Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Vague postprandial abdominal heaviness or fullness• Anorexia and weight loss• Upper GI endoscopic biopsy and histologic confirmation +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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) +++ Laboratory Findings + • Anemia is present in 40% of patients• Carcinoembryonic antigen (CEA) levels are elevated in 65% of patients, usually indicating extensive spread of the tumor +++ Imaging Findings + • 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 +++ Rule Out + • Benign gastric ulcer + • Upper GI endoscopy and biopsy will provide histologic diagnosis• CT scan for staging +++ When to Admit + • High-grade gastric outlet obstruction preventing adequate enteral nutrition and hydration• Severe bleeding from ulcer + • Resect tumor, adjacent margin of stomach (6 cm proximally) and duodenum, regional lymph nodes (no radical lymphadenectomy), and portions of adjacent organs if involved +++ Surgery +++ Indications + • 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 +++ Contraindications + • Limited life expectancy (< 1-2 months) and prohibitive operative risk +++ Medications +... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth