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Gastric Cancer

Gastric Cancer is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Malignant neoplasm occurring in the stomach
  • Infiltration to lymph nodes, omentum, lungs, and liver is rapid.
  • Uncommon in U.S. natives
  • Synonym(s): linitis plastica (“leather bottle stomach”)

Pediatric Considerations
Rare

Pregnancy Considerations
  • Rarely diagnosed during pregnancy
  • Prognosis is poor.

Epidemiology

  • Predominant age: >55 years (2/3 are >65 years)
  • Predominant gender: male > female (1.7:1)
  • Incidence is decreasing globally but remains the fifth most common malignancy and the third leading cause of cancer death worldwide.

Incidence
  • 5.9/100,000 males (North America)
  • 2.5/100,000 females (North America)
  • 24,590 new cases per year (United States)

Etiology and Pathophysiology

Helicobacter pylori–associated gastric cancers are associated with interactions between bacterial virulence factors and host inflammatory responses.


Genetics
  • More common in people with blood group A
  • 2 to 4 times more common in first-degree relatives
  • 1–3% of gastric cancers are associated with inherited gastric cancer predisposition syndromes (hereditary diffuse gastric cancer [CDH1] gene).
  • Amplification or overexpression of the HER2 protein is associated with some gastric cancers.

Risk Factors

  • H. pylori infection is primary risk in 65–80%.
  • Smoking/tobacco abuse is second leading risk factor.
  • Diet rich in additives (e.g., smoked, pickled, or salted foods; highly spiced foods), nitrates, and nitrites have been implicated.
  • Atrophic gastritis/intestinal metaplasia
  • Pernicious anemia
  • Preexisting diabetes mellitus
  • Overweight and obesity: Strength of association increases with increasing body mass index (BMI).
  • Certain hereditary syndromes (familial adenomatous polyposis, hereditary nonpolyposis colon cancer, Peutz-Jeghers syndrome)
  • Barrett esophagus
  • Patients in lower socioeconomic status have higher risk of gastric cancer.
  • Low consumption of fruits and vegetables
  • Ethnicity: Hispanic, Japanese, Chilean, Costa Rican
    • Migrants from high-incidence areas (e.g., Iceland, Chile, or Japan) to low-incidence areas maintain an increased risk, whereas their offspring have an occurrence rate that corresponds to that of the new location.

General Prevention

  • Avoid tobacco, engage in regular exercise, maintain optimal body weight, and maintain a healthy diet.
    • Diets that include 5 to 20 servings of both fruits and vegetables each week reduce the risk of gastric malignancy by ~50%.
  • Insufficient data to recommend routine gastric cancer screening
  • Screening to identify and eradicate H. pylori may reduce the risk. The impact may be greatest with increasing age and in high-prevalence areas.

Commonly Associated Conditions

  • Giant hypertrophic gastritis (Ménétrier disease)
  • Intestinal metaplasia
  • Atrophic gastritis
  • H. pylori infection

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Citation

Stephens, Mark B., et al., editors. "Gastric Cancer." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer.
Gastric Cancer. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer. Accessed April 24, 2019.
Gastric Cancer. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer
Gastric Cancer [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastric Cancer ID - 816407 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816407/all/Gastric_Cancer PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -