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CA Stomach

CA Stomach

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Stomach cancer

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Gastric cancer
Classification and external resources

A suspicious stomach ulcer that was diagnosed as cancer on biopsy and resected. Surgical specimen.

ICD-10

C16.

ICD-9

151

OMIM

137215

3 Radiation o 4. Stomach cancer causes about 800.2 Chemotherapy o 4.4 Multimodality therapy 5 Epidemiology 6 In other animals 7 References .2 Staging 4 Management o 4.[1] Contents [hide] y y y y y y y 1 Signs and symptoms 2 Causes 3 Diagnosis o 3.1 Surgery o 4. and the liver. commonly referred to as stomach cancer. lymph nodes.000 deaths worldwide per year.1 Histopathology o 3. can develop in any part of the stomach and may spread throughout the stomach and to other organs. particularly the esophagus. lungs.DiseasesDB 12445 eMedicine med/845 MeSH D013274 Gastric cancer.

y 8 Exte al li s [e i ] ig s symp ms E sc ic ima e of li itis plastica a t pe of stomac ca ce whe e the e ti e stomach is i a e lea i with blood comi out of it ¤   ¡ ¢ £ £ ¤ to a leathe bottle -li e appea a ce Stomach ca ce is ofte as mptomatic or causes onl nonspecific s mptoms in its earl sta es By the time symptoms occur. one of the mai n reasons for its poor prognosis cit ti ee e ] Stomach cancer can cause the following signs and symptoms: Stage 1 (Early) y y y Indigestion or a burning sensation ( heartburn) Loss of appetite. especially for meat Abdominal discomfort or irritation le) Stage 2 ( i . the cancer has often reached an advanced sta e (see below).

but in only 2% of such infections. pylori is the main risk factor in 65±80% of gastric cancers. and pickled vegetables (appear to increase the risk of stomach cancer. This can lead to anemia."[3] A December 2009 article in American Journal of Clinical Nutrition found a statistically significant inverse correlation between higher adherence to a Mediterranean Dietary Pattern and stomach cancer. though causality has yet to be established. this feature suggests a tumor in the cardia or e tension of the gastric tumor in to the esophagus. Diagnosis should be done by a gastroenterologist or an oncologist. gastric ulcer or tropical sprue.y y Weakness and fatigue Bloating of the stomach. from 40% increased risk for current smokers to 82% increase for heavy smokers which is nearly twice the risk for non smoking . H. Smoking increases the risk of developing gastric cancer considerably. Note that these can be symptoms of other problems such as a stomach virus. intestinal metaplasia and various genetic factors are associated with increased risk levels.[4] In more detail. into compounds that have been found to cause stomach cancer in animals. On the other hand. They can be converted by certain bacteria. pylori. usually after meals Sta e 3 Late y y y y y y Abdominal pain in the upper abdomen Nausea and occasional vomiting Diarrhea or constipation Weight loss Bleeding (vomiting blood or having blood in the stool) which will appear as black. such as H. The clinical medical reference the Merck Manual states that diet plays no role in the genesis of stomach cancer. [6] In Japan and other countries bracken consumption and spores are correlated with incidence of stomach cancer.[2] However. salted fish and meat.[7] A very important but preventable cause of gastric cancer is tobacco smoking.[5] Appro imately ten percent of cases show a genetic component. the American Cancer Society lists the following dietary risks. eating fresh fruits and vegetables that contain antio idant vitamins (such as A and C) appears to lower the risk of stomach cancer. [edit Causes Infection by Helicobacter pylori is believed to be the cause of most stomach cancer while autoimmune atrophic gastritis.) Nitrates and nitrites are substances commonly found in cured meats. and protective factors. Dysphagia. for stomach cancer: "smoked foods.

