Introduction
Stomach cancer, also known as gastric cancer, is a malignant tumor arising from the gastric mucosa. It remains a major global health problem, particularly in East Asia and developing countries. Most cases are diagnosed at an advanced stage due to nonspecific early symptoms.
Types of Stomach Cancer
- Adenocarcinoma (intestinal type, diffuse type – Lauren classification)
- Gastrointestinal stromal tumor (GIST)
- Gastric lymphoma (MALT lymphoma)
- Neuroendocrine tumors (carcinoid)
- Squamous cell carcinoma (rare)
Pathogenesis
- Chronic Helicobacter pylori infection leading to gastritis → atrophy → intestinal metaplasia → dysplasia → carcinoma
- Dietary factors: high salt, smoked foods, nitrosamines
- Genetic alterations: CDH1 mutation, TP53 abnormalities
- Chronic inflammation and oxidative stress
- Smoking and alcohol consumption
Laboratory Diagnosis
- Upper GI endoscopy with biopsy (gold standard)
- Histopathology for tumor type and grade
- Immunohistochemistry: HER2, Ki-67, PD-L1
- Molecular testing: HER2 amplification, MSI, EBV status
- Imaging: CT scan, PET scan, endoscopic ultrasound (staging)
- Tumor markers: CEA, CA 19-9 (monitoring)
Treatment
- Surgical resection (partial or total gastrectomy)
- Chemotherapy (perioperative or palliative)
- Radiotherapy (selected cases)
- Targeted therapy (trastuzumab for HER2-positive tumors)
- Immunotherapy (PD-1 inhibitors)
- Nutritional and supportive care
Prevention
- Eradication of H. pylori
- A healthy diet rich in fruits and vegetables
- Reduce smoked and salted foods
- Smoking cessation
- Early screening in high-risk populations
Keynotes
- Adenocarcinoma is the most common gastric cancer.
- H. pylori is the strongest risk factor.
- Endoscopic biopsy confirms diagnosis.
- Multimodal therapy improves survival.
- Early detection significantly improves prognosis.
Further Readings
- https://everhope.care/blogs/pathophysiology-of-gastric-cancer
- https://www.wikidoc.org/index.php/Stomach_cancer_pathophysiology
- https://www.canceraustralia.gov.au/cancer-types/stomach_cancer/types-stomach-cancer
- https://binaytara.org/cancernews/article/stomach_cancer-101
- https://www.viamedsalud.com/ivoqa/en/disease/stomach_cancer/stomach-cancer-types-diagnosis
- https://www.cancer.gov/types/stomach
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8550817
- https://cancer.ca/en/cancer-information/cancer_types/stomach/diagnosis
- https://schospitalib.staywellsolutionsonline.com
- https://www.brighamandwomens.org/cancer/stomach_cancer/diagnosis-and-stages
- https://www.hcgoncology.com/types-of-cancers/stomach_cancer
- https://www.pacehospital.com/stomach_cancer-types-symptoms-causes-diagnosis-treatment-prevention
- https://link.springer.com/chapter/10.1007/978-981-16-6026-9_15
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8656738
- https://www.usz.ch/en/disease/stomach_cancer/https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623365/3/GASTROPATHIES