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What is Gastric Cancer

Gastric cancer is the third most common cause of cancer-related death in the world and it remains difficult to cure in Western countries, primarily because most patients present with advanced disease. In the United States, stomach malignancy is currently the 15th most common cancer. The stomach begins at the gastroesophageal junction and ends at the duodenum.

Symptoms

Early gastric cancer has no associated symptoms; however, some patients with incidental complaints are diagnosed with early gastric cancer. Most symptoms of gastric cancer reflect advanced disease. All physical signs in gastric cancer are late events. By the time they develop, the disease is almost invariably too far advanced for curative procedures.

Signs and symptoms of gastric cancer include the following:

  • Nausea or vomiting

  • Dysphagia

  • Postprandial fullness

  • Loss of appetite

  • Melena or pallor from anemia

  • Hematemesis

  • Weight loss

  • Palpable enlarged stomach with succussion splash

  • Enlarged lymph nodes such as Virchow nodes (ie, left supraclavicular) and Irish node (anterior axillary)

Diagnonsis

Imaging studies that aid in the diagnosis of gastric cancer in patients in whom the disease is suggested clinically include the following:

  • Esophagogastroduodenoscopy (EGDS) with biopsy

  • CT scanning or MRI of the chest, abdomen, and pelvis: To assess the local disease process and evaluate potential areas of spread

  • Endoscopic ultrasonography (EUS): Staging tool for more precise preoperative assessment of the tumor stage

Surgical Approach

The surgical approach in gastric cancer depends on the location, size, and locally invasive characteristics of the tumor.

Types of surgical intervention in gastric cancer include the following:

  • Laparoscopic or Open Total gastrectomy, if required for negative margins

  • Laparoscopic or Open Esophagogastrectomy for tumors of the cardia and gastroesophageal junction

  • Laparoscopic or Open Subtotal gastrectomy for tumors of the distal stomach

  • Laparoscopic or Open Lymph node dissection

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