Epidemiology
- Incidence: 12.00 cases per 100,000 person-years
- Peak incidence: 70+ years
- Sex ratio: more common in males 2:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Aetiology
Associations
Pathophysiology
Histology
- signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis
Clinical features
Referral criteria
NICE cancer referral guidelines for gastric cancer suggest the following:
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer.
Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis.
Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with:
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer.
Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
- with dysphagia or
- aged 55 and over with weight loss and any of the following:
- upper abdominal pain
- reflux
- dyspepsia.
Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis.
Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with:
- treatment‑resistant dyspepsia or
- upper abdominal pain with low haemoglobin levels or
- raised platelet count with any of the following:
- nausea
- vomiting
- weight loss
- reflux
- dyspepsia
- upper abdominal pain, or
- nausea or vomiting with any of the following:
- weight loss
- reflux
- dyspepsia
- upper abdominal pain.
Investigations
Investigation
Staging
- diagnosis: endoscopy with biopsy
- staging: CT or endoscopic ultrasound - endoscopic ultrasound has recently been shown to be superior to CT
Staging
- CT scanning of the chest abdomen and pelvis is the routine first line staging investigation in most centres.
- Laparoscopy to identify occult peritoneal disease
- PET CT (particularly for junctional tumours)
Management
- Proximally sited disease greater than 5-10cm from the OG junction may be treated by sub total gastrectomy
- Total gastrectomy if tumour is <5cm from OG junction
- For type 2 junctional tumours (extending into oesophagus) oesophagogastrectomy is usual
- Endoscopic sub mucosal resection may play a role in early gastric cancer confined to the mucosa and perhaps the sub mucosa (this is debated)
- Lymphadenectomy should be performed. A D2 lymphadenectomy is widely advocated by the Japanese, the survival advantages of extended lymphadenectomy have been debated. However, the overall recommendation is that a D2 nodal dissection be undertaken.
- Most patients will receive chemotherapy either pre or post operatively.
Prognosis
| Disease extent | Percentage 5 year survival |
|---|---|
| All RO resections | 54% |
| Early gastric cancer | 91% |
| Stage 1 | 87% |
| Stage 2 | 65% |
| Stage 3 | 18% |