-IBIS-1.5.0-
tx
digestive system
stomach cancer
diagnoses

definition and etiology

definition:
Neoplasm of the stomach. Adenocarcinoma accounts for most stomach neoplasm. Other histological types include lymphoma, squamous cell, carcinoid and leiomyosarcoma.

etiology:
Etiology is not well established, although it is associated with metaplasia of the gastric mucosa: pernicious anemia, atrophic gastritis, gastric atrophy. Other factors include diet (particularly salty or smoked foods), previous gastric surgery, poverty.

The disease exhibits wide epidemiological variations. High levels exist in Japan, Chile, and Iceland. In the U.S. it is most common in the North, in the poor, and in blacks.

The incidence increases with age (<25% of patients are under 50 yr.).

signs and symptoms

The disease may initially manifest with mild symptoms. All the common signs associated with stomach problems may arise but are commonly less severe than in an ulcer, for example. The most common first sign is of a metastasis while the primary malignancy remains "silent". Weight loss and anemia, usually iron deficiency, may be present. In later stages:
• coffee-ground vomiting
• epigastric mass
• sentinel node above left clavicle (Virchow's)

lab findings:
• barium X-ray studies
• endoscopy and biopsy

course and prognosis

Classified according to gross appearance:
• protruding (polypoid or fungating)
• penetrating (sharp, well circumscribed border, may be ulcerated)
• superficial spreading (along the mucosa or within the wall); if there is infiltration of the wall with fibrous reaction, a"leather bottle" stomach (linitis plastica) may result
• miscellaneous

Conventional therapy of choice is surgical resection. Chemotherapy and radiation have not been shown to be particularly helpful, although new experimental protocols may prove more useful.

Prognosis is generally poor, even with surgery.

differential diagnosis

• gastric ulcer
• gastritis


footnotes