Fatima Carneiro, pathologist, Medical Faculty of Porto and Hospital Sao Joao, Porto, Portugal

Biography

Fátima Carneiro is Professor of Pathology (Faculty of Medicine of the University of Porto) and Senior Researcher at Ipatimup/i3S. She was President of the European Society of Pathology (2011-2013) and President of the Portuguese Academy of Medicine (2018-2020). She was awarded by the Portuguese Foundation for Science and Technology “for an outstanding curriculum vitae” (2005) and received the Order of “Infante D. Henrique” (Grand Officer) awarded by the President of Republic “for outstanding services to science” (2006). She was nominated as “The most influential pathologist in the world” in 2018 (by “The Pathologist”). She is (co)author of more than 400 peer-reviewed publications (Scopus h index: 85) and 26 book chapters, including books issued by the IARC and the UICC. She was co-editor of the WHO Blue Book on “Tumours of the Digestive System” (4th edition), standing member of the Editorial Board of the WHO Classification of Tumours series (5th edition) and, currently, Expert Member of the WHO Blue Books Editorial Board for Digestive System Tumours Volume (6th edition). Her research is focused on the etiopathogenesis and molecular pathology of gastric cancer.

Summary of presentation

The intestinal type of gastric cancer (IGC) is a histological subtype of gastric adenocarcinoma based on Lauren’s classification system corresponding, in WHO classification, to tubular/papillary adenocarcinoma. It is often linked to environmental and lifestyle factors (H. pylori infection, smoking and heavy alcohol consumption, low intake of fresh fruits and vegetables). IGC is more prevalent in regions with a high incidence of gastric cancer and it is more common in males, usually in older adults (50–70 years old). IGC often develops through a multistep process called the Correa cascade (Chronic gastritis → Atrophic gastritis → Intestinal metaplasia → Dysplasia → Cancer).

According to the TCGA molecular classification, IGC is more frequently identified in three groups:  Epstein Barr virus (EBV)-Positive (characterized by high PD-L1/PD-L2 expression, DNA hypermethylation, and frequent mutations in PIK3CA); Microsatellite Instability (MSI); Chromosomal Instability (CIN), with frequent chromosomal amplifications, including those involving HER2, FGFR2, and MET. Molecular profiling (e.g., HER2, MET, MSI, FGFR2) is crucial to identify eligible patients for targeted therapies. Combining targeted agents with immunotherapy or chemotherapy is a promising approach for the treatment of IGC.