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Gastric cancer
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Risk Factors
In the United States, gastric cancer ranks 14th in incidence among the major types of cancer malignancies. While the precise etiology is unknown, acknowledged risk factors for gastric cancer include:
* Helicobacter pylori gastric infection.
* Advanced age.
* Male gender.
* Diet low in fruits and vegetables.
* Diet high in salted, smoked, or preserved foods.
* Chronic atrophic gastritis.
* Intestinal metaplasia.
* Pernicious anemia.
* Gastric adenomatous polyps.
* Family history of gastric cancer.
* Cigarette smoking.
* Menetrier disease (giant hypertrophic gastritis).
* Familial adenomatous polyposis.
Prognosis
The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall. Tumor grade may also provide some prognostic information.
In localized distal gastric cancer, more than 50% of patients can be cured. However, early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States. The remaining patients present with metastatic disease in either regional or distant sites. The overall survival rate in these patients at 5 years ranges from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regional disease. Even with apparent localized disease, the 5-year survival rate of patients with proximal gastric cancer is only 10% to 15%. Although the treatment of patients with disseminated gastric cancer may result in palliation of symptoms and some prolongation of survival, long remissions are uncommon.
Gastrointestinal stromal tumors occur most commonly in the stomach.
Cellular Classification of Gastric Cancer
There are two major types of gastric adenocarcinoma:
* Intestinal.
* Diffuse.
Intestinal adenocarcinomas are well differentiated, and the cells tend to arrange themselves in tubular or glandular structures. The terms tubular, papillary, and mucinous are assigned to the various types of intestinal adenocarcinomas. Rarely, adenosquamous cancers can occur.
Diffuse adenocarcinomas are undifferentiated or poorly differentiated, and they lack a gland formation. Clinically, diffuse adenocarcinomas can give rise to infiltration of the gastric wall (i.e., linitis plastic).
Some tumors can have mixed features of intestinal and diffuse types. |
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