is the only sure way to confirm the presence of cancer cells. Gastric cancer shows a male predominance in its incidence as up to three males are affected for every female. Other gastroscopic modalities such as optical coherence tomography are also being tested investigationally for similar applications.[14] A very small percentage of diffuse type gastric cancers (see Histopathology below) are thought to be genetic. [edit Dia nosis To find the cause of symptoms.[18] .[15] Some researchers [16] showed a correlation between Iodine deficiency or e cess. Hereditary Diffuse Gastric Cancer (HDGC) has recently been identified and research is ongoing. The patient may also have one or all of the following e ams: y y y Gastroscopic e am is the diagnostic method of choice. with subsequent histological analysis. This involves insertion of a fiber optic camera into the stomach to visualize it.[17] The proposed mechanism of action is that iodide ion can function in gastric mucosa as an antio idant reducing species that can deto ify poisonous reactive o ygen species. such as hydrogen pero ide. Upper GI series (may be called barium roentgenogram) Computed tomography or CT scanning of the abdomen may reveal gastric cancer. does a physical e am. This tissue is then sent to a pathologist for histological e amination under a microscope to check for the presence of cancerous cells. the doctor asks about the patient's medical history. iodine deficient goitre and gastric cancer. Endocytoscopy involves ultra high magnification to visualize cellular structure to better determine areas of dysplasia. a decrease of the incidence of death rate from stomach cancer after implementation of the effective I prophyla is was reported too.population. Estrogen may protect women against the development of this cancer form. Various gastroscopic modalities have been developed to increased yield of detect mucosa with a dye that accentuates the cell structure and can identify areas of dysplasia. The International Cancer Genome Consortium is leading efforts to map stomach cancer's complete genome. However. or the presence of spread to local lymph nodes. A biopsy. [11][12][13] Alcohol as cause of cancer along with tobacco smoking as cause of cancer increase the risk of developing other cancers as well. Gastric cancers due to smoking mostly occur in upper part of stomach near esophagus[8][9][10] Another lifestyle cause of gastric cancer besides smoking is consumption of alcohol. genetic testing and treatment options are already available for families at risk. Abnormal tissue seen in a gastroscope e amination will be biopsied by the surgeon or gastroenterologist. and may order laboratory studies. but is more useful to determine invasion into adjacent tissues.

[19] ¥ ¥ Various blood tests may be done. A condition of darkened hyperplasia of the skin. Also. known as acanthosis nigricans .A number of cutaneous conditions are associated with gastric cancer. Gastric signet ring cell carcinoma. [e it] Histopathology Poor to moderately differentiated adenocarcinoma of the stomach. H&E stain. fre uen tly of the axilla and groin. which is the rapid development of skin lesions known as seborrheic keratoses. a stool test may be performed to check for blood in the stool. ¦ . H&E stain. including: Complete Blood Count (CBC) to check for anemia. is associated with intra -abdominal cancers such as gastric cancer. Other cutaneous manifestations of gastric cancer include tri e lms (a similar darkening h yperplasia of the skin of the palms) and the sign of Leser-Trelat.

or other tests to check these areas. originating from glandular epithelium of the gastric mucosa. Intestinal type adenocarcinoma tumor cells describe irregular tubular structures. it associates inte stinal metaplasia in neighboring mucosa. cellular pleomorphism and mucosecretion. Around 5% of gastric malignancies are lymphomas (MALTomas. the submucosa. multiple lumens. It is poorly differentiated. the next step is to stage. harboring pluristratification. or MALT lymphoma). colloid. a PET scan. . If the mucus remains inside the tumor cell. if so. adenocarcinoma may present 3 degrees of differentiation: well.[20] Histologically. § ¨ § © ¨ © [e it] Staging If cancer cells are found in the tissue sample. Because stomach cancer can spread to the liver. linitis plastica. especially to the liver. what par ts of the body are affected. reduced stroma ("back to back" aspect). Depending on gland ular architecture. Blood tests for tumor markers. and the cure rate. and thence the muscularis propria . the pancreas. Various tests determine whether the cancer has spread and. y y y Gastric ade carci ma is a malignant epithelial tumor. Often. moderate and poorly differentiated. Adenocarcinomas tend to aggressively invade the gastric wall. infiltrating the muscularis mucosae. H&E stain. Stomach cancers are overwhelmingly adenocarcinomas (90%). such as carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) may be ordered. Diff se type adenocarcinoma (mucinous. or find out the extent of the disease. as their levels correlate to extent of metastasis. the doctor may order a CT scan. leather-bottle stomach) Tumor cells are discohesive and secrete mucus which is delivered in the interstitium producing large pools of mucus/colloid (optically "empty" spaces). there are two major types of gastric adenocarcinoma (Lauren classification): i testi al type or iff se type.[21] Carcinoid and stromal tumors may also occur. it pushes the nucleus to the periphery.Adenocarcinoma of the stomach and intestinal metaplasia . and other organs near the stomach as well as to the lungs."sig et-ri g cell". an endoscopic ultrasound exam.

