Gastric cancer is the second commonest cause of death from malignancy in the world. It arises usually in a stomach that has been chronically inflamed over many years leading to a pan-gastritis, gastric atrophy, hypochlorhydria and intestinal metaplasia. Risk factors include a high salt, low vegetable and fruit diet, duodenogastric reflux and Helicobacter pylori infection. These, in conjunction with other environmental factors and a genetic predisposition, lead to the development of cancer mainly in middle aged and elderly people. Histologically carcinomas are classified as “intestinal” or “diffuse”; both however are strongly associated with infection with Helicobacter pylori. The classical triad of symptoms; abdominal pain, anorexia and weight loss is usually associated with advanced cancer which carries a poor prognosis. Early gastric cancer may be identified by screening programmes, active investigation of minor dyspeptic symptoms or those typically associated with peptic ulcer. If the lesion has not invaded the muscularis propria the prognosis is good. Early cancer if limited in extent can be treated by endoscopic mucosal resection (EMR), however most cases of cancer are treated by partial or total gastrectomy with or without adjuvant chemotherapy. Screening for gastric cancer is not available, or practicable in most countries. A more logical method to reduce mortality might involve screening for Helicobacter infection in young adults and treatment of affected individuals with antibiotic therapy. Prospective studies have not been carried out, but it is likely that this approach would allow effective primary prevention of this disease.
KeywordsGastric Cancer Pylorus Infection Early Gastric Cancer Advanced Gastric Cancer Intestinal Metaplasia
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