Gastric Cancer - Types, Causes and Symptoms

Gastric carcinoma is the second most common cancer in the world. The incidence is highest in Japan, China, Eastern Asia and Eastern Europe, ranging between 36.3 and 77.8 per 100 000 in men and 16.8 and 33.3 per 100 000 in women, an approximate 2:1 male preponderance. It is primarily a disease of the elderly, with a peak incidence at age 70-80.

Types of Gastric Carcinoma

Approximately 90% of stomach cancers are adenocarcinomas (the remaining 10% are non-Hodgkin's lymphomas and leiomyosarcomas). Adenocarcinomas are subdivided into intestinal and diffuse histological types (Lauren classification). The intestinal variety arises from a background of chronic gastritis and is generally well circumscribed. The diffuse type usually arises within apparently normal gastric mucosa and tends to be poorly localized, infiltrating beneath the mucosa through the muscle of the stomach wall. In the advanced stage, this leads to a thickened and shriveled stomach known as linitis plastica (leather bottle stomach). Unfortunately it is this type of disease that is often seen in the younger patient.

Causes and risk factors of Gastric carcinoma:

Risk factors for intestinal-type gastric carcinoma (those for the diffuse type are largely undefined) include smoking and diet (in particular high consumption of preserved food and high salt intake); there is a weak association with excess alcohol intake. Other diseases associated with gastric carcinoma are pernicious anaemia, atrophic gastritis, gastric adenomatous polyps and H. pylori infection, an increasingly important risk factor associated with a 2-fold increase in risk of gastric cancer.

Course of Gastric Carcinoma

Local

In the early stages, when the disease is confined to the mucosa or submucosa, it may be either a prominent nodule or a depressed ulcer. Excavated cancers may cause upper gastrointestinal bleeding and anaemia, whilst large exophytic growths near the cardia can (rarely) produce dysphagia.

Metastatic

The majority of tumours present with local or with lymph node metastases. Spread may be lymphatic, haematogenous (to the liver, lungs and brain) or transcoelomic to the peritoneum, omentum or ovaries (Krukenberg tumour).

Symptoms of Gastric Carcinoma

A common presentation is that of new-onset dyspepsia in a middle-aged patient (over 45 years). Symptoms are often non-specific such as epigastric discomfort, post-prandial fullness, loss of appetite or vague indigestion. Other symptoms include dysphagia, nausea or vomiting (especially after eating), weight loss and those of iron deficiency anaemia.

Clinical examination is often unremarkable in early stage disease. In advanced disease, clinical findings may include a mass in upper abdomen, enlarged liver, enlargement of the lymph glands, classically in the left supraclavicular fossa (Virchow's node, Troisier's sign), ascites and jaundice.

Types,Causes and Symptoms of Gastric carcinoma
Diagnosis and Treatment of Gastric Carcinoma