Gastric Cancer

27/05/2013 by admin | Oncology

 

  1. Incidence is decreasing, higher in males than females
  2. Pathophysiology:
    1. o RFs include atrophic gastritis, previous surgery for PU disease. Role of H. pylori is controversial. There is a proven association between H.pylori and gastric lymphoma (MALToma), but the relationship with adenocarcinoma is less clear.
    2. o Dietary RFs: smoked food, salt, pickled fish, low fruit intake.
  3. Clinical features:
    1. o Often presents late as there are no early clinical symptoms
    2. o Common p/c: epigastric pain (mass in 50%), vomiting, early satiety, dysphagia, Virchow’s node, paraneoplastic (=dermatomyositis, acanthosis nigricans)
    3. Dyspepsia (often prompts ix), however most patients with gastric cancer will have less acid output than usual (=gastric atrophy).
    4.  
    1. Anaemia: occult GI bleeding = iron deficiency. Most common presentation
    2. Weight loss: suggests advanced metastatic disease
    3. Vomiting: indicates impending gastric outflow obstruction
  1. Ix:
    1. o Endoscopy and biopsies: to make diagnosis
    2. o Liver USS: to detect hepatic mets
  2. Mx:
    1. o Prognosis is poor – 5 years survival = 10%
    2. o Surgery: should be considered in most cases, because even in advanced disease, surgical bypasses (i.e. gastrojejunostomy) can provide good palliation
    3. o CT/RT: less useful in gastric carcinoma 
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