Stomach or gastric cancer usually affects age group of 55-65 years. It is seen more in males. There is a hereditary tendency and an increased incidence of stomach cancer in those with blood group A.
Factors associated with increased risk for stomach cancer are-
- High salt intake.
- Exposure to alpha-toxins, nickel refining and rubber processing.
- Living in areas with high nitrate content in the soil.
- Chronic gastritis usually type-A.
Stages of Gastric Cancer
Nearly 95% of stomach cancers are adenocarcinomas.
The remaining includes lymphoma, leiomyosarcoma, carcinoid tumor, metastatic cancer and others.
Morphological type’s are
- Ulcerating and infiltrating.
Three most important prognostic variables are the depth of the tumor invasion and presence of metastasis.
By the TNM (tumor, node, and metastasis) classification 5 year survival rates vary from 70% fro stage I, 30% for stage II, 9% for stage III and 0.5% and 2% for stage IV.
Clinical Features of Stomach Cancer
Patient may present with the following symptoms
- Epigastric discomfort, fullness or burning after heavy meal or belching.
- Disturbance of appetite and nausea.
- Decrease in appetite.
- Recurrent bouts of nausea and vomiting.
- Post-prandial distress simulating peptic ulcer.
- Haematemesis (vomiting of blood) or malena (blood in stools) may be the first presenting symptom in some cases.
- Slight dysphagia (difficulty in eating) after solid foods, cough induced by swallowing and regurgitation may occur if lesion is in lower esophagus.
- Colonic symptoms include diarrhea due to rapid stomach emptying or even constipation and lower abdominal discomfort.
- Patient may approach medical help with compliant of lump in abdomen.
- Loss of weight and strength.
- Anemia and pallor.
- Symptoms due to metastasis- like ascites, jaundice, and pathological fractures.
- Acute abdomen- rarely perforation of gastric carcinoma may be the first manifestation.
Signs of Stomach Cancer
Epigastric mass, jaundice, a left supra-clavicular node or ascites may be seen.
Physical signs almost invariably signify an incurable disease, with the exception of pyloric stenosis which may be caused by a relatively early cancer.
Diagnosis of Gastric Cancer
- Radiology: Double contrast studies are done to detect mucosal abnormalities due to neoplastic invasion/infiltration.
- Endoscopy: If barium meal results are equivocal, then brush cytology combined with biopsy with help of endoscopy helps confirming the diagnosis.
- CT-scan is often useful in staging of stomach cancer particularly for detecting hepatic and lymph node metastasis.
Treatment for Stomach Cancer
- Radiotherapy is not frequently used as gastric adenocarcinoma is a relatively radio-resistant tumor. Therefore, radiation can help only in palliation of pain.
- Chemotherapy has been used, however results are not encouraging. It has been used to down-stage locally advanced cancer prior to surgery.
- Surgery remains the main treatment modality for cure and palliation.
- In early cases, local gastric resection and in more advanced cases sub-total or total gastrectomy is the treatment of choice.