Gastric carcinoma is a malignant tumour of the stomach epithelium, commonly presenting with weight loss, early satiety, and dyspepsia. It’s the second most common cause of cancer-related death globally, often detected late due to nonspecific symptoms.
Fast Facts and Key Epidemiology
- Male:Female = 2:1
- Peak age: >50 years
- Higher prevalence in Japan, Chile, China, and parts of Scandinavia
- Less common now in the West due to food preservation, early H. pylori treatment
Major Causes and Risk Factors
Infection:
- H. pylori – increases risk by 2–3×
Dietary Risks:
- Smoked/pickled foods
- Nitrosamines
- Benzpyrene exposure
- Low fruit/veg intake
Genetic & Personal Risks:
- Blood group A
- Pernicious anaemia
- Family history (e.g., CDH1 mutation)
- Partial gastrectomy history
- Hypogammaglobulinaemia
Common Histological Types
- Intestinal type – gland-forming; linked to diet, H. pylori
- Diffuse type – poorly cohesive, signet-ring cells, linitis plastica
- Polypoid, ulcerative, infiltrating masses
Clinical Symptoms and Red Flags
Early Signs:
- Epigastric pain, postprandial fullness
- Nausea
- Loss of appetite
Red Flags:
- Weight loss
- Dysphagia (if involving cardia)
- Anaemia
- Melena or vomiting
- Physical signs (Virchow’s node, Krukenberg tumour)
Spread Patterns of Gastric Cancer
From the image:
- Lymphatics (Virchow’s node – left supraclavicular)
- Haematogenous – liver, lung, bone
- Transcoelomic – ovaries (Krukenberg tumour), peritoneum
- Direct – pancreas, spleen, colon, diaphragm
TNM Staging and 5-Year Prognosis
TNM Staging:
- T1 – mucosa/submucosa
- T2 – into muscularis propria
- T3 – through muscularis to serosa
- T4 – serosal/organ invasion
- N1 – local nodes (~3 cm)
- N2 – regional nodes (3+ cm)
- N3 – distant nodal metastasis
5-Year Survival:
| Stage | Description | Survival Rate |
|---|---|---|
| I | T1–2, N0, M0 | 75% |
| II | T1–4, N1–2, M0 | 35% |
| III | T3, N1–3, M0 | 10% |
| IV | T4, N3, M1 | 2% |
Investigations and Diagnostic Tools
Initial Screening:
- FBC, U+E, LFTs
Key Investigations:
- OGD + biopsy – confirms diagnosis
- Barium meal – for patients who can’t tolerate OGD
- CT scan / PET-CT – staging and metastasis detection
- Endoscopic ultrasound (EUS) – depth of tumour
- Laparoscopy – assess for peritoneal spread
Treatment Options: Curative and Palliative
Curative Treatment
Stage I–III:
- Surgical resection (partial or total gastrectomy)
- Regional lymphadenectomy
- ± Neoadjuvant/adjuvant chemotherapy
- Endoscopic mucosal resection for very early cancer
Palliative Treatment (Stage IV)
- Gastrojejunostomy – bypass obstruction
- Laser therapy, radiotherapy, alcohol injection
- Palliative chemotherapy (e.g., ECF regimen)
Surgery Types Based on Tumor Site (as per diagram)
- Total gastrectomy + Roux-en-Y for proximal/linitis plastica
- Billroth I partial gastrectomy – distal cancers
- Polya partial gastrectomy – for mid-body lesions
- Extent of resection depends on margins and spread
Special Notes on GISTs and Genetic Links
Gastrointestinal Stromal Tumours (GISTs):
- Arise from muscular layer
- Treated with TKI (Imatinib)
- Resistant to traditional chemo
Genetic Syndrome:
- CDH1 mutation (E-cadherin gene)
- Strong link to diffuse-type gastric carcinoma
- Consider prophylactic gastrectomy
Survival Rates and Patient Outlook
- Overall 5-year survival: 5–20%
- Distal cancers with early diagnosis: ~50%
- Linitis plastica/metastatic disease: ~<5%
- Prognosis depends on stage, tumour location, and resection margins
Frequently Asked Questions (FAQs)
Q1. Is gastric carcinoma curable?
Yes, if caught early. Stage I disease has a 75% 5-year survival, but most cases present late.
Q2. What’s the most common site of gastric cancer?
The antrum and body of the stomach are most commonly involved.
Q3. Is H. pylori always present in gastric cancer?
Not always, but it significantly increases risk (2–3×), especially for intestinal-type adenocarcinoma.
Q4. Can gastric ulcers turn into cancer?
Yes, particularly if non-healing, atypical, or in older patients. Always biopsy gastric ulcers.
