The Truth about Gastric Cancer

By: Al-nazar L. Sabtula, M.D.
Edited: Felix Domingo, Jr. M.D.

Incidence and mortality

Gastric cancer is the fourth most common cancer and the second leading cause of cancer-related death worldwide, with 700 000 deaths annually. In Asia Pacific (AP) region, it remains a major health burden.

Gastric cancer rate is twice as more common in men than in women. Adenocarcinoma of the stomach constitutes 90-95% of all gastric malignancies. When diagnosed at an early stage, 5-year survival rates for gastric cancer exceed 90%. However, when diagnosed at an advanced stage, 5-year survival rates may be only in the range of 10-20%.

Risk factors

Gastric cancer may often be multifactorial, involving both inherited predisposition and environmental factors. Environmental factors implicated in the development of gastric cancer include Helicobacter pylori infection, diet (pickled vegetables, salted fish, salt,smoked meats, and food containing nitrates), cigarette smoking, obesity, previous gastric surgery, pernicious anemia, adenomatous polyps, chronic atrophic gastritis, and radiation exposure.

Warning Signals

Gastric cancer progresses silently to an advanced stage before symptoms alert the physician or the patient. Most symptoms of gastric cancer reflect advanced disease. Patients may complain of indigestion, nausea or vomiting, dysphagia, postprandial fullness, loss of appetite, melena, hematemesis, and weight loss.
All physical signs are also late events. By the time they develop, the disease is almost invariably too far advanced for curative procedures.Signs may include a palpable enlarged stomach with succussion splash; hepatomegaly; periumbilical metastasis (Sister Mary Joseph nodule); and enlarged lymph nodes such as Virchow nodes (ie, left supraclavicular) and Irish node (anterior axillary). Blumer shelf (ie, shelflike tumor of the anterior rectal wall) may also be present. Some patients experience weight loss, and others may present with melena or pallor from anemia.

Early detection

Although presently, a strategy of population screening for gastric cancer is being adopted in Japan,Korea and Matsu Island in Taiwan. No formal programs exist in other countries, either in terms of gastric cancer screening or screening for modifiable factors such as H. pylori infection. In order to increase survival, earlier diagnosis of symptomic patients should be the goal. Patients over age 50 with vague epigastric symptoms, unexplained anemia, and weight loss should undergo upper gastrointestinal series or endoscopic

Treatment

Surgery remains the most effective method of treating gastric cancer.

Prevention

Studies have shown that H. pylori eradication and high intake of fresh fruits and vegetables and low intake of pickled and salted foods reduce the risk of gastric cancer.