Stomach cancer 

☼ An Overview

Distributed under Creative Commons license

☼ Introduction

• leading cause of cancer related morbidity

• Second most common cause of cancer related

deaths after Lung cancer (10.4% of all cancer related deaths).  

• 60% cases occur in the developing world • linked to dietary habits and unhealthy food

preservation practices

☼Causes-

• A/S/L- Elderly Male Asians and East Europeans.

• Diet- Food preserved by drying, smoking, salting and

pickling Dietary nitrites converted to carcinogenic N-nitroso compounds by bacteria in the

stomach.

• Helicobacter Pylori infection-People with H. Pylori bacteria infection of the stomach have greater risk.

Causes- contd

• Prior stomach surgery-People with a history of stomach surgery face a greater risk due to alteration in normal ph of the stomach.

• Stomach Disorders- Pernicious anemia, achlorhydria and atrophic gastritis 6 times more prone.

• Smoking

• Hereditary- underlying genetic factors are poorly understood (KRAS mutation, c-met amplification)

Rarely, some gastric ulcers may turn into cancer.

☼ Types

• 90% arise from the glandular cells of the stomach wall and are called Adenocarcinomas.

• Others – Gastric Lymphomas (cancer of gastric lymphatic tissue) Soft tissue sarcomas (e.g. Leiomyosarcomas) Carcinoids

☼Clinical features • Early stages asymptomatic.

• non-specific symptoms like indigestion, nausea, vomiting and sometimes Pain.

• bloated feeling after eating, loss of appetite, dark colored stools (due to presence of blood) and feeling of tiredness (due to anemia).

• Late features- peritoneal and pleural effusions, Jaundice and cachexia.

• Hepatomegaly usually occurs and presence of an enlarged left supraclavicular lymphnode (Virchow's sign) is a typical finding.

☼Treatment• Surgical intervention Partial/subtotal gastrectomy , Total gastrectomy + making of a new stomach

from S.I

• Radiation therapy- external beam radiation (5 days/week*6 to 8

weeks). Tomotherapy HI-ART (Tomotherapy highly

integrated adaptive radiotherapy) for specific reduced doses.

• Chemotherapy – 5 fluorouracil, Cisplatin, Doxorubicin.

• Immunotherapy

☼ Prognosis

• Indicators - Stage - Tumor Size - Histological Type - Degree of cytological atypia - Lymphatic/vascular invasion

• Generally, five year survival is a poor 30%.

• Younger patients have more aggressive disease.

Dr. Neelesh Bhandari MBBS(A.F.M.C), MD (Path.)

PGP Human Rights.