Research Excellence: predicting gastric cancer

As the recipient of an NHMRC Postgraduate Scholarship, Dr Tjandra has returned to the laboratory bench to complete postdoctoral studies at Monash University, in addition to clinical work. He will pursue further research into identifying and characterising risk factors for bowel and gastric cancer. Read on to find out more about Dr Tjandra’s research, in his own words.

Gastric cancer is a devastating diagnosis for patients to receive. It is a rare cancer in Australia, with some 2500 people expected to be diagnosed this year, but it often does not present with symptoms until late, and 5 year survival is still in the realm of 30 – 40%. In countries with much higher prevalence of gastric cancer such as in East Asia, which is possibly related to much higher rates of the bacterium Helicobacter pylori and where population screening programs have been implemented for earlier detection, the 5 year survival rate is closer to 60 – 70%.

I lost my father to cancer at a young age and strongly believe in improving early detection and prevention before the cancer develops. 

Australia’s uptake of faecal occult blood testing, mammography and skin checks have saved many lives. Like polyps in bowel cancer, gastric cancer also has a precursor lesion called ‘gastric intestinal metaplasia’, which occurs along the pathway of chronic inflammation in the stomach. However, only a small proportion of patients who develop this condition will progress to stomach cancer.  

Some of the clinical and histological risk factors which confer particularly high risk have been identified but there remains a gap in knowledge in the best way to accurately risk stratify patients for progression. Australia does not yet have its own guidelines or published data on prevalence of gastric intestinal metaplasia in our diverse population. 

Ultimately, ideal risk assessment would be based on a patient’s clinical/pathological, genomic aberrational and immunological parameters. This would help to identify patients with intestinal metaplasia who are at highest risk of progression and require closer surveillance for early intervention such as endoscopic resection, to close the mortality gap compared with high prevalence countries; simultaneously, it could identify low risk individuals who can cease or have reduced surveillance, reducing burden to the patient and the healthcare system.

Identifying and characterising these risk factors will be the focus of my doctoral studies, which will be a return to the lab bench on top of my clinical work. 

I am incredibly honoured to have been awarded an NHMRC Postgraduate Scholarship and the Gustav Nossal Scholarship Award which will support my research significantly.