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  • • Vague postprandial abdominal heaviness or fullness

    • Anorexia and weight loss

    • Upper GI endoscopic biopsy and histologic confirmation

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Epidemiology

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  • 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

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Symptoms and Signs

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  • • 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)

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Laboratory Findings

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  • • Anemia is present in 40% of patients

    • Carcinoembryonic antigen (CEA) levels are elevated in 65% of patients, usually indicating extensive spread of the tumor

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Imaging Findings

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  • • 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

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  • • 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

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Rule Out

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  • • Benign gastric ulcer

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  • • Upper GI endoscopy and biopsy will provide histologic diagnosis

    • CT scan for staging

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When to Admit

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  • • High-grade gastric outlet obstruction preventing adequate enteral nutrition and hydration

    • Severe bleeding from ulcer

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  • • 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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Surgery

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Indications

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  • • Curative resection if no metastases and reasonable operative risk

    • Palliative resection if the stomach is still movable and life expectancy is estimated to be more than 1-2 months

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Contraindications

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  • • Limited life expectancy (< 1-2 months) and prohibitive operative risk

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Medications

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  • • Adjuvant chemotherapy after curative surgery has not been of value

    • For advanced disease, ...

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