Stomach Cancer

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• published: 19 Oct 2012
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Endoscopy of Gastric Cancer Endoscopy This is the most common test used to diagnose stomach cancer. An endoscope is a thin, flexible tube with a light and camera at the end. During an endoscopy, the doctor or nurse endoscopist can see inside your gullet (esophagus) and stomach. They can also take photographs video clips and a sample of tissue (biopsy) to be examined under a microscope. Sometimes the endoscopy tube has an ultrasound probe at the end, which allows an ultrasound scan to be done of the stomach and surrounding structures to be done. This is known as an endoscopic ultrasound. An endoscopic ultrasound can also look at and take samples of lymph nodes to help with staging. The stomach has to be empty before an endoscopy, so you'll be asked not to eat or drink anything for at least six hours beforehand. Most people have a sedative before an endoscopy to make them feel relaxed and drowsy. This is given as an injection into a vein in your hand. A local anaesthetic spray may also be used to numb the back of your throat. You'll need to lie on your left side on a couch and swallow the first part of the endoscope. It will then be guided further down your gullet, and into your stomach. Once the endoscope is in place, some air will be put down it. This makes it easier to see all areas of your stomach. When the test is over, the endoscope is gently pulled out. An endoscopy takes about 10 minutes. it's not painful. The effects of the sedative should only last a few hours. You'll then be able to go home. You should arrange for someone to drive or travel home with you. Physical Examination Physical examination may provide clues to diagnose gastric cancer. The presence of anemia, occult blood in the stool, and weight loss may suggest a malignancy. A midepigastric palpable mass or nodular liver may be helpful in localizing the process to the abdomen. The patient may appear completely healthy on physical exam. Additional findings may include: abdominal mass, liver metastases, gastric distention, weight loss, supraclavicular adenopathy (Virchow's node), rectal mass (Blumer's shelf), enlarged ovary (Krukenberg's syndrome), or umbilical metastases (Sister Mary Joseph's node). Migratory phlebitis (Trousseau's syndrome), seborrheic keratosis and freckles (Leser-Trélat sign), muscle weakness, splenomegaly, ascites, obstructive jaundice, and peritoneal carcinomatosis may be noted in more advanced disease. Immunohistochemical techniques are used to differentiate low-grade lymphomas of MALT from benign reactive lymphoid hyperplasia. Lymphomas show monoclonality of the lymphoid proliferation. Clinicians should be aware of the possibility that non-Hodgkin's lymphoma of the stomach may be linked to acquired immunodeficiency syndrome (AIDS). There are essentially three modes of therapy for the treatment of gastric cancer. Curative resection, including endoscopic resection, appears the most effective. Surgical resection entails the removal of the primary tumor and regional lymph nodes with resection margins free of tumor. Gastric cancer has not been shown to respond successfully to radiation alone. Chemotherapy has demonstrated limited success with multi-drug regimens. Etiology Helicobacter pylori infection is the cause of most stomach cancer. Autoimmune atrophic gastritis (see Gastritis and Peptic Ulcer Disease: Autoimmune Metaplastic Atrophic Gastritis) and various genetic factors (see Tumors of the GI Tract: Gastrointestinal Stromal Tumors) are also risk factors. Dietary factors are not proven causes. Pathophysiology Gastric adenocarcinomas can be classified by gross appearance: Protruding: The tumor is polypoid or fungating. Penetrating: The tumor is ulcerated. Superficial spreading: The tumor spreads along the mucosa or infiltrates superficially within the wall of the stomach. Linitis plastica: The tumor infiltrates the stomach wall with an associated fibrous reaction that causes a rigid "leather bottle" stomach. Miscellaneous: The tumor shows characteristics of ≥ 2 of the other types; this classification is the largest. Prognosis is better with protruding tumors than with spreading tumors because protruding tumors become symptomatic earlier.