Carcinoma of the stomach

• Especially common in Japan

Associated with;

• Blood group A
• H. pylori
• Atrophic gastritis, pernicious anaemia
• Adenomatous polyps
• Low social class
• Smoking

Pathology

• Adenocarcinoma may be polypoloid, ulcerating or leather bottle type (linitis plastica)

Presentation

• Symptoms;
  • Dyspepsia
  • Weight loss
  • Vomiting
  • Dysphagia
  • Anaemia
• Signs;
  • Epigastric mass
  • Hepatomegaly
  • Jaundice
  • Ascites
  • Virchow’s node (Troisier’s sign)
  • Acanthosis nigricans

Spread

• Local
• Lymphatics
• Blood
• Transcoelomic e.g. ovary Krukenberg’s tumour

Tests

• Gastroscopy plus multiple ulcer edge biopsies
• Endoscopic ultrasound and CT/MRI are useful for staging

Treatment

• For tumours in the distal 2/3 partial gastrectomy maybe sufficient but if more proximal total gastrectomy may be required
• Combination chemotherapy may prolong survival in advanced disease

Survival

• <10% overall, nearly 20% for those undergoing radical surgery