Stomach cancer presenting symptoms can include weight loss and abdominal pain. Patients with proximal or gastroesophageal junction tumors 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 tumor 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 tumors are adenocarcinomas. Other histologic types include lymphoma, leiomyosarcoma, neuroendocrine tumors, and squamous cell carcinomas, but these are uncommon and will not be discussed here.
History and exam
Key diagnostic factors
- abdominal pain
- weight loss
Other diagnostic factors
- age 50-70 years
- male sex
- family history
- lower gastrointestinal bleeding
- pernicious anemia
- 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
- PET/CT scan
localized: suitable for surgery
localized: not suitable for surgery
advanced and metastatic disease
- Peptic ulcer disease
- Benign esophageal stricture
- NCCN clinical practice guidelines in oncology: gastric cancer
- Immunotherapy and targeted therapy for advanced gastroesophageal cancer: ASCO guideline
Endoscopy (upper gastrointestinal)More Patient leaflets
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