2009).(7)
*This table indicated that patients having moderate risk factors (M.S= 0.55). The analysis shows that sample complaining of(using to much anti-inflammatory drugs, Suffering from stress and anxiety, complaining of gastric ulcer, high consumption of spicy food,& Consume fast food) were highly risk while factors (Working with chemicals in health hazards related places such as rubber and coal���, Suffering from overweight, Consume alcohol) were low risk as showed in table (2)
Factor:- A diet which is high in smoked, salt, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. (American Cancer Society 2016). (8)
-Anti-inflammatory drugs :an over view of public studies showed that people who regularly take non steroidal anti-inflammatory drugs appear to have a slightly lower risk of stomach cancer , these drugs are called NSAIDs. Examples aspirin, ibuprofen, nurofen. researches in 2010 reviewed the trials looking at whether daily aspirin can protect against health conditions. yThe found that taking daily aspirin may reduce the dying from stomach cancer this need more research though, and regular use of NSAIDs can increase the risk of developing stomach and duodenal ulcer. (9)
-gastric ulcer: The relation between peptic ulcer and stomach cancer has long been disputed, but there is accumulating evidence that gastric ulcer disease is positively associated and duodenal ulcerations negatively associated with the risk of developing stomach cancer. As Helicobacter pylori infection is associated with both types of ulceration and stomach cancer, the varying outcomes of the infection indicate that factors other than the infection must be of importance. At present, there is no convincing evidence that pharmacologic inhibition of acid secretion for treatment of peptic ulcer increases the risk of stomach cancer. However, some recent studies indicate that prolonged treatment with proton pump inhibitors may accelerate the development of atrophic gastritis, a risk factor for stomach cancer, in individuals infected with H. pylori. It has repeatedly been shown that there is an at least twofold increased risk of stomach cancer (15) years after gastric resection for peptic ulcer disease, and that the risk increases with the passage of time. Whether vagotomy has the same risk-increasing effect is still unclear.(10)
-working in coal metal or rubber industries: chemicals that are released in these environments have been linked to development of stomach cancer.(11)
-being overweight or obese: being overweight or obese is a possible cause of cancers of cardiac (the upper part of the stomach nearest the esophagus) , but the strength of this link not yet clear.(12)
*This table indicated that there are no significant association between risk factors and socio-demographic characteristics of patients with gastric cancer at p-value= 0.05. as showed in table (3)
– smoking; there is evidence linking cigarette smoking to many types of cancer , including stomach cancer , smokers have been found to be at greater risk of developing cancer more than non-smoker.(13)
*This table show significant relationship between the risk factors among patients with gastric cancer are associated more frequently with intermediate educational level. as showed in table (4)
Conclusion
The result of the study indicated that more than half of the sample was male, their age group was 50 ��� 59 year old , most of them were married,& they were with primary and intermediate educational level. The study indicated that patients having moderate risk factors (M.S= 0.55). The analysis shows that sample complaining of (using too much antibiotic, Suffering from stress and anxiety, complaining of gastric ulcer, high consumption of spicy food,& Consume fast food) were highly risk while factors (Working with chemicals in health hazards related places such as rubber and coal���, Suffering from overweight, Consume alcohol) were low risk. They were frequently with chronic diseases were hypertension diabetes mellitus ( heart disease , and cancer .some of the patients have no family history of gastric cancer, other the patients were with O blood group type while13.3% of them were with type AB. More of the patients were smokers who are smoke (1-2) packet/day, (20 -29) cigarette/day, 40% of them are smoking for the period of ten years or less. The research showed that risk factors among patients with gastric cancer are associated more frequently with age group of (50 ��� 59) years old. The study showed that risk factors among patients with gastric cancer are associated significantly more fre-
quently with low educational level
Recommendation: the researchers recommends to:
��� Provide specialists gastric cancer centers for early detection of carcinoma & treatment, equipped with all new technology machine of screening the cancer.
��� Provide specialist centers for education the patient of high risk for gastric carcinoma to flow up, continuous checking & apply preventable measures for cancer.
��� Awareness the people by mass media about the risk factors of gastric cancer, & its preventable measures.
��� To continue other studies in this field.
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Oncotarget. 2017 Jan 17; 8(3): 4781���4795.
Published online 2016 Nov 25. doi: 10.18632/oncotarget.13591
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