• Vague postprandial abdominal heaviness or fullness
• Anorexia and weight loss
• Upper GI endoscopic biopsy and histologic confirmation
• Ulcerating (25%): Ulcer-tumor that extends through all gastric layers
• Polypoid (25%): Large, bulky intraluminal growths
• Superficial spreading (15%): Confined to the mucosa and submucosa; also known as early gastric cancer
• Linitis plastica (10%): Spreading tumor involving all gastric layers
• Advanced (35%): Large tumors partly within and partly outside stomach
• 40% in antrum, 30% in the body and fundus, 25% at the cardia, and 5% involve the entire organ
• Helicobacter pylori infection carries a 3.6- to 18-fold increased risk of gastric cancer
• Mean age at diagnosis is 63 years
• Majority are adenocarcinoma; squamous cell arises from esophagus
• Intestinal type histology has better prognosis than diffuse type
• Postprandial abdominal heaviness
• Anorexia develops early; weight loss averages about 6 kg
• Vomiting, often containing blood, is a feature if pyloric obstruction occurs
• Epigastric mass in 25% of cases
• Hepatomegaly in 10% of cases
• In 50% of cases, stool positive for occult blood; melena is seen in a few
• Signs of distant spread
-Metastases to the neck (Virchow node)
-Metastases anterior to rectum detectable on rectal examination (Blumer shelf)
-Metastases to ovaries (Krukenberg tumors)
• Anemia is present in 40% of patients
• Carcinoembryonic antigen (CEA) levels are elevated in 65% of patients, usually indicating extensive spread of the tumor
• Large gastric carcinomas can usually be identified at endoscopy
• All gastric lesions, whether polypoid or ulcerating, should be examined by taking multiple biopsy and brush cytologic specimens during endoscopy
• Vague postprandial abdominal heaviness or fullness, along with anorexia and weight loss should prompt upper GI endocopy and biopsy
• Any endoscopically evident gastric ulcer should be adequately biopsied to rule out carcinoma
• Resect tumor, adjacent margin of stomach (6 cm proximally) and duodenum, regional lymph nodes (no radical lymphadenectomy), and portions of adjacent organs if involved
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