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General Surgery
Gastric Cancer
Malignant tumors arising from the cells lining the inner surface of the stomach. The most common type is Adenocarcinoma, originating from the mucus-producing glands in the inner lining of the stomach.
ℹWhat is Gastric Cancer?
Adenocarcinoma developing from mucus-producing cells of the stomach is classified into two main categories based on location:
- Gastric Cardia Cancer: Starts in the top part of the stomach, in the first few centimeters (about 2.5 cm) just below where it joins the esophagus.
- Non-Cardia Gastric Cancer: Cancers that start in all other sections of the stomach.
Gastric Adenocarcinoma is further subclassified based on microscopic appearance:
- Intestinal Adenocarcinoma: Well-differentiated (mature) cells. Cancer cells resemble normal cells under the microscope.
- Diffuse Adenocarcinoma: Poorly-differentiated (immature) cells. Tends to grow and spread rapidly; treatment is more challenging.
Common Symptoms
Early Stage — Indigestion
Indigestion, stomach discomfort, and bloating after meals.
Early Stage — Nausea
Mild nausea and loss of appetite.
Early Stage — Heartburn
Burning sensation in the epigastric region.
Advanced Stage — Blood in Stool
One of the symptoms that appear when cancerous tissue penetrates through the stomach wall.
Advanced Stage — Weight Loss
Unexplained weight loss and stomach pain.
Advanced Stage — Jaundice
Yellowing of the eyes and skin (icterus).
Advanced Stage — Ascites and Dysphagia
Abdominal distension (ascites) and difficulty swallowing.
Diagnosis Methods
Stomach Endoscopy (Gastroscopy)
Endoscopic examination of the esophagus, stomach, and duodenum. Biopsies are taken from suspicious areas. The presence of H. pylori is also examined.
Barium Swallow Test
X-ray imaging of the esophagus and stomach after ingestion of barium; mass lesions can be identified.
Computed Tomography (CT)
Metastatic evaluation is performed on tissues surrounding the stomach, intestinal structures, liver, and lungs.
Cancer Biomarkers
Evaluation of HER2 protein, PD-L1 (checkpoint protein), Microsatellite Instability (MSI), and Tumor Mutational Burden (TMB).
Staging Investigations
Staging is performed using endoscopic ultrasonography, FDG-PET CT, Gadolinium-enhanced MRI, and Laparoscopy.
Causes
Smoking
A significant factor that substantially increases gastric cancer risk.
Gastroesophageal Reflux
The backflow of stomach acid into the esophagus increases the risk.
Occupational Exposure
Workers in the rubber and coal industries are at increased risk.
Dietary Habits
Excessively salty, smoked, and industrially processed foods are the most significant dietary risk factors.
Treatments
Endoscopic Resection (EMR/ESD)
In very early-stage gastric cancer, superficial and limited tumors are removed endoscopically.
Subtotal Gastrectomy
Only the cancerous portion of the stomach is surgically removed with surrounding tissue, and stomach integrity is restored.
Total Gastrectomy
Removal of the entire stomach. The esophagus is directly connected to the duodenum.
Lymph Node Dissection
Removal of lymph nodes to where the cancer is likely to spread.
Chemotherapy
Administered as Neoadjuvant (pre-surgical tumor reduction), Adjuvant (post-surgical), and Palliative (symptom relief in advanced stages).
Targeted Therapy
Trastuzumab is used for HER2-positivity and Ramucirumab is used for anti-angiogenesis.
Immunotherapy
Pembrolizumab or Nivolumab can be effective in PD-L1 positive and MSI-H high patients.
Radiotherapy
May be administered in combination with chemotherapy post-surgery to clear the area or to control pain/bleeding in advanced cancers.