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Early-detection demo · Gastric cancer

Signet-ring cell foci on CDH1 surveillance EGD

Multifocal signet-ring foci in random gastric biopsies (T1a) — pre-invasive diffuse-type cancer caught before mass formation.

Patient: Henrik · 36 · CDH1 carrierModality: EGDRisk: high · 88/100
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01

Risk profile

What OCTON knew before the scan
Risk
88
high
Tier
high
CDH1 c.1003C>T pathogenic variant · father lost to diffuse gastric cancer at 41 · sister underwent prophylactic gastrectomy at 28 · annual EGD with random biopsies on the international protocol.
Contributing factors
  • CDH1 pathogenic variant+50
  • Family history (father < 50)+22
  • Age 36+4
  • Northern-European ancestry (founder)+6
  • H. pylori negative+-2
Narrative

CDH1 carriers face 70–80% lifetime diffuse-type gastric-cancer risk. Annual EGD with random biopsies catches pre-invasive disease before a mass forms — at which point gastrectomy is curative.

02

Scan + AI report

What EGD found · Upper endoscopy with white-light + NBI · 30 random biopsies per international HDGC protocol
EGD · DEMO
Lauren / AJCC T1a · diffuse
OCTON · scanning · live
conf 0.85
OCTON Impression · 82% confidence

Endoscopic appearance grossly normal; surveillance random biopsies revealed multifocal signet-ring cell foci in 4/30 sites. Histology consistent with T1a diffuse-type gastric carcinoma.

Findings
  • Multifocal signet-ring foci · 4/30 random biopsy sites · Gastric body + antrum
  • No mass / ulceration on white-light or NBI · Stomach
  • H. pylori negative · Antrum
Differential diagnosis
  • T1a diffuse-type gastric carcinoma80%
  • Indolent in-situ signet-ring change12%
  • Reactive cytologic atypia8%
Recommended actions
  • ▸Multidisciplinary HDGC clinic referral
  • ▸Total prophylactic gastrectomy with D2 lymphadenectomy within 6–8 weeks
  • ▸Annual breast MRI + mammogram for the lobular-breast-cancer risk arm
  • ▸Cascade testing for first-degree relatives
Caveats
  • Endoscopy alone is INSUFFICIENT in CDH1 — biopsy yield is the diagnostic signal.
  • Gastrectomy is preventive AND curative when caught at T1a.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Prophylactic total gastrectomy
FrequencyOnce
Startsage 25
International HDGC Consortium 2020
Monitoring
Surveillance EGD with 30 random biopsies
FrequencyAnnual (until prophylactic gastrectomy)
Startsage 20
International HDGC Consortium 2020
Monitoring
Annual breast MRI + mammogram
FrequencyAnnual
Startsage 30
NCCN Genetic/Familial v2.2025
04

What changed

The early-detection win

CDH1 surveillance caught microscopic T1a diffuse cancer in 4/30 random biopsies — prophylactic gastrectomy is preventive AND curative.

Run this for yourself

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