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Gastric Cancer
- Epidemiology
- Gender: More common in men
- Age: 40 to 70 years
- Pathophysiology
- Adenocarcinoma accounts for 95% of cases
- Atrophic Gastritis precedes metaplasia and malignancy
- Risk Factors
- Familial Adenomatous Polyposis
- Non-polyposis hereditary Colon Cancer
- Gastric adenoma
- Barrett’s Esophagus (cardiac and esophageal border)
- Tobacco Abuse
- Chronic atrophic Gastritis
- positive family history in 4% of cases
- diseases that produce hypochlorhydric or achlorhydric states
- 🡪 encourage bacterial colonization and conversion of dietary nitrates and nitrites into nitrosamines:
- pernicious anaemia
- chronic gastritis
- Pernicious AnemiaÂ
- Prior subtotal gastrectomy (after 15-20 years) – risk of malignancy in residual stump is increased 2-6 fold
- increased incidence in certain ethnic and racial groups
- blacks, American Indians, Maori’s, Japanese
- Environmental
- Tobacco smoking, obesity, occupations involving rubber production and exposure to X-radiation or gamma radiation
- Symptoms
- Asymptomatic in early stages in 80% of cases
- Late stage symptoms
- Weight loss
- Nausea and Vomiting
- Abdominal Pain
- Early satiety
- Signs
- Palpable epigastric mass
- Hepatomegaly
- Lymphadenopathy (e.g. periumbilical or supraclavicular)
- Differential Diagnosis
- Peptic Ulcer Disease
- Gastroesophageal Reflux disease
- Diagnostic Testing
- Upper endoscopy (Esophogastroduodenoscopy or EGD)
- Endoscopic Ultrasonography (EUS)
- Prognosis: Five year survival
- Stages (Summary of AJCC Staging – not an exact list)
- Stage 0: Tis, N0, M0 (Carcinoma in-situ) 90%
- Stage I: T1, N0, M0 (Submucosa involved) <78%
- Stage II: T1-T3, N0-N2, M0 (visceral peritoneum) 34%
- Stage III: T2a-T4, N0-N2, M0 (local tumor invasion) <20%
- Stage IV: T1-T4, N1-N3, M0-1 (increased metastases) 7%
- Prevention
- Tobacco Cessation
- Dietary changes (possible benefit)
- Decrease Alcohol intake
- Decrease smoked, pickled or salted food intake
- Increase fruit and vegetable intake
- Aggressively treat and monitor associated conditions
- Barrett’s Esophagus
- Atrophic Gastritis
- Helicobacter Pylori infection
- Screening EGD for high risk patients every 1-3 years
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