Diagnosis

Gastric cancer

Etiology

Pathophysiology [zss]

1. Chronic inflammation --> Precancerous lesions

   • Gastric ulcers

   • Atrophic gastritis

   • Pernicious anemia

2. Dysplasia --> carcinoma (a mass or a nonhealing ulcer)

   • Adenocarcinoma comprises 95% of malignant gastric cancer

   • Linitis plastica (leather bottle): extensive infiltration --> nondistended stomach

3. Disease often goes undiagnosed until its advanced stages due to the late onset of symptoms, complicating treatment and lowering survival rates

Risk factors [zss]

• Chronic gastritis

• H. pylori infection

• Epstein-Barr virus

• Gastric ulcer

• Gastroesophageal reflux

• Post-partial gastrectomy

• Diet (salt --> gastritis, smoked or cured foods, contaminated drinking water)

• Obesity

• Cigarette smoking

• Alcohol

• Age

• Environmental factors: Rubber manufacturing, tin mining, metal processing, and coal

• Blood type A

• Genetic factors (10% of stomach cancer cases are familial in origin)

  • Hereditary Nonpolyposis Colorectal Cancer

  • Familial Adenomatous Polyposis

  • Peutz-Jeghers syndrome

  • Li-Fraumeni syndrome

  • Hereditary breast and ovarian cancer syndrome

  • Cowden Disease

Epidemiology

Incidence per 100.000 [vhd][tnc][ysw][9o9]

Approach

• Blood test

• Gastroscopy

• Biopsy

• CT abdomen

• Endoscopic ultrasound

• Pelvic exam

• Rectal examination

• Hemofec

Treatment

• Treatment depends on: [cur]

  • The stage of the disease 

  • The severity of symptoms 

  • Wishes and preferences 

  • General health

1. Endoscopic resection: Possible if the cancer is in the very early stages

2. Curative surgery: the best option if the cancer is stage 1, 2 or 3

   • Partial gastrectomy: Open or laparoscopic

   • Total gastrectomy: Open or laparoscopic

   • Chemotherapy before (down staging) or after surgery (reduce risk of recurrence)

3. Palliative care:

   • Feeding tube

   • Chemotherapy

   • Radiation therapy

   • Targeted therapy (Trastuzumab if HER2-positive stomach cancer)

   • Immunotherapy (stimulate the immune system to attack cancer cells)

   • Endoluminal stent placement

   • Endoluminal laser therapy

   • Gastrojejunostomy or gastric bypass

Differential diagnoses

Eosinophilic esophagitis, Esophageal cancer, Esophageal stricture, Esophagitis, Familial adenomatous polyposis, Gastric lymphoma, Gastritis, Gastroenteritis, Gastroesophageal reflux disease, Gastrointestinal stromal tumor, Menetriers disease, Pancreatic cancer, Pernicious anemia, Ulcer disease