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.