[25] A Minnesota population was diagnosed 10% in Stage I. otherwise by gastrectomy and lymphadenectomy without need for chemotherapy or radiation. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials. [26] However in a high-risk population in the Valdivia Province of southern Chile. and 18% in Stage III. 13% in Stage II. Sta e I. patients were diagnosed 7% in Stage I 17% in Stage II.[citation needed ] An antibody-drug conjugate IMGN242 is in phase II .[27] [edit Mana ement As with any cancer. Cancer has spread to nearby tissues and more distant lymph nodes. or irinotecan. Penetration to the second layer and more distant lymph nodes. a cure is still possible in some cases. Sta e III. the stage of the disease. Treatment for stomach cancer may include surgery. Sta e IV. capecitabine. treatment is adapted to fit each person's individual needs and depends on the size. and/or stents to keep the digestive tract open. and chemotherapy by drugs such as 5-fluorouracil. location. The clinical stages of stomach cancer are:[22][23] y y y y y Sta e 0. and e tent of the tumor. because early stomach cancer causes few symptoms. or has metastatized to other organs. o aliplatin. Treated as for Stage II. Unfortunately. Stage 1B may be treated with chemotherapy (5-fluorouracil) and radiation therapy. including laser treatment. etoposide. Stage 1A is treated by surgery. or penetration to the fourth layer and either nearby tissues or nearby or more distant lymph nodes. and 28% in Stage III. Penetration to the second or third layers of the stomach (Sta e 1A) or to the second layer and nearby lymph nodes (Sta e 1B). surgery. including removal of the omentum. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for e amination by a pathologist. and/or radiation therapy. epirubicin. Sta e II. A cure is very rarely possible at this stage. The TNM staging system is also used.Staging may not be complete until after surgery. Limited to the inner lining of the stomach. Treated as for Stage I. or all four layers but not the lymph nodes. and general health. cisplatin. the disease is usually advanced when the diagnosis is made. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Treatable by endoscopic mucosal resection when found very early (in routine screenings). doceta el. Some other techniques to prolong life or improve symptoms are used. sometimes with additional neoadjuvant chemotherapy. or the third layer and only nearby lymph nodes. Penetration to the third layer and more distant lymph nodes. only 5% of patients were diagnosed in the first two stages and 10% in stage III. chemotherapy.[24] In a study of open-access endoscopy in Scotland.

The combination of Herceptin with chemotherapy for treating metastatic gastric cancer was also . and more recently cisplatin and ta otere. Some think this is because it reduces the gastric acid in your stomach and helps numb the stomach walls. Inc.[31] Clinical researchers have e plored the benefits of giving chemotherapy before surgery to shrink the tumor.[28] [29] There is a well known remedy that eating jalapeño peppers daily can help reduce the pain of stomach cancer. In this procedure. and chemotherapy. Depending on the e tent of invasion and the location of the tumor. The relative benefits of these different drugs. BCNU (carmustine). The advantage is that it is a much smaller operation than removing the stomach. Surgical interventions are currently curative in less than 40% of cases.) in combination with cisplatin and a fluoropyrimidine (capecitabine or 5-fluorouracil). Combination treatment with chemotherapy and radiation therapy has some activity in selected post surgical settings. Some drugs used in stomach cancer treatment have included: 5-FU (fluorouracil) or its analog capecitabine. The surgeon removes part or all of the stomach. methyl-CCNU (Semustine). together with the inner lining of stomach (mucosa).clinical trials. is removed from the wall of the stomach using an electrical wire loop through the endoscope. has usually served to palliatively reduce the size of the tumor. if used. alone and in combination. surgery may also include removal of part of the intestine or pancreas. relieve symptoms of the disease and increase survival time. used to resect a large area of mucosa in one piece. Tumors in the lower part of the stomach may call for a Billroth I or Billroth II procedure. the tumor. For patients who have HER2 overe pressing metastatic gastric or gastroesophageal (GE) junction adenocarcinoma. with the basic goal of removing all cancer and a margin of normal tissue. Endoscopic submucosal dissection (ESD) is a similar technique pioneered in Japan. stomach cancer has not been particularly sensitive to these drugs. [edit Chemothera The use of chemotherapy to treat stomach cancer has no firmly established standard of care. the patient would need a formal stomach resection. Endoscopic mucosal resection (EMR)[30] is a treatment for early gastric cancer (tumor only involves the mucosa) that has been pioneered in Japan. or as adjuvant therapy after surgery to destroy remaining cancer cells. are unclear. in cases of metastasis. Unfortunately. and do orubicin (Adriamycin). This was based on an improvement of the median overall survival (OS) of 2. but is also available in the United States at some centers. Genentech. who have not received prior treatment for their metastatic disease. the US Food and Drug Administration granted approval (2010 October) for trastuzumab (Herceptin. often using drugs in various combinations.5 months[32] with trastuzumab plus chemotherapy treatment compared to chemotherapy alone (BO18255 ToGA trial). If the pathologic e amination of the resected specimen shows incomplete resection or deep invasion by tumor. and.[citation needed] [edit Sur er Surgery is the most common treatment. as well as the surrounding lymph nodes. as well as Mitomycin C. may only be palliative.

