Stomach cancer presenting symptoms can include weight loss and abdominal pain. Patients with proximal or gastro-oesophageal junction tumours may present with dysphagia.
Upper gastrointestinal endoscopy with biopsy demonstrating carcinoma is required to confirm the diagnosis. Staging based on imaging is required.
Early-stage disease is treated with surgery alone.
Treatment for locally advanced disease includes surgery followed by postoperative chemoradiation, or chemotherapy before or after surgery.
Metastatic disease is treated with chemotherapy, immunotherapy, or chemoradiation and supportive care measures. Treatment is influenced by tumour biomarker expression.
Common complications are gastric bleeding and gastric outlet obstruction.
Stomach cancer is a neoplasm that can develop in any portion of the stomach and may spread to the lymph nodes and other organs. Most tumours are adenocarcinomas. Other histological types include lymphoma, leiomyosarcoma, neuroendocrine tumours, and squamous cell carcinomas, but these are uncommon and will not be discussed here.
History and exam
Key diagnostic factors
- presence of risk factors
- abdominal pain
- weight loss
Other diagnostic factors
- age 50 to 70 years
- male sex
- family history
- lower gastrointestinal bleeding
- pernicious anaemia
- Helicobacter pylori
- N-nitroso compounds
- diet low in fruits and vegetables
- high-salt diet
- family history
1st investigations to order
- upper gastrointestinal endoscopy with biopsy
- comprehensive metabolic panel
Investigations to consider
- CT of chest/abdomen/pelvis
- endoscopic ultrasound
localised: suitable for surgery
localised: not suitable for surgery
advanced and metastatic disease
- Peptic ulcer disease
- Benign oesophageal stricture
- Informed consent for GI endoscopic procedures
- Adverse events associated with EUS and EUS-guided procedures
Endoscopy (upper gastrointestinal)More Patient leaflets
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