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 to 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
Mariela Blum Murphy, MD
Department of GI Medical Oncology
University of Texas
MD Anderson Cancer Center
MBM declares that she has no competing interests.
Ahmed Abdelhakeem, MD
Department of Internal Medicine
Sam Houston State University
Baptist Hospitals of Southeast Texas
AA declares that he has no competing interests.
Dr Mariela Blum Murphy and Dr Ahmed Abdelhakeem would like to gratefully acknowledge Dr Valerie Reed and Dr Prajnan Das, previous contributors to this topic.
VR and PD declare that they have no competing interests.
Theodore Hong, MD
Gastrointestinal Radiation Oncology
Massachusetts General Hospital Cancer Center
TH declares that he has no competing interests.
Andreas Leodolter, MD
Head of Department
Department of Gastroenterology
AL declares that he has no competing interests.
- Peptic ulcer disease
- Benign esophageal stricture
- Informed consent for GI endoscopic procedures
- Adverse events associated with EUS and EUS-guided procedures
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