000 inhabitants in 2004. or used only with chemotherapy in cases where the individual is unabl e to undergo surgery. Patients were randomized after surgery to the standard group of observation alone.5 3. it is generally in combination with surgery and chemotherapy. When used.5-8 8-12. [edit] Epidemiology Age-standardized death from stomach cancer per 100. [34] no data less than 3. the Intergroup 0116 (SWOG 9008) study [33] showed a survival benefit to the combination of chemotherapy and radiation therapy in patients with nonmetastatic.sanctioned by the European regulatory authorities (2010 January). [edit] Multimodality therapy While previous studies of multimodality therapy (combinations of surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumor for palliation of incurable disease. Doctors have also tested putting the anticancer dru gs directly into the abdomen. compared to 27 months with observation. chemotherapy and radiation therapy) gave mixed resu lts.5 12. Those in the study arm receiving chemotherapy and radiation ther apy survived on average 36 months. or the study arm of combination chemotherapy and radiation therapy. completely resected gastric cancer.5-17 . [e it] Radiation Radiation therapy (also called radiotherapy) is the use of high -energy rays to damage cancer cells and stop them from growing. often with warmed solutions of the medication ( intraperitoneal hyperthermic chemoperfusion ).

a . It is the leading cancer type in Korea.000 cases diagnosed in 2002. and lack of appetite. but it is more common in other countries. [edit In other animals The stomach is a muscular organ of the gastrointestinal tract that holds food and begins the digestive process by secreting gastric juice. Metastasis occurs in 80-90% of individuals with stomach cancer.9% in the age-group of 20 to 29.17-21. Signs vary but may include vomiting (especially if blood is present). with 20.[35] It is a disease with a high death rate (~800. the veterinarian will perform special X-rays and/or abdominal ultrasound. weight loss.500 cases) of all new cancer cases yearly in the United States. the mortality was 11.8% of malignant neoplasms.[35][36] It represents roughly 2% (25. Gastroscopy. Bowel movements may be dark and tarry in nature. with a si month survival rate of 65% in those diagnosed in early stages and less than 15% of those diagnosed in late stages. only 3 new cases of stomach cancer in people under 30 years of age in 1999 were diagnosed.1% of that 5% in the age-group of 30 to 39 and 18.000 per year) making it the second most common cause of cancer death worldwide after lung cancer. The most common cancers of the stomach are adenocarcinomas but other histological types have been reported.000 (1996).5-26 26-30.[39] Other studies show that less than 5% of stomach cancers occur in people under 40 years of age with 81. In order to determine whether cancer is present in the stomach.[1] It is more common in men and in developing countries. One in a million people under the age of 55 seeking medical attention for indigestion has stomach cancer [37] and one in 50 of all ages seeking medical attention for burping and indigestion have stomach cancer.[40] For Taiwan (statistic not shown on the above map).75 per 100. anemia.[38] Out of 10 million people in the Czech Republic.5 30.5 21.5-35 35-40 40-45 45-50 more than 50 Stomach cancer is the fourth most common cancer worldwide with 930.

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