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| | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{DiseaseDisorder infobox | | | {{CMG}}; {{AE}} {{OK}}, {{PSD}}, {{MAD}} |
| Name = Stomach cancer |
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| ICD10 = {{ICD10|C|16||c|15}} |
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| ICD9 = {{ICD9|151}} }}
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| {{CMG}} | |
| {{Stomach cancer}} | | {{Stomach cancer}} |
| {{Editor Help}} | | {{SK}} Gastric cancer, Gastric carcinoma, Carcinoma of stomach |
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| ==[[Stomach cancer overview|Overview]]== | | ==[[Stomach cancer overview|Overview]]== |
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| ==[[Stomach cancer historical perspective|Historical Perspective]]== | | ==[[Stomach cancer historical perspective|Historical Perspective]]== |
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| | ==[[Stomach cancer classification|Classification]]== |
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| ==[[Stomach cancer pathophysiology|Pathophysiology]]== | | ==[[Stomach cancer pathophysiology|Pathophysiology]]== |
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| ==[[Stomach cancer epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Stomach cancer causes|Causes]]== |
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| | ==[[Stomach cancer differential diagnosis|Differentiating Stomach Cancer from other Diseases]]== |
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| | ==[[Stomach cancer epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Stomach cancer risk factors|Risk Factors]]== | | ==[[Stomach cancer risk factors|Risk Factors]]== |
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| ==[[Stomach cancer screening|Screening]]== | | ==[[Stomach cancer screening|Screening]]== |
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| ==[[Stomach cancer causes|Causes]]==
| | ==[[Stomach cancer natural history|Natural History, Complications and Prognosis]]== |
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| ==[[Stomach cancer differential diagnosis|Differentiating Stomach cancer]]==
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| ==[[Stomach cancer natural history|Complications & Prognosis]]== | |
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| ==Diagnosis==
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| [[Stomach cancer history and symptoms|History and Symptoms]] | [[Stomach cancer physical examination|Physical Examination]] | [[Stomach cancer staging|Staging]] | [[Stomach cancer laboratory tests|Laboratory tests]] | [[Stomach cancer electrocardiogram|Electrocardiogram]] | [[Stomach cancer x ray|X Rays]] | [[Stomach cancer CT|CT]] | [[Stomach cancer MRI|MRI]] [[Stomach cancer echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Stomach cancer other imaging findings|Other images]] | [[Stomach cancer other diagnostic studies|Alternative diagnostics]]
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| ==Treatment==
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| [[Stomach cancer medical therapy|Medical therapy]] | [[Stomach cancer surgery|Surgical options]] | [[Stomach cancer primary prevention|Primary prevention]] | [[Stomach cancer secondary prevention|Secondary prevention]] | [[Stomach cancer cost-effectiveness of therapy|Financial costs]] | [[Stomach cancer future or investigational therapies|Future therapies]]
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Stomach cancer staging|Staging]] | [[Stomach cancer history and symptoms|History and Symptoms]] | [[Stomach cancer physical examination|Physical Examination]] | [[Stomach cancer laboratory findings|Laboratory Findings]] | [[Stomach cancer endoscopy and biopsy|Endoscopy and Biopsy]] | [[Stomach cancer chest x ray|Chest X Ray]] | [[Stomach cancer CT|CT]] | [[Stomach cancer MRI|MRI]] | [[Stomach cancer echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Stomach cancer other imaging findings|Other Imaging Findings]] | [[Stomach cancer other diagnostic studies|Other Diagnostic Studies]] |
| To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:
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| * [[Gastroscopic exam]] is the diagnostic method of choice
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| * [[Upper GI series]] (may be called barium roentgenogram)
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| * [[Fecal occult blood|Fecal occult blood test]] is obsolete except possibly as a screening test; a negative test proves nothing and a positive result may result from a large number of other conditions beside gastric carcinoma.
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| Abnormal tissue seen in a gastroscope examination will be [[biopsy|biopsied]] by the [[surgery|surgeon]] or [[gastroenterologist]]. This tissue is then sent to a [[pathology|pathologist]] for [[histology|histological]] examination under a microscope to check for the presence of cancerous cells. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.
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| A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as [[acanthosis nigricans]], commonly prompts a study into gastric carcinoma. It should be noted that this hyperplasia can be found in obese individuals with no underlying cancer.
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| ===Histopathology===
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| *''Gastric [[adenocarcinoma]]'' is a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. It invades the gastric wall, infiltrating the [[muscularis mucosae]], the submucosa and thence the muscularis propria. Histologically, there are two major types of gastric cancer (Lauren classification): intestinal type and diffuse type.
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| *''Intestinal type adenocarcinoma'': tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiate.
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| *''Diffuse type adenocarcinoma (mucinous, colloid):'' Tumor cells are discohesive and secrete mucus which is delivered in the interstitium producing large pools of mucus/colloid (optically "empty" spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "''signet-ring cell''".
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| ==Staging==
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| If cancer cells are found in the tissue sample, the next step is to [[cancer staging|stage]], or find out the extent of the disease. Various tests determine whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a [[CT scan]], an ultrasound exam, or other tests to check these areas. Blood tests for [[tumor marker]]s, such as [[carcinoembryonic antigen]] (CEA) and carbohydrate antigen (CA) may be ordered, as their levels correlate to extent of metastasis, especially to the liver, and the cure rate.
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| Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.
