Gastric Cancer

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Pathology 4 Genetics 5 Clinical-manifestations 6 Diagnostic-procedures 7 Complications 8 Differential-diagnosis 9 Management 10 More General Terms 11 Additional Terms 12 Internet Database 13 References

Etiology

• 60-70% of gastric carcinomas are causally related to infection with H pylori
• dietary salt may play a role
• 90% of gastric mucosa-associated lymphoid tissue ( MALT) lymphomas are associated with H pylori
• conversion of dietary nitrates to carcinogenic nitrites by gastric bacteria has been postulated
• pseudoachalasia

Epidemiology

• increased incidence of gastric carcinoma in

• Native Americans
• Hispanics
• African Americans

• gastric carcinoma is 2nd most common malignancy worldwide

Pathology

• gastric adenocarcinoma
• gastric mucosa-associated lymphoid tissue ( MALT) lymphoma

Genetics

• abnormal transcripts of FHIT found in ~50%
• K-ras & p53 mutations may play a role
• overexpression of TPBG, PLXNB1, TNFRSF6B, RTEL1
• chromosomal deletion within 17q12 region involving CDK12 producing fusion transcripts with ERBB2 may be a cause of gastric cancer
• associated with defects in KLF6
• other implicated genes: Zg14, ATAD2, AMIGO2, B3GNT6, CKAP2, LZIC, LETMD1, OLFM4, MYCT1, GUSB, CAPN9, SLC5A8, URG4, CASP10, CD97, CDH1, ADAMTS12, WISP1, TSPAN8, PSCA

Clinical-manifestations

• periumbilical nodule (Sister Mary Joseph's node)
• left suprclavicular lymphadenopathy ( Virchow's node)
• enlarged ovaray (Krukenberg's tumor)
• mass in the cul-de-sac on rectal examination (Blumer's shelf)
• ascites Laboratories:

• autoantibodies: KIAA1524 (research)

Diagnostic-procedures

• upper endoscopy with magnification [5]

Complications

• 
  
• disease interaction(s) of cancer with Alzheimer's disease

Differential-diagnosis

• MALT lymphoma

Management

• most patients present with advanced disease [1]
• surgical resection

• most patients relapse after surgery [1,3]
• endoscopic mucosal resection may be useful for recurrence [4]

• adjunctive chemotherapy may be of benefit [3]

• standard of care after surgical resection for stage T2 or higher [1]
• 5-fluorouracil/ leucovorin
• docetaxel, cisplatin + fluorouracil [6]
• relapse remains common

• inoperable disease

• capecitabine in combination with a platinum-based regimen

• radiation therapy is at best palliative
• gastric MALT lymphoma is treated with antibiotics for H pylori rather than surgery [1]
• follow up:

• monitor serum vitamin B12 in patients who have had proximal or total gastrectomy

More General Terms

• malignant neoplasm (cancer)
• gastric disease

Additional Terms

• Helicobacter pylori
• staging of gastric carcinoma

Internet Database

OMIM: 137215
OMIM: 176807

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 569-71
3. Journal Watch 21(19):152, 2001 Macdonald et al, N Engl J Med 345:725, 2001
4. Yokoi C, Gotoda T, Hamanaka H, Oda I. Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc. 2006 Aug;64(2):212-8. PMID: [1]
5. Fukui H, Shirakawa K, Nakamura T, Suzuki K, Masuyama H, Fujimori T, Hiraishi H, Terano A. Magnifying pharmacoendoscopy: response of microvessels to epinephrine stimulation in differentiated early gastric cancers. Gastrointest Endosc. 2006 Jul;64(1):40-4. PMID: [2]
6. Van Cutsem E et al, Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil and first-line therapy for advanced gastric cancer. A report of V325 Study Group. J Clin Oncol 2006, 24:4991 PMID: [3]
7. Stomach Cancer: NIH Institute and Center Resources [4]
8. Guidelines on the management of oesophageal and gastric cancer Scottish Intercollegiate Guidelines Network (SIGN) [5]
9. National Guideline Clearinghouse Surgical treatment of gastric cancer ngc-guideline: [6]
   - Gastric cancer. (Intracorp) ngc-guideline: [7]
   - Management of oesophageal and gastric cancer. A national clinical guideline. Scottish Intercollegiate Guidelines Network ngc-guideline: [8]
   - Systemic therapy for advanced gastric cancer. Program in Evidence-based Care ngc-guideline: [9]

gastric cancer