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Gastric Carcinoma

Updated : April 19, 2024





Background

Gastric carcinoma is a cancer which begins in the cell lining of the stomach. It is the fifth most common seen cancer and for death related cancer it is on third place. 

This is classified into two types as intestinal and diffuse. Surgical resection with lymphadenectomy is the only treatable therapy available for gastric carcinoma.  

Epidemiology

Gastric cancer incidence is declines globally.  The causes which are attributed to viral detection and given treatment.  

The risk factors include lifestyle changes and environmental modification.  In black men it is seen more than in white men. 

Anatomy

Pathophysiology

According to lauren’s histopathologic taxonomy study on gastric carcinoma it shows two primary types: Intestinal and compensatory hypergastrinemia. 

The intestinal type resembles gastrointestinal tract adenocarcinomas. While Compensation-induced inflammation leads to intestinal metaplasia and cancer. 

Etiology

Various risk factors including high salt preserved foods, smoking, Vitamin A and C deficiency. The H. pylori infection has risk of 46 to 63% risk. 
In Epstein-Barr virus infection it shows cases around 5 to 10% globally. 
Radiation exposure and previous gastric surgery also be considered as risk factors. 

Genetics

Prognostic Factors

Gastric Carcinoma Prognosis is correlates with tumor extent and nodal involvement. 

Span of 5 years is survival rate which varies from zero for disseminated disease to 50% for localized illness. 

The localized carcinoma has a 5-year survival rate of 10 to 15% in people with proximal gastric cancer. 

Clinical History

Gastric carcinoma is more diagnosed in older individuals, in those more than 55-years-old.  

Younger individuals can also develop stomach cancer, but it is less seen. 

Physical Examination

Age group

Associated comorbidity

  • Helicobacter pylori Infection: Chronic infection with H. pylori is a significant risk factor for gastric carcinoma. This bacteria can lead to a persistent inflammatory response in the stomach lining, which raises the risk of cancer. 
  • Chronic Gastritis: Long-term inflammation of the stomach lining, often associated with conditions like autoimmune gastritis, can contribute to the development of gastric cancer. 
  • Family History: Stomach cancer in the family may raise the risk. 

Associated activity

Acuity of presentation

Early stages are considered asymptomatic. The symptoms occurred during this cancer such as indigestion, bloating, and mild abdominal discomfort.  

Symptoms are more noticeable in patients and become severe simultaneously with disease progression.   

Differential Diagnoses

Gastroesophageal Reflux Disease 

Peptic Ulcer Disease 

Functional Dyspepsia 

Gastroenteritis  

Pancreatitis 

 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The primary treatment for patients with early-stage cancer is surgical intervention. The focus is to remove the tumor and surrounding tissues.  

The surgical procedures may include partial or total gastrectomy. 

In some cases where the cancer is advanced then surgery may be performed to relieve symptoms or complications. 

 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of a non-pharmacological approach for treating Gastric Carcinoma

Healthy diet should be consumed by patient such as grains, fruits, vegetables, and whole grains.   

Daily physical activity improves overall well-being of patient. 

Give psychosocial assistance with counselling and support group involvement. 

 

Role of Chemotherapy in the treatment of Gastric Carcinoma

Fluorouracil is an antimetabolite which interferes with DNA and RNA synthesis. It inhibit the growth of cancer cells. 

Role of Targeted therapy in the treatment of Gastric Carcinoma

Bevacizumab belongs to targeted therapy which inhibits the vascular endothelial growth factor (VEGF). It works to prevent blood vessel formation. 

Use of Intervention with a procedure in treating Gastric Carcinoma

Gastrectomy involves surgical removal of the stomach is performed. 

In the early stages of gastric carcinoma endoscopic mucosal resection may be used to remove the cancerous tissue. 

Systemic chemotherapy is indicated as the main treatment for advanced stages in terms of adjuvant after surgery. 

Use of phases in managing Gastric Carcinoma

Physicians should identify individuals at a higher risk for gastric carcinoma. Regular screening should be conducted in high-risk individuals to identify precancerous lesions.  

Follow palliative care to reduce symptoms and increase quality of patient’s life. 

 

Medication

 

ramucirumab (Rx)

8

mg/kg

Solution

Intravenous (IV)

every 2 weeks

60

minutes

Continue the therapy until disease progression or unacceptable toxicity occurs    If the 1st infusion is tolerable, then go with subsequent infusions given over 30 minutes



fluorouracil 

200-1000 mg/m² per day intravenously for 24 hours as a part of a platinum-based regimen)
Frequency and duration of every cycle differs on the basis of dose and regimen



gimeracil 

In combination with tegafur and oteracil:
Take a dose of 40 mg/m2 as per body surface area two times daily for one week pre-operatively and for 15 days after operation starting on day 15 after operation



 

ramucirumab (Rx)

Safety and efficacy are not studied  



 

ramucirumab (Rx)

Refer adult dosing



Media Gallary

Gastric Carcinoma

Updated : April 19, 2024




Gastric carcinoma is a cancer which begins in the cell lining of the stomach. It is the fifth most common seen cancer and for death related cancer it is on third place. 

