Stomach cancer
From Medical-Wiki
Gastric cancer is the second leading cause of cancer-related deaths in the world. This is due to some extent because of exceedingly high rates in many Asian countries. 5-year survival rates following curative surgery range from 30% to 50% for stage II disease and 10% to 25% for stage III disease. Operative mortality rate at major academic centers is 3%.
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Signs & symptoms
Early on, gastric carcinoma has relatively few symptoms. Patients with advanced disease may complain of indigestion, nausea or vomiting, dysphagia, anorexia, weight loss and early satiety. Very late complications include peritoneal and pleural effusions, gastric outlet obstruction, jaundice, and cachexia. [1]
Risk factors
There has been an association of gastric carcinoma with the presence of H. pylori. Some studies have suggested, “In the subgroup of H pylori carriers without precancerous lesions, eradication of H pylori significantly decreased the development of gastric cancer. Further studies to investigate the role of H pylori eradication in participants with precancerous lesions are warranted.” [2]
Other risk factors include tobacco use, familial adenomatous polyposis, gastric adenomas, Barrett’s esophigitis, pernicious anemia, and chronic atrophic gastritis. [3]
Diagnosis
Oncology guidelines call for the workup of a patient to begin with a CBC, UA, SMA12, platelets, CT of the abdomen, CT of the pelvis in females, and esophagogastroduodenoscopy. These guidelines also establish a detailed algorithm for treatment. [4]
International guidelines for identification and prevention of the disease call for adoption of healthy lifestyles and eradication of H. pylori. Endoscopy is indicated in those patients with symptoms of esophageal reflux and “alarm symptoms.” The alarm symptoms are dysphagia, recurrent vomiting, anorexia, weight loss, and gastrointestinal blood loss. A specific recommendation was made for those patients with Barrett’s esophigitis establishing that, “there should be a structured biopsy protocol with quadrantic biopsies every two centimetres and biopsy of any visible lesion.” [5]
Stages
Staging of tumor via the AJCC criteria begins with stage 0, carcinoma in-situ. Stage I is basically involvement of submucosa or submucosa. Stage II is involvement of visceral peritoneum. Stage III is local invasion or invasion of lymph nodes. Stage IV is distant metastasis. [6]
