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[[Image:Stomach_diagram.svg|thumb|200px|left|Diagram of the stomach]]
[[Image:Stomach_diagram.svg|thumb|200px|left|Diagram of the stomach]]
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==Classification==
==Classification==
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
Stomach cancer is the fifth most common cancer worldwide.<ref name=UK>[http://www.cancerresearchuk.org/cancer-info/cancerstats/types/stomach/incidence/uk-stomach-cancer-incidence-statistics#geog       Stomach cancer incidence statistics. Cancer research UK]</ref>  In the United States, stomach cancer represents roughly 1.3% of all new cancer cases yearly<ref name=SEERstat>[http://seer.cancer.gov/statfacts/html/stomach.html SEER stat fact sheets: stomach cancer]</ref>. In 2011, the age-adjusted prevalence of stomach cancer was estimated to be 23.5 cases per 100,000 individuals in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> Stomach cancer is two times more common in men than in women, and the incidence increases with age.
Stomach cancer is the fifth most common cancer worldwide.<ref name="UK">[http://www.cancerresearchuk.org/cancer-info/cancerstats/types/stomach/incidence/uk-stomach-cancer-incidence-statistics#geog Stomach cancer incidence statistics. Cancer research UK]</ref>  In the United States, stomach cancer represents roughly 1.3% of all new cancer cases yearly<ref name="SEERstat">[http://seer.cancer.gov/statfacts/html/stomach.html SEER stat fact sheets: stomach cancer]</ref>. In 2011, the age-adjusted prevalence of stomach cancer was estimated to be 23.5 cases per 100,000 individuals in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> Stomach cancer is two times more common in men than in women, and the incidence increases with age.


==Risk Factors==
==Risk Factors==
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==Surgery==
==Surgery==
Surgery is the mainstay of treatment for stomach cancer.
Surgery is the mainstay of treatment for stomach cancer.  [[Endoscopic surgery|Endoscopic resection]] is suggested for early gastric cancer. There are criteria for [[Endoscopic surgery|endoscopic resection]] of ealry gastric cancer. Methods for endoscopic resection include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). [[Side effects]] of [[endoscopy]] includes [[bleeding]] and [[perforation]]. For '''T1''' tumors, a gross resection margin of '''2 cm''' should be obtained. Proximal margin of at least '''3 cm''' is recommended for '''T2''' or deeper [[Tumor|tumors]] with an expansive growth pattern and '''5 cm''' for those with an [[Infiltration analgesia|infiltrative]] growth pattern. For tumors invading the [[Esophagus|esophagus,]] a '''5-cm''' margin is not necessarily required, but [[frozen section]] examination of the resection line is desirable to ensure a R0 resection. There is a debate about optimal [[lymph nodes]] removal. D1 [[lymphadenectomy]] refers to a dissection of only the perigastric lymph nodes. D2 [[lymphadenectomy]] is an extended [[lymph node]] dissection, includes removal of nodes along the [[hepatic]], [[Left gastric artery|left gastric]], [[Celiac artery|celiac]], and [[Spleen|splenic]] arteries, as well as those in the [[splenic hilum]]. D3 dissection is a superextended [[lymphadenectomy]]. The surgery includes D2 lymphadenectomy plus the removal of nodes within the [[porta hepatis]] and periaortic regions.


==Primary prevention==
==Primary prevention==

Revision as of 23:34, 27 November 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

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Overview

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Overview

Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus and the small intestine. Stomach cancer causes nearly one million deaths worldwide per year.[1]

Diagram of the stomach


Classification

Stomach cancer may be classified into adenocarcinoma, lymphoma, gastrointestinal stromal tumor, and carcinoid tumor.

Pathophysiology

The pathophysiology of stomach cancer depends on histologic subtypes.

Differential diagnosis

Stomach cancer must be differentiated from gastric lymphoma, gastric metastasis, gastritis, benign gastric ulcer, menetrier disease.

Epidemiology and Demographics

Stomach cancer is the fifth most common cancer worldwide.[2] In the United States, stomach cancer represents roughly 1.3% of all new cancer cases yearly[3]. In 2011, the age-adjusted prevalence of stomach cancer was estimated to be 23.5 cases per 100,000 individuals in the United States.[4] Stomach cancer is two times more common in men than in women, and the incidence increases with age.

Risk Factors

Common risk factors in the development of stomach cancer are helicobacter pylori infection, cigarette smoking, family history of stomach cancer, and a diet high in salted smoked or preserved foods.

Screening

There is no screening recommended for stomach cancer.

Natural history, Complications and Prognosis

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.

Staging

According to the American Joint Committee on Cancer, there are 4 stages of stomach cancer based on the tumor spread.

Symptoms

Symptoms of stomach cancer include abdominal pain, bloating, weight loss, hematemesis and melena.

Physical Examination

Patients with stomach cancer generally appear healthy. Common physical examination findings include abdominal distention, palpation of an abdominal mass, and pallor. Leser-Trelat sign and presence of Virchow's node (left supraclavicular lymphadenopathy), Sister Mary Joseph nodule (visible periumbilical nodule), Blumer's shelf (rectal mass/shelf on rectal exam) and/or Trousseau's syndrome (migratory phlebitis) on physical examination are highly suggestive of stomach cancer.

Endoscopy and Biopsy

Biopsy may be helpful in the diagnosis of stomach cancer.

CT

Abdominal CT scan may be helpful in the diagnosis of stomach cancer.

Other imaging findings

Fluoroscopy may be diagnostic of stomach cancer.

Medical therapy

The optimal therapy for stomach cancer depends on the stage at diagnosis.

Surgery

Surgery is the mainstay of treatment for stomach cancer.  Endoscopic resection is suggested for early gastric cancer. There are criteria for endoscopic resection of ealry gastric cancer. Methods for endoscopic resection include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Side effects of endoscopy includes bleeding and perforation. For T1 tumors, a gross resection margin of 2 cm should be obtained. Proximal margin of at least 3 cm is recommended for T2 or deeper tumors with an expansive growth pattern and 5 cm for those with an infiltrative growth pattern. For tumors invading the esophagus, a 5-cm margin is not necessarily required, but frozen section examination of the resection line is desirable to ensure a R0 resection. There is a debate about optimal lymph nodes removal. D1 lymphadenectomy refers to a dissection of only the perigastric lymph nodes. D2 lymphadenectomy is an extended lymph node dissection, includes removal of nodes along the hepaticleft gastricceliac, and splenic arteries, as well as those in the splenic hilum. D3 dissection is a superextended lymphadenectomy. The surgery includes D2 lymphadenectomy plus the removal of nodes within the porta hepatis and periaortic regions.

Primary prevention

Effective measures for the primary prevention of stomach cancer include smoking cessation, helicobacter pylori infection eradication, and having a balanced diet rich in fruits and vegetables.

References

  1. "Cancer". World Health Organization. Feb 2006. Retrieved 2007-05-24.
  2. Stomach cancer incidence statistics. Cancer research UK
  3. SEER stat fact sheets: stomach cancer
  4. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

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