Chapter 24. Stomach and Duodenum Diseases
Sections 4. Gastric Carcinoma ★★★★★ • 4.1 Epidemiology • 4.2 Risk Factors • 4.3 Pathology • 4.4 Diagnosis • 4.5 Staging • 4.6 Treatment • 4.7 Outcomes
Epidemiology • Every year, around 990,000 people are diagnosed with GC worldwide, of whom approximately 738,000 die. GC is the 4th most common incident cancer and the 2nd most common cause of cancer death. • GC incidence is different concerning sex and geographical variability. Men are two to three times more susceptible than women. The incidence displays huge geographical diversity. It is noted that more than 50% of new incidents come up in developing countries. Areas with the highest probability for GC development encompass regions like Central and South America, Eastern Europe and East Asia (China and Japan). • The 5-year survival rate is mildly good only in Japan. In Europe, the ratio fluctuates between 10–30%. The increased 5-year survival rate is probably due to early diagnosis using the endoscopic examination method, which allows for the early detection and resection of cancer
Epidemiology
Risk Factors Helicobacter pylori infection associated With Increased Risk for Developing in the worldwide
Pathology The Borrmann classification system developed in 1926; it remains useful today for the description of endoscopic findings. This system divides gastric carcinoma into five types, depending on the lesion’s macroscopic appearance. One type, linitisplastica, describes a diffusely infiltrating lesion involving the entire stomach
Pathology Lauren Classification system separates gastric adenocarcinoma into intestinal or diffuse types based on histology, with both types having distinct pathology, epidemiology, and prognosis
Pathology Typical adenocarcinoma with signet ring cells shown on close-up. Well-circumscribed lesion in the posterior gastric body
Diagnosis _ Signs and Symptoms • The symptoms of gastric cancer are generally nonspecific and contribute to its frequently advanced stage at the time of diagnosis. They include epigastric pain, early satiety, and weight loss. • These symptoms are frequently mistaken for more common benign causes of dyspepsia including PUD and gastritis. The pain associated with gastric cancer tends to be constant, nonradiating, and is generally not relieved by eating. More advanced lesions may present with either obstruction or dysphagia depending on the location of the tumor. Some degree of GI bleeding is common, with up to 40% of patients having some form of anemia and up to 15% having frank hematemesis
Diagnosis _ Signs and Symptoms • A complete history and physical examination should be performed, with special attention to any evidence of advanced disease. This includes metastatic nodal disease, supraclavicular (Virchow’s) or periumbilical (Sister Mary Joseph’s node), and evidence of intraabdominal metastases such as hepatomegaly, jaundice, or ascites. Drop metastases to the ovaries (Krukenberg’s tumor) may be detectable on pelvic examination and peritoneal metastases can be felt as a firm (Blummer’s) shelf on rectal examination. • A complete blood count, chemistry panel, including liver function tests, and coagulation studies should be carried out