This is classified into two types as intestinal and diffuse. Surgical resection with lymphadenectomy is the only treatable therapy available for gastric carcinoma.  

Gastric cancer incidence is declines globally.  The causes which are attributed to viral detection and given treatment.  

The risk factors include lifestyle changes and environmental modification.  In black men it is seen more than in white men. 

According to lauren’s histopathologic taxonomy study on gastric carcinoma it shows two primary types: Intestinal and compensatory hypergastrinemia. 

The intestinal type resembles gastrointestinal tract adenocarcinomas. While Compensation-induced inflammation leads to intestinal metaplasia and cancer. 

Various risk factors including high salt preserved foods, smoking, Vitamin A and C deficiency. The H. pylori infection has risk of 46 to 63% risk. 
In Epstein-Barr virus infection it shows cases around 5 to 10% globally. 
Radiation exposure and previous gastric surgery also be considered as risk factors. 

Gastric Carcinoma Prognosis is correlates with tumor extent and nodal involvement. 

Span of 5 years is survival rate which varies from zero for disseminated disease to 50% for localized illness. 

The localized carcinoma has a 5-year survival rate of 10 to 15% in people with proximal gastric cancer. 

Gastric carcinoma is more diagnosed in older individuals, in those more than 55-years-old.  

Younger individuals can also develop stomach cancer, but it is less seen. 

  • Helicobacter pylori Infection: Chronic infection with H. pylori is a significant risk factor for gastric carcinoma. This bacteria can lead to a persistent inflammatory response in the stomach lining, which raises the risk of cancer. 
  • Chronic Gastritis: Long-term inflammation of the stomach lining, often associated with conditions like autoimmune gastritis, can contribute to the development of gastric cancer. 
  • Family History: Stomach cancer in the family may raise the risk. 

Early stages are considered asymptomatic. The symptoms occurred during this cancer such as indigestion, bloating, and mild abdominal discomfort.  

Symptoms are more noticeable in patients and become severe simultaneously with disease progression.   

Gastroesophageal Reflux Disease 

Peptic Ulcer Disease 

Functional Dyspepsia 

Gastroenteritis  

Pancreatitis 

 

The primary treatment for patients with early-stage cancer is surgical intervention. The focus is to remove the tumor and surrounding tissues.  

The surgical procedures may include partial or total gastrectomy. 

In some cases where the cancer is advanced then surgery may be performed to relieve symptoms or complications. 

 

Healthy diet should be consumed by patient such as grains, fruits, vegetables, and whole grains.   

Daily physical activity improves overall well-being of patient. 

Give psychosocial assistance with counselling and support group involvement. 

 

Fluorouracil is an antimetabolite which interferes with DNA and RNA synthesis. It inhibit the growth of cancer cells. 

Bevacizumab belongs to targeted therapy which inhibits the vascular endothelial growth factor (VEGF). It works to prevent blood vessel formation. 

Gastrectomy involves surgical removal of the stomach is performed. 

In the early stages of gastric carcinoma endoscopic mucosal resection may be used to remove the cancerous tissue. 

Systemic chemotherapy is indicated as the main treatment for advanced stages in terms of adjuvant after surgery. 

Physicians should identify individuals at a higher risk for gastric carcinoma. Regular screening should be conducted in high-risk individuals to identify precancerous lesions.  

Follow palliative care to reduce symptoms and increase quality of patient’s life. 

 

ramucirumab (Rx)

8

mg/kg

Solution

Intravenous (IV)

every 2 weeks

60

minutes

Continue the therapy until disease progression or unacceptable toxicity occurs    If the 1st infusion is tolerable, then go with subsequent infusions given over 30 minutes



fluorouracil 

200-1000 mg/m² per day intravenously for 24 hours as a part of a platinum-based regimen)
Frequency and duration of every cycle differs on the basis of dose and regimen



gimeracil 

In combination with tegafur and oteracil:
Take a dose of 40 mg/m2 as per body surface area two times daily for one week pre-operatively and for 15 days after operation starting on day 15 after operation



ramucirumab (Rx)

Safety and efficacy are not studied  



ramucirumab (Rx)

Refer adult dosing



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