This action might not be possible to undo. Are you sure you want to continue?
It is located in the upper abdomen, between the esophagus and the small intestine. Stomach cancer is also called gastric cancer. Most (85%) cases of gastric cancer are adenocarcinomas that occur in the lining of the stomach (mucosa). Approximately 40% of cases develop in the lower part of the stomach (pylorus); 40% develop in the middle part (body); and 15% develop in the upper part (cardia). In about 10% of cases, cancer develops in more than one part of the organ. Stomach cancer can spread (metastasize) to the esophagus or the small intestine, and can extend through the stomach wall to nearby lymph nodes and organs (e.g., liver, pancreas, colon). It also can metastasize to other parts of the body (e.g., lungs, ovaries, bones). Incidence According to the National Cancer Institute (NCI), approximately 760,000 cases of stomach cancer are diagnosed worldwide and more than 24,000 cases are diagnosed in the United States each year. Incidence is highest in Japan, South America, Eastern Europe, and parts of the Middle East. Worldwide, stomach cancer is the second leading cause of cancer-related deaths Risk Factors and Causes The cause of stomach cancer is unknown. Age and gender are risk factors and the disease is more common in men over the age of 55. A diet high in salt and nitrates and low in vitamins A and C increases the risk for stomach cancer. Other dietary risk factors include food preparation (e.g., preserving food by smoking, salt-curing, pickling, or drying) and environment (e.g., lack of refrigeration, poor drinking water). A diet high in raw fruits and vegetables, citrus fruits, and fiber may lower the risk for stomach cancer. Medical conditions that increase the risk for the disease include pernicious anemia (vitamin B-12 deficiency), chronic inflammation of the stomach (atrophic gastritis), and intestinal polyps (noncancerous growths). Genetic (hereditary) risk factors include hereditary nonpolyposis colon cancer (HNPCC) syndrome and Li-Fraumeni syndrome (conditions that result in a predisposition to cancer), and a family history of gastrointestinal cancer. People with type A blood also have an increased risk for stomach cancer. Acquired (not present at birth) risk factors include the following: Signs and Symptoms of Gastric Cancer Early stomach cancer usually does not cause symptoms (i.e., is asymptomatic). Symptoms usually indicate advanced disease and include the following: • • • • • • Abdominal discomfort or pain Blood in stool Bloating (especially after eating) Diarrhea or constipation Fatigue Diagnosis Diagnosis of stomach cancer involves taking a medical history and performing a physical examination and laboratory tests. A palpable (i.e., able to be felt with the fingers) tumor or mass may indicate advanced disease. Tests may include fecal occult blood test, complete blood count (CBC), upper GI series (also called barium swallow), gastroscopy, and imaging tests. Fecal occult blood test is used to detect microscopic blood in the stool, which may indicate stomach or other gastrointestinal (GI) cancers (e.g., colorectal cancer). Complete blood count (CBC) is a simple blood test used to measure the concentration of white blood cells, red blood cells, and platelets.
Chemotherapy and radiation therapy may be used in addition to surgery (adjuvant treatment) or as palliative treatment. Nearby lymph nodes may be involved. Recurrent Patient with previous gastric cancer was cancer free. the patient drinks a thick. Endoscopic mucosal resection may be used to treat early stomach cancer (i. but cancer returned. Gastric Surgery The extent of surgery depends on the extent of the disease. the esophagus is attached directly to the small intestine. and the patient's age and overall health. the entire stomach (total gastrectomy) or part of the stomach (partial or subtotal gastrectomy) is removed. The goal of treatment for early-stage stomach cancer is to cure the disease. once doctors know how far along the cancer is. air is blown into the esophagus and stomach to help the liquid coat the wall of the organs more thoroughly Gastric Cancer Staging Staging is a method of judging the progress of the cancer in a patient. the goal is to reduce pain and restore some quality of life (called palliative treatment). and loss of appetite. surrounding lymph nodes also are removed (lymph node dissection). This is known as metastasis. chalky liquid (barium) that coats the esophagus and stomach and makes it easier to detect abnormal areas on x-ray. In double-contrast barium swallow. The connection between these organs is called an anastomosis. Recovery from the procedure varies depending on the patient’s age and overall health. the stage of the disease. In most cases. There are a number of aspects to staging. In this surgery.e. tumor smaller than 3 cm that has not invaded beyond the innermost layer of the stomach lining [submucosa]).g. and extent of the tumor. Stage IV Cancer has affected nearby organs and tissues. . A simplified approach puts patients into six groups or stages based on how far the cancer has advanced: Stage 0 Cancer has just begun to affect the inner stomach.. This procedure involves removing only the tumor and surrounding tissue. Surgery for cancer of the upper stomach (cardia) may require removal of the stomach and part of the esophagus (called esophagogastrectomy). The staging process looks at the tumor and the extent to which it has spread to other parts of the body. or barium swallow. Most patients experience postsurgical pain. Stage III Cancer has penetrated all tissue layers of stomach or distant lymph nodes may be involved.• In an upper GI series. That is. In advanced cases. location. the spleen) may also be removed. the type of surgery. Cancer may even have been carried through the lymph system to distant parts of the body. Following total gastrectomy.. the surgeon reattaches the stomach to the esophagus or small intestine. weakness. fatigue. When a large section of the stomach is removed during partial gastrectomy. and the stage of the disease. • • • Surgical Treatment for Gastric Cancer Treatment for stomach cancer depends on the size. Gastrectomy is the most common treatment for stomach cancer. Gastrectomy requires a large incision. they can decide on the best course of treatment. Stage I Cancer has begun to penetrate toward the outer layer of stomach. when a cure is unlikely. Stage II Cancer has progressed farther through tissue layers of stomach or more distant lymph nodes may be involved. Surgical removal (resection) is the only curative treatment. Parts of nearby tissues or organs (e.
