Clinical Review ABC of the upper gastrointestinal tract

Cancer of the stomach and pancreas

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7326.1413 (Published 15 December 2001) Cite this as: BMJ 2001;323:1413
  1. Matthew J Bowles,
  2. Irving S Benjamin

    Cancers of the stomach and the pancreas share similarly poor prognoses. However, long term survival is possible if patients present at an early stage. In England and Wales carcinoma of the stomach and pancreas cause about 7% and 4% of all cancer deaths respectively. In women they are the fourth and fifth most common causes of cancer death; in men their respective rankings are third equal (with colonic cancer) and seventh.

    Endoscopic appearance of gastric carcinoma on the lesser curve of the stomach

    The incidence of distal gastric carcinoma has fallen in the West, probably because of decreasing rates of infection with Helicobacter pylori, but it remains one of the main causes of death from malignancy worldwide. The incidence of proximal gastric cancer seems to be rising. These two gastric cancers depend on the distribution and severity of H pylori gastritis, as discussed in the earlier chapter on the pathophysiology of duodenal and gastric ulcers and gastric cancer.1

    Cancer of the stomach

    Gastric adenocarcinoma is rare below the age of 40 years, and its incidence peaks at about 60 years of age. Men are affected twice as often as women. Chronic atrophic pangastritis associated with H pylori infection is one of the most important risk factors for distal gastric cancer.

    Risk factors for gastric cancer

    • H pylori infection and atrophic gastritis

    • Pernicious anaemia

    • Adenomatous gastric polyps

    • Partial gastrectomy

    • Abnormalities in E-cadherin gene

    • Family history of gastric cancer

    Clinical presentation

    Symptoms may not occur until local disease is advanced. Patients may have symptoms and signs related to secondary spread (principally to the liver) and to the general effects of advanced malignancy, such as weight loss, anorexia, or nausea. Epigastric pain is present in about 80% of patients and may be similar to that from a benign gastric ulcer. If caused by obstruction of the gastric lumen, it is relieved by …

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