Gastric Cancer
Epidemiology and Etiology
The highest incidence rates for gastric cancer are in eastern Asia, Eastern Europe, and South America, whereas the lowest incidence is in North America and Africa.
Gastric cancer is estimated to account for 27,600 cases and 11,010 deaths in the US in 2020.1 Gastric cancer occurs more frequently in males. Risk factors include H. pylori infection, high salt intake, diets low in fruits and vegetables, previous partial gastrectomy for benign ulcer, achlorhydria associated with pernicious anemia, cigarette smoking, alcohol consumption, and blood group A. Hereditary diffuse gastric cancer (HDGC) is an inherited type of gastric cancer in families with germline CDH1 (E-cadherin) mutations and any patient presenting with HDGC under the age of 40 or with a known CDH1 mutation should be offered genetic counseling and prophylactic total gastrectomy. A number of additional hereditary cancer syndromes are also associated with gastric cancers.12Pathology
More than 90% of gastric cancers are adenocarcinomas and nearly 15%-20% of patients with gastric cancer may have HER2 amplification or overexpression.
Clinical Presentation
The most common symptoms are weight loss, decreased appetite or early satiety, and abdominal discomfort. Dysphagia or regurgitation may occur with gastroesophageal junction tumors and refractory vomiting may occur with pyloric obstruction. Physical examination may show metastases to the left supraclavicular node (Virchow node) or periumbilical node (Sister Mary Joseph node). Iron deficiency anemia may develop from chronic gastrointestinal blood loss.
Diagnostic Testing
Diagnosis is established by upper endoscopy. CT of the chest and abdomen should be obtained in all patients, and CT of the pelvis should be performed in women to exclude ovarian involvement (Krukenberg tumor). Additional tests include H. pylori testing, EUS, and PET scan. Staging laparoscopy may be indicated before surgery to assess for peritoneal involvement in some cases.
Staging
The TNM classification is generally similar to that of esophageal cancer. Clinical stage: 0 (TisN0M0), I (T1-2N0M0), IIA (T1-2N1-3M0), IIB (T3-4N0M0), III (T3-4aN1-3M0), IVA (T4bN1-3M0), IVB (M1).
TREATMENT
• Stage I-IVA: Medically fit patients with resectable disease should undergo surgery. Perioperative chemotherapy with a fluoropyrimidine-based regimen is frequently included, except in patients with T1 disease (submucosal invasion or less) who may be treated with surgery alone. Medically unfit patients or those with unresectable disease may be treated with chemoradiation or chemotherapy alone.
• Stage IVB (metastatic): Treatment options for metastatic gastric cancer are similar to those used in esophageal cancer, with combination regimens including fluoropyrimidines, platinum drugs, taxanes, irinotecan, trastuzumab, and ICIs.12
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- Agrawal M.. Textbook of Pediatrics. 3rd ed. — CBS Publishers,2025. — 973 p., 2025