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| ==Treatment== | | ==Treatment== |
| Like any cancer, treatment is adapted to fit each person's individual needs and depends on the size, location, and extent of the tumor, the stage of the disease, and general health. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, [[chemotherapy]], and/or [[radiation therapy]]. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.
| | [[Stomach cancer medical therapy|Medical Therapy]] | [[Stomach cancer surgery|Surgery]] | [[Stomach cancer primary prevention|Primary Prevention]] | [[Stomach cancer secondary prevention|Secondary Prevention]] | [[Stomach cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stomach cancer future or investigational therapies|Future or Investigational Therapies]] |
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| ====Surgery====
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| Surgery is the most common treatment for stomach cancer. The surgeon removes part (subtotal or partial gastrectomy) or all (total [[gastrectomy]]) of the stomach, as well as some of the tissue around the stomach, with the basic goal of removing all cancer and a margin of normal tissue. Depending on the extent of invasion and the location of the tumor, surgery may also include removal of part of the [[esophagus]], [[splenectomy|spleen]], [[oophorectomy|ovaries]], intestine or pancreas . Tumors in the lower parts of the stomach may call for a Billroth I or Billroth II procedure. Endoscopic mucosal resection is a treatment for early gastric cancer that has been pioneered in Japan, but is available in the United States at some centers. In this procedure, the tumor is removed from the wall of the stomach using an endoscope, with the advantage in that it is a smaller operation than removing the stomach. Surgical interventions are currently curative in less than 40% of cases, and, in cases of metastasis, may only be [[palliative]].
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| ====Chemotherapy====
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| [[Chemotherapy]] is the use of systemic drugs to fight the stomach cancer. Unfortunately, gastric cancer has not been especially sensitive to these drugs until recently, and historically served to palliatively reduce the size of the tumor and increase survival time. Some drugs used in stomach cancer treatment include: [[5-FU]] (fluorouracil), BCNU (carmustine), methyl-CCNU (Semustine), and [[doxorubicin]] (Adriamycin), as well as Mitomycin C, and more recently [[cisplatin]] and [[taxotere]] in various combinations. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Combination treatment with chemotherapy and radiation therapy is also under study. Doctors are testing a treatment in which anticancer drugs are put directly into the abdomen ([[intraperitoneal hyperthermic chemoperfusion]]). Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease. The side effects of chemotherapy depend mainly on the drugs the patient receives.
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| ====Radiation therapy====
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| [[Radiation therapy]] (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. When used, it is generally in combination with surgery and chemotherapy, or used only with chemotherapy in cases where the individual is unable to undergo surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumor for [[palliation]] of incurable disease | |
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| ====Multimodality Therapy====
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| While previous studies of multimodality therapy (combinations of surgery, chemotherapy and radiation therapy) gave mixed results, the Intergroup 0116 (SWOG 9008) study ([http://content.nejm.org/cgi/content/abstract/345/10/725?andorexacttitleabs=and&search_tab=articles&tocsectionid=Original+Articles&tmonth=Aug&searchtitle=Articles&excludeflag=TWEEK_element&sortspec=Score+desc+PUBDATE_SORTDATE+desc&hits=20&where=titleabstract&tyear=2006&andorexactfulltext=and&fyear=1996&fmonth=Aug&searchterm=stomach+adenocarcinoma&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT NEJM study abstract]) showed a survival benefit to the combination of chemotherapy and radiation therapy in patients with nonmetastatic, completely resected gastric cancer. Patients were randomized after surgery to the standard group of observation alone, or the study arm of combination chemotherapy and radiation therapy. Those in the study arm receiving chemotherapy and radiation therapy survived on average 36 months, compared to 27 seconds with observation.
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| ====Biological therapy====
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| Biologic therapy is still in the testing stages for stomach cancer. The side effects of biological therapy vary with the type of treatment. Some cause flu-like symptoms, such as chills, fever, weakness, nausea, vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise or bleed easily. These problems may be severe, and patients may need to stay in the hospital during treatment.
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| ==External links== | | ==Case Studies== |
| * Article on [http://jmg.bmjjournals.com/cgi/content/full/41/7/508 Hereditary Diffuse Gastric Cancer]
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| * National Cancer Institute [http://www.cancer.gov/cancertopics/pdq/treatment/gastric/HealthProfessional/page1 Gastric cancer treatment guidelines]
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| * Photos at: [http://www.pathologyatlas.ro/Gastric%20Carcinoma%20Intestinal%20Type.html Atlas of Pathology]
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| ==References==
| | [[Stomach cancer case study one|Case #1]] |
| {{reflist|2}}
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| <ref>Lewis, S.M., Heitkemper, M.M., & Dirksen, S.R. Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 6th ed. St. Louis: Mosby, 2004.</ref>
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| <ref>McCance, K., & Huether, S. Pathophysiology: The Biologic Basis for Disease in Adults & Children, 4th ed. St. Louis: Mosby, 2002.</ref>
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| {{Gastroenterology}} | | {{Gastroenterology}} |
| {{Tumors}} | | {{Tumors}} |
| {{SIB}} | | {{WH}} |
| [[Category:Types of cancer]]
| | {{WS}} |
| [[Category:Conditions diagnosed by stool test]]
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| [[Category:Oncology]]
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| [[bg:Рак на стомаха]]
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| [[da:Ventrikelcancer]]
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| [[de:Magenkarzinom]]
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| [[es:Cáncer de estómago]]
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| [[fr:Cancer de l'estomac]]
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| [[it:Tumore dello stomaco]]
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| [[he:סרטן הקיבה]]
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| [[ms:Barah perut]]
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| [[nl:Maagkanker]]
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| [[ja:胃癌]]
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| [[no:Magekreft]]
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| [[pl:Rak żołądka]]
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| [[pt:Cancro do estômago]]
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| [[fi:Mahasyöpä]]
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| [[sv:Magsäckscancer]]
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| [[zh:胃癌]]
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