e. individuals should minimize their intake of dried. this may be difficult. • • • Buy the Book PDA Download . should eat an adequate amount of fruits. salty foods. and whole grains.Complications of surgery include the following: • • • • • Anastomosis failure Blood clots Bowel obstruction (ileus) Inflammation of the gall bladder (cholecystitis) or pancreas (pancreatitis) Pneumonia Chemotherapy Chemotherapy involves using drugs to destroy cancer cells. Chemotherapy drugs target rapidly dividing cells and travel throughout the body via the bloodstream (called systemic treatment). high-fat foods and animal proteins should only be consumed moderately. In addition. This treatment may be used after stomach cancer surgery to destroy remaining cancer cells and prevent recurrence (adjuvant treatment). since all the causes are not well understood. With most cancers. In the case of gastric cancer. Individuals. Chemotherapy drugs may be administered orally or through an IV (i. Dietary risk factors can be managed. prevention involves moderating the lifestyle and environmental exposure factors that seem to be associated with it. through a vein) and treatment often is administered on an outpatient basis.. especially those in risk groups. vegetables. Side effects may be severe and include the following: • • Diarrhea Fatigue • Hair loss Stomach Cancer (suppressed immune system) • Increased risk for infection • • • • Loss of appetite Nausea and vomiting Reduced red blood cell count (anemia) Prevention Stomach cancer cannot be prevented in all cases. Most importantly.
Chile. less common are localized gastric lymphomas (see Lymphomas) and leiomyosarcomas. Gastric adenocarcinoma accounts for 95% of malignant tumors of the stomach. obstruction. Long-term survival is poor except for those with local disease. Etiology Helicobacter pylori infection is the cause of most stomach cancer. incidence is extremely high in Japan. Hispanics. China. and Iceland. Dietary factors have not proven to be a cause. In the US. followed by CT and endoscopic ultrasound for staging. incidence has declined in recent decades to the 7th most common cause of death from cancer. Stomach cancer is the 2nd most common cancer worldwide. Inflammatory polyps may develop in .Update Me E-mail alerts The Merck Manual Minute Print This Topic Email This Topic Etiology of stomach cancer is multifactorial. it is most common among blacks. Gastric polyps can be precursors of cancer. Diagnosis is by endoscopy. but the incidence varies widely. butHelicobacter pylori plays a significant role. Symptoms include early satiety. and bleeding but tend to occur late in the disease. > 75% of patients are > 50 yr. Its incidence increases with age. and American Indians. Autoimmune atrophic gastritis (see Gastritis and Peptic Ulcer Disease: Autoimmune Metaplastic Atrophic Gastritis) and various genetic factors (see Tumors of the GI Tract: Gastrointestinal Stromal Tumors) are also risk factors. Stomach cancer accounts for an estimated 21.000 deaths in the US annually. Treatment is mainly surgery.000 cases and over 11. In the US. chemotherapy may provide a temporary response.
