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- 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”)
- Rarely diagnosed during pregnancy
- Prognosis is poor.
- 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.
- 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.
- 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.
- 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.
- 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