Gastric Cancer

Gastric cancer is a condition which has declined in incidence in recent years as the prevalence of H. pylori, the commonest causative agent has declined in the general population. Like oesophageal cancer it usually effects people over 45 years of age but can be seen in people younger than this in exceptional circumstances. Whilst it has a good prognosis if identified at an early stage, particularly in patients who are fit for more aggressive intervention it commonly presents in frailer patients, who have significant comorbidity and at a late stage of disease.

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Most gastric cancers are adenocarcinomas, although rarely other forms of disease such as gastric lymphoma may arise. Treatment very much depends on the stage and nature of the disease and the general fitness of the patient. Fit patients diagnosed at and early stage have a good prognosis. Patients usually present with anaemia, epigastric pain, weight loss and early satiety, or a combination of these symptoms. Presentation with gastrointestinal bleeding (haematemesis or melaena) and anaemia is less common but recognised. If cancer is suspected further investigation using CT scanning and other tests may be required in order to assess the extent and spread of the tumour.

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Decisions regarding treatment are usually based on a combination of the location, extent and symptoms related to the tumour and the general fitness and co-morbidities of the patient. It may include surgery, chemotherapy, radiotherapy, stenting of the tumour or supportive care alone. Such decisions are made in the UK following multi-disciplinary team discussion.