usually resulting from dietary restriction. jaundice. are the most likely to develop cancer. left . umbilical. although rare. abnormalities include an epigastric mass. this classification is the largest. fractures). Dysphagia may result if cancer in the cardiac region of the stomach obstructs the esophageal outlet. (4) Linitis plastica—the tumor infiltrates the stomach wall with an associated fibrous reaction that causes a rigid “leather bottle” stomach. and fundic foveolar polyps are common among patients taking proton pump inhibitors. Cancer is particularly likely if an adenomatous polyp is > 2 cm in diameter or has a villous histology. Adenomatous polyps. Stomach Cancer Symptoms and Signs Initial symptoms are nonspecific. (3) Superficial spreading—the tumor spreads along the mucosa or infiltrates superficially within the wall of the stomach. Because malignant transformation cannot be detected by inspection. Later. Protruding tumors have a better prognosis than spreading tumors because they become symptomatic earlier. ascites. the first symptoms are caused by metastasis (eg. early satiety (fullness after ingesting a small amount of food) may occur if the cancer obstructs the pyloric region or if the stomach becomes nondistensible secondary to linitis plastica. is common. (2) Penetrating—the tumor is ulcerated. Loss of weight or strength. Patients and physicians alike tend to dismiss symptoms or treat the patient for acid disease. often consisting of dyspepsia suggestive of peptic ulcer. but secondary anemia may follow occult blood loss. particularly multiple ones. Occasionally. Physical findings may be unremarkable or limited to heme-positive stools.patients taking NSAIDs. The incidence of stomach cancer is generally decreased in patients with duodenal ulcer. Late in the course. Massive hematemesis or melena is uncommon. (5) Miscellaneous—the tumor shows characteristics of two or more of the other types. Pathophysiology Gastric adenocarcinomas can be classified by gross appearance: (1) Protruding —the tumor is polypoid or fungating. all polyps seen at endoscopy should be removed.
and an ovarian or rectal mass. Japanese) but is not recommended in the US. particularly doublecontrast barium studies. More widespread disease is almost always fatal within 1 yr. should be done to assess anemia. If CT is negative for metastasis. a biopsy limited to the mucosa misses tumor tissue in the submucosa. Pulmonary. and possible liver metastases. and bone lesions may occur. Patients suspected of having stomach cancer should have endoscopy with multiple biopsies and brush cytology. hydration. general condition. hepatomegaly. a rise signifies recurrence. including CBC. may show lesions but rarely obviate the need for subsequent endoscopy. Diagnosis • • Endoscopy with biopsy Then CT and endoscopic ultrasound Differential diagnosis commonly includes peptic ulcer and its complications. and pelvis. For tumors involving local lymph nodes. follow-up should include CEA levels. and liver function tests. If an elevated CEA dropped after surgery. Gastric lymphomas have a better prognosis and are discussed in Lymphomas. electrolytes. Follow-up screening for recurrence in treated patients consists of endoscopy and CT of the chest. Screening: Screening with endoscopy is used in high-risk populations (eg. If the tumor is limited to the mucosa or submucosa. survival is 20 to 40%. Treatment . endoscopic ultrasound should be done to determine the depth of the tumor and regional lymph node involvement. Prognosis Prognosis depends greatly on stage but overall is poor (5–yr survival: < 5 to 15%) because most patients present with advanced disease.supraclavicular. Patients in whom cancer is identified require CT of the chest and abdomen to determine extent of tumor spread. 5–yr survival may be as high as 80%. CNS. Carcinoembryonic antigen (CEA) should be measured before and after surgery. X–rays. abdomen. Basic blood tests. Occasionally. Findings guide therapy and help determine prognosis. or left axillary lymph nodes.
cisplatin . Resection of locally advanced regional disease results in a 10–mo median survival (vs 3 to 4 mo without resection). or leucovorin in various combinations) may produce temporary response but little improvement in 5–yr survival. doxorubicin . Radiation therapy is of limited benefit. and at most. sometimes combined with chemotherapy. However. mitomycin . . radiation. Curative surgery involves removal of most or all of the stomach and adjacent lymph nodes and is reasonable in patients with disease limited to the stomach and perhaps the regional lymph nodes (< 50% of patients). palliative procedures should be undertaken. Metastasis or extensive nodal involvement precludes curative surgery. In patients not undergoing surgery. Adjuvant chemotherapy or combined chemotherapy and radiation therapy after surgery may be beneficial if the tumor is resectable. Palliative surgery typically consists of a gastroenterostomy to bypass a pyloric obstruction and should be done only if the patient's quality of life can be improved.• Surgical resection. combination chemotherapy regimens (5– fluorouracil . or both Treatment decisions depend on tumor staging and the patient's wishes (some may choose to forgo aggressive treatment—see Medicolegal Issues: Advance Directives). the true extent of tumor spread often is not recognized until curative surgery is attempted.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.