Carcinoma of stomach
Cancer of stomach is more common in older people, it is seen more in people with blood group A. It is seen more in China, Japan and Chile. In the United states it is more common in blacks, people from lower economic strata and from the north. Stomach cancer is supposed to be arising due to high dietary intake of salt, carbohydrates, preservatives like nitrates and also due to the hydrocarbons, nitrites , nitrosamines from smoked fish etc. Low dietary intake of fiber and vegetables also is contributory. Long standing achlorhydria, infection with Helicobacter pylori are also incriminated. However, all these factors are not definitely proved to be causing carcinoma stomach. Three distinct varieties of carcinoma stomach are known. 1. The most common cauliflower like growth 2. Cancer arising in an ulcer and 3. Diffuse cancer involving all the layers of the whole of the stomach, called linitis plastica. The most common site of cancer in the stomach is the prepyloric region.
Clinical features: In the initial stages of carcinoma stomach, there may not be any symptoms apart from vague dyspepsia like syndrome with fullness , loss of appetite, indigestion etc. Later the symptoms are pain in the epigastrium especially after food, nausea and vomiting. There may be bleeding from the growth causing hematemesis and melina. Systemic findings are weakness and anemia, both due to lowered food intake and loss of blood from the growth. A palpable mass may be present, especially in late stages. If there is infiltration of the lymph nodes, liver and pancreas the pain becomes severe and the patient develops jaundice. Supraclavicular lymph nodes get enlarged on the left side in late stages. Prepyloric growths tend to obstruct passage of food, so cause symptoms of obstruction like vomiting early.
Diagnosis: Barium meal radