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Gastric Cancer

Gastric Carcinoma

Gastric carcinoma is one of the most lethal malignancies in the world, primarily because of a late diagnosis. Male gender, cigarette smoking, a positive family history, and older age are principal risk factors. Only mild symptoms of dyspepsia and abdominal pain are usually seen in the early stages. Imaging studies including computed tomography, but more importantly, endoscopy with biopsy and histopathological examination, are necessary to make the diagnosis.


Presentation

Gastric carcinoma, although rarely encountered in the western world (a little over 26,000 cases are estimated in the United States in 2016), is one of the most common cancers worldwide, as a very high number of cases is seen in South America, Eastern Europe, and Eastern parts of Asia [1] [2] [3]. In fact, almost 1,000,000 people are diagnosed each year, with more than 730,000 deaths, making it the second most common cause of death due to a malignant disease [1] [4] [5]. One of the reasons for such a poor prognosis is the insidious clinical presentation, particularly in the early stages of the disease. Dyspepsia is the principal complaint, which may be accompanied by mild and nonspecific abdominal pain, weight loss, and/or anorexia [6]. In the presence of larger tumors that obstruct normal passage of food or impair normal stomach function, nausea, vomiting, and early satiety might be reported, whereas hematemesis, melena, and possibly severe hemorrhage appear when ulceration of the tumor occurs [6]. Several risk factors have been established, such as male gender (male-to-female ratio ranging from 2-12:1), cigarette smoking, excess alcohol consumption, as well as genetic factors (a positive family history), Helicobacter pylori infection, and previous radiation [1] [4] [7]. Furthermore, gastric carcinoma of the cardia region is associated with obesity and gastroesophageal reflux disease (GERD) [2].

Fatigue
  • , dyspnea, rash, neutropenia, anemia, and myalgia The most common adverse reactions associated with Herceptin in metastatic gastric cancer were neutropenia, diarrhea, fatigue, anemia, stomatitis, weight loss, upper respiratory tract infections, fever,[herceptin.com]
  • However, some people may choose not to go through PT because of fatigue or pain.[physio-pedia.com]
  • Some symptoms of gastric cancer, such as early satiety (fullness), mild belly pain and fatigue are the same as or similar to the manifestations of other less serious and common conditions.[hopkinsmedicine.org]
  • The most frequently occurring treatment-related adverse events (AEs) of all grades were fatigue (18.9%), pruritus (8.9%), rash (8.5%), hypothyroidism (7.7%), decreased appetite (7.3%), anemia (6.9%), nausea (6.9%), diarrhea (6.6%), and arthralgia (5.8%[onclive.com]
  • […] symptoms of advanced stomach cancer are: nausea and vomiting frequent heartburn loss of appetite, sometimes accompanied by sudden weight loss constant bloating early satiety (feeling full after eating only a small amount) bloody stools jaundice excessive fatigue[healthline.com]
Hemoptysis
  • He had pain in the upper abdomen, passage of blackish stool and an episode of hemoptysis later on. A provisional diagnosis of gastric carcinoma with cirrhosis and ascites was made.[ncbi.nlm.nih.gov]
Exertional Dyspnea
  • A 60-year-old woman, with a history of partial gastrectomy for gastric cancer 11 years ago, presented with exertional dyspnea with anti-Jo-1 antibody-positive myositis. Surgical lung biopsy showed NSIP with metastatic gastric cancer.[ncbi.nlm.nih.gov]
Nausea
  • A 67-year-old woman with a history of early-stage gastric cancer in remission was admitted to our hospital with 3 days of headache and nausea.[ncbi.nlm.nih.gov]
  • In the presence of larger tumors that obstruct normal passage of food or impair normal stomach function, nausea, vomiting, and early satiety might be reported, whereas hematemesis, melena, and possibly severe hemorrhage appear when ulceration of the tumor[symptoma.com]
  • Since the digestive tract is also included in rapidly dividing cells, patients may also have digestive problems including stomach aches, nausea, vomiting and loss of appetite [23].[physio-pedia.com]
Dyspepsia
  • Only mild symptoms of dyspepsia and abdominal pain are usually seen in the early stages.[symptoma.com]
  • Long term follow up of a representative population of UK patients with uncomplicated dyspepsia is warranted.[gut.bmj.com]
  • It often produces no specific symptoms when it is superficial and potentially surgically curable, although up to 50% of patients may have nonspecific gastrointestinal complaints such as dyspepsia 2.[radiopaedia.org]
  • Epigastric fullness, nausea, loss of appetite, dyspepsia, and mild gastric discomfort may also occur. Dysphagia may be a prominent symptom for patients with tumors in the cardia or gastroesophageal junction.[halstedsurgery.org]
Hematemesis
  • In the presence of larger tumors that obstruct normal passage of food or impair normal stomach function, nausea, vomiting, and early satiety might be reported, whereas hematemesis, melena, and possibly severe hemorrhage appear when ulceration of the tumor[symptoma.com]
  • Case 1 in an 11-year-old girl presented with hematemesis. A gastroscopic examination was performed, and a pathological diagnosis of signet ring cell carcinoma was made.[ci.nii.ac.jp]
  • […] and severity of underlying illness) Cough Gastric Ulcers Dyspepsia, including belching, bloating, distention, and fatty food intolerance Heartburn Chest discomfort Hematemesis or melena resulting from gastrointestinal bleeding Symptoms consistent with[physio-pedia.com]
  • Patients may complain of the following: 1) Abdominal pain, from vague to severe 2) Indigestion, heartburn, and vomiting 3) Difficulty in swallowing 4) Postprandial bloating 5) Loss of appetite 6) Black tarry feces (related to gastrointestinal bleeding) 7) Hematemesis[cancer-symptoms.com]
  • At later stages the following symptoms may occur: General signs Weight loss Chronic iron deficiency anemia ; (paleness, fatigue, headaches) Gastrointestinal signs Abdominal pain Early satiety Nausea or vomiting Dysphagia Acute gastric bleeding ( hematemesis[amboss.com]
Abdominal Mass
  • Where the disease is advanced, the doctor’s examination may reveal: Abdominal mass/es; Enlarged lymph nodes (lymphadenopathy) Bowel obstruction; Fluid in the abdomen (ascites); Enlarged liver (hepatomegaly); and/or Lower extremity fluid accumulation ([myvmc.com]
  • Then examine the abdomen: inspect for any obvious abdominal masses, palpate for tenderness and percuss for ascities.[fastbleep.com]
  • They are predominantly associated with two predisposing factors: lack of thorough peritoneal fixation and fulcrums such as abdominal masses or adhesions.[news-medical.net]
  • mass Testicular mass Skin lesions Malignant Neoplasms of the Small Intestine Nausea Vomiting Intestinal obstruction Case Reports/ Case Studies 1) The Management Of Double Neoplasms: A Case Of A Patient With Small Cell Lung And Gastric Cancer Successfully[physio-pedia.com]
Sciatica
  • Sciatica is usually caused by a herniated disc or spinal canal stenosis. Sciatic nerve palsy may be caused by nondiscogenic etiologies that may be either intrapelvic or extrapelvic.[ncbi.nlm.nih.gov]

