The overall incidence of gastric ca...

The overall incidence of gastric cancer in the United States has rapidly declined through the past 50 years. Gastric cancer is now the 13th most numerous common cause of cancer mortality in the United States, with an estimated 12100 deaths in 2003 (1) However, in developing countries, the incidence of gastric cancer is a great deal higher and is second solitary to lung cancer in rates of mortality.

The typical patient with gastric cancer is male (male-to-female ratio, 17:1) and between 40 and 70 years of age (mean age, 65 years). Native Americans, Hispanic Americans, and blacks are twice as likely as whites to have gastric carcinoma.

Ninety-five percent of all malignant gastric tumors are adenocarcinomas; the remaining 5 percent include lymphomas, stromal tumors, and other rare tumors. (2) The overall declining incidence of gastric carcinoma is related to distal stomach tumors caused through Helicobacter pylori infection. Proximal stomach tumors of the cardiac region have actually increased in incidence in fresh years. (3) This trend has been attributed to the increased incidence of Barrett's esophagus and its direct correlation with the disclosure of esophageal adenocarcinoma. (4) This review discusses diagnosis, treatment, and survival issues in patients with gastric adenocarcinoma.

Etiology

Many risk factors have been associated with the disentanglement of gastric cancer, and the pathogenesis is most numerous likely multifactorial (Table 1). (256) Although significant, genetic abnormalities (such as DNA aneuploidy, oncogene amplification or mutation, and allelic los of tumor suppressor genes) are not understood well enough to allow formulation of a order of succession of progression to the progress to maturity of gastric carcinoma. One postulation forward the development of this disease involves a succession of histologic changes that make a beginning with atrophic gastritis, advance to mucosal metaplasia, and eventually come in a malignancy. (2)

Certain genetic or familial syndrome gastric colonization from H. pylori, and conditions resulting in gastric dysplasia have been reported as definite risk factors for the unravelling of stomach cancer. The use of tobacco, dietary risk factors (i.e., high intake of salted, smok or pickled sustenances and low intake of fruits and vegetables), and exces alcohol consumption also have been implicated as causal simple bodys (2,5-7) A high intake of vitamin C may have a protective result (8) [Evidence level B, case-control study]

Diagnosis

The initial diagnosis of gastric carcinoma repeatedly is delayed because up to 80 percent of patients are asymptomatic during the early stages of stomach cancer. (9) In Japan, a higher incidence of adenocarcinoma and rigorous screening processe have l to a greater number of cases of gastric cancer being ascertained in an early stage (i.e., when limited to the mucosa and submucosa, with or without lymph node involvement). Unfortunately, in the United States, greatest in number cases of gastric cancer are discovered solitary after local invasion has advanced.

Weight los abdominal pain, nausea and vomiting, early satiety, and peptic sore symptoms may accompany late-stage gastric cancer. Signs may include a palpably enlarged stomach, a primary mass (rare), an enlarged liver, Virchow's node (i.e., left supraclavicular), Sister Mary Joseph's nodule (periumbilical), or Blumer's shelf (metastatic tumor felt upon rectal examination, with growth in the rectouterine/ rectovesical space).

Patients presenting with the aforementioned symptoms and those with multiple risk factors for gastric carcinoma require further work-up. Esophagogastroduodenoscopy (EGD) is the diagnostic imaging operation of choice in the work-up of gastric carcinoma. (10) However, a double-contrast barium swallow, a cost-conscious, noninvasive, and readily available close attention may be the initial degree (11) (Figure 1). This radiographic consideration provides preliminary information that may help the physician determine if a gastric lesion is instant and whether the lesion has benign or malignant features. Gastric festers without any malignant characteristics seen forward barium swallow have a specificity of more than 95 percent in ruling abroad gastric cancer. However, when indeterminate springs are reported or when one as well as the other benign and malignant signs are quick in emergencies further diagnostic evaluation is necessary.

[FIGURE 1 OMITTED]

EGD is a highly sensitive and specific diagnostic criterion especially when combined with endoscopic biopsy. Multiple biopsy specimens should be obtained from any visually suspicious areas; this pace involves repeated sampling at the same tissue site, for a like reason that each subsequent biopsy reaches deeper into the gastric wall.

After the initial diagnosis of gastric cancer is established, further evaluation for metastases is necessary to determine treatment options. Comput tomographic (CT) scanning is a useful order of detecting liver metastases greater than 5 mm in diameter, perigastric involvement, peritoneal seeding, and involvement of other peritoneal mode of buildings (e.g., ovaries, rectal shelf). However, CT scanning is unable to allow assessment of tumor spread to adjacent lymph nodes unles they are enlarged. In addition, it has not been shown to be effective in allowing determination of the stillness of tumor invasion and cannot reliably support detection of solitary liver or lung metastases smaller than 5 mm in diameter. (12)