Stomach cancer overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
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Overview
Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus and the small intestine. Stomach cancer causes nearly one million deaths worldwide per year.[1]
Classification
Stomach cancer may be classified into adenocarcinoma, lymphoma, gastrointestinal stromal tumor, and carcinoid tumor.
Pathophysiology
The pathophysiology of stomach cancer depends on histologic subtypes.
Differential diagnosis
Stomach cancer must be differentiated from gastric lymphoma, gastric metastasis, gastritis, benign gastric ulcer, menetrier disease.
Epidemiology and Demographics
Stomach cancer is the fifth most common cancer worldwide.[2] In the United States, stomach cancer represents roughly 1.3% of all new cancer cases yearly[3]. In 2011, the age-adjusted prevalence of stomach cancer was estimated to be 23.5 cases per 100,000 individuals in the United States.[4] Stomach cancer is two times more common in men than in women, and the incidence increases with age.
Risk Factors
Common risk factors in the development of stomach cancer are helicobacter pylori infection, cigarette smoking, family history of stomach cancer, and a diet high in salted smoked or preserved foods.
Screening
There is no screening recommended for stomach cancer.
Natural history, Complications and Prognosis
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.
Staging
According to the American Joint Committee on Cancer, there are 4 stages of stomach cancer based on the tumor spread.
Symptoms
Symptoms of stomach cancer include abdominal pain, bloating, weight loss, hematemesis and melena.
Physical Examination
Patients with stomach cancer generally appear healthy. Common physical examination findings include abdominal distention, palpation of an abdominal mass, and pallor. Leser-Trelat sign and presence of Virchow's node (left supraclavicular lymphadenopathy), Sister Mary Joseph nodule (visible periumbilical nodule), Blumer's shelf (rectal mass/shelf on rectal exam) and/or Trousseau's syndrome (migratory phlebitis) on physical examination are highly suggestive of stomach cancer.
Endoscopy and Biopsy
Biopsy may be helpful in the diagnosis of stomach cancer.
CT
Abdominal CT scan may be helpful in the diagnosis of stomach cancer.
Other imaging findings
Fluoroscopy may be diagnostic of stomach cancer.
Medical therapy
The optimal therapy for stomach cancer depends on the stage at diagnosis.
Surgery
Surgery is the mainstay of treatment for stomach cancer. Endoscopic resection is suggested for early gastric cancer. There are criteria for endoscopic resection of ealry gastric cancer. Methods for endoscopic resection include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Side effects of endoscopy includes bleeding and perforation. For T1 tumors, a gross resection margin of 2 cm should be obtained. Proximal margin of at least 3 cm is recommended for T2 or deeper tumors with an expansive growth pattern and 5 cm for those with an infiltrative growth pattern. For tumors invading the esophagus, a 5-cm margin is not necessarily required, but frozen section examination of the resection line is desirable to ensure a R0 resection. There is a debate about optimal lymph nodes removal. D1 lymphadenectomy refers to a dissection of only the perigastric lymph nodes. D2 lymphadenectomy is an extended lymph node dissection, includes removal of nodes along the hepatic, left gastric, celiac, and splenic arteries, as well as those in the splenic hilum. D3 dissection is a superextended lymphadenectomy. The surgery includes D2 lymphadenectomy plus the removal of nodes within the porta hepatis and periaortic regions.
Primary prevention
Effective measures for the primary prevention of stomach cancer include smoking cessation, helicobacter pylori infection eradication, and having a balanced diet rich in fruits and vegetables.
References
- ↑ "Cancer". World Health Organization. Feb 2006. Retrieved 2007-05-24.
- ↑ Stomach cancer incidence statistics. Cancer research UK
- ↑ SEER stat fact sheets: stomach cancer
- ↑ Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.