Workup

The nonspecific presentation and insidious course of gastric carcinoma make early recognition rather difficult. Nevertheless, the role of the physician in making the initial assumption through a detailed patient history and a complete physical examination is essential. In the presence of dyspepsia and associated gastrointestinal complaints in older individuals (particularly over 55 years of age), gastric carcinoma must be excluded [7]. Thus, the employment of imaging studies is the next step in the workup. Many authors have agreed that upper gastrointestinal tract endoscopy is the cornerstone when it comes to gastric carcinoma, and the technique is widely recommended for both screening and diagnostic purposes [1] [7]. An additional benefit of upper endoscopy is that it provides the ability to obtain a biopsy sample that will, after histopathological examination, confirm gastric carcinoma. As the treatment strategy (but also the prognosis) depends on the tumor stage, the extent of tumor invasion and dissemination must be assessed as well [8]. Various techniques have been described, but the use of computed tomography (particularly multiple detector CT -MDCT) in the evaluation of the pelvis, abdomen, and chest for the nodal or metastatic spread is the gold standard [7] [8]. Laparoscopy is also described as a tool for investigating the degree of local invasion and determining optimal treatment strategy [7].

Cytopenia
  • Here we report a relative low risk myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) patient, with a rare t(1; 19)chromosome translocation. This patient also suffered from gastric carcinoma.[ncbi.nlm.nih.gov]
Wuchereria Bancrofti
  • Microfilariae of Wuchereria bancrofti inhabit peripheral blood, and nocturnal periodicity is observed in the Indian subcontinent.[ncbi.nlm.nih.gov]
Liver Biopsy
  • In 2012, abdominal ultrasound and percutaneous liver biopsy revealed recurrence of the metastasis in the right liver lobe. Progression of the disease was observed after palliative chemotherapy (epirubicin, oxaliplatin, and capecitabine).[ncbi.nlm.nih.gov]

Treatment

  • In addition, the present study assessed alterations in sirtuin expression following 5‑FU treatment with reverse transcription‑quantitative polymerase chain reaction. 5‑FU treatment induced apoptosis and inhibited proliferation in BGC‑823 and AGS gastric[ncbi.nlm.nih.gov]

Prognosis

  • MTT, wound healing and Transwell experiments were conducted to study the effect of VEGF on tumor incidence, metastasis and prognosis.[ncbi.nlm.nih.gov]

Etiology

  • Sciatic nerve palsy may be caused by nondiscogenic etiologies that may be either intrapelvic or extrapelvic. It is important to image the entire course of the nerve to distinguish these etiologies quickly.[ncbi.nlm.nih.gov]
  • Pylori infection is a major etiologic factor in the development of intestinal type gastric cancer ( Parsonnet et al. 1991 ).[mycancergenome.org]
  • Etiology Gastric cancer continues to be one of the leading causes of cancer-related death. A significant development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection.[radiopaedia.org]
  • Etiology or Risk factors Chronic inflammation, exposure to diverse carcinogens, and genetic susceptibility are among factors associated with an increased risk of gastric cancer.[cancer-symptoms.com]

Epidemiology

  • Keywords: gastric cancer, epidemiology, classification, risk factors, treatment This work is published and licensed by Dove Medical Press Limited.[dovepress.com]
  • Epidemiology of gastric cancer. In: Correa P, Haenszel W, eds. Epidemiology of cancer of the digestive tract. The Hague, the Netherlands: Martinus Nijhoff, 1982:58–84. 6. Correa P, Cuello C, Duque E..[nejm.org]
  • Author information 1 1 Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. 2 2 Department of Epidemiology and[ncbi.nlm.nih.gov]
  • A significant development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection. Most gastric cancers occur sporadically, whereas 8-10% have an inherited genetic component.[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • However, the pathogenesis and pathophysiology of this debilitating condition still remains obscure and no effective management was recommended. The present study aims to elucidate the pathophysiology of PTTM.[ncbi.nlm.nih.gov]
  • […] of gastrointestinal obstruction Partial gastrectomies may be used in exceptional cases References: [13] Complications Malignant acanthosis nigricans A paraneoplastic syndrome seen in adenocarcinomas of GI origin, especially in gastric adenocarcinoma Pathophysiology[amboss.com]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 54. Gunderson LL, Donohue JH, Alberts SR. Ashman JB, Jaroszewski DE, eds.[pennstatehershey.adam.com]
  • H. pylori, however, is a plausible pathophysiologic cofactor for cancer.[nejm.org]

Prevention

  • A preventive transcatheter arterial chemoembolization (TACE) was conducted at 4 weeks after hepatectomy. Another FOLFOX regimen was suggested, but was refused by the patient.[ncbi.nlm.nih.gov]
  • […] iStock/magicmine Health Europa explored with United European Gastroenterology about the efforts regarding gastric cancer treatment, understanding and prevention.[healtheuropa.eu]
  • Causes, Risk Factors, and Prevention Learn about the risk factors for stomach cancer and what you might be able to do to help lower your risk. Early Detection, Diagnosis, and Staging Know the signs and symptoms of stomach cancer.[cancer.org]
  • This review briefly summarizes the most important aspects of gastric cancers, which include epidemiology, risk factors, classification, diagnosis, prevention, and treatment.[dovepress.com]
  • Explore the links on this page to learn more about gastric cancer prevention, screening, treatment, statistics, research, and clinical trials.[cancer.gov]

References

Article

  1. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention. Cancer Epidemiol Biomarkers Prev. 2014;23(5):700-713. Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric Adenocarcinoma: Review and Considerations for Future Directions. Ann Surg. 2005;241(1):27-39.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
  3. Maconi G, Manes G, Porro GB. Role of symptoms in diagnosis and outcome of gastric cancer. World J Gastroenterol. 2008;14(8):1149-1155.
  4. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.
  5. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010;19:1893–907.
  6. Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric Adenocarcinoma: Review and Considerations for Future Directions. Ann Surg. 2005;241(1):27-39.
  7. Guidelines for the management of oesophageal and gastric cancer; British Society of Gastroenterology. 2011;
  8. Horton KM, Fishman EK. Current role of CT in imaging of the stomach. Radiographics. 2003;23(1):75-87.

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Last updated: 2019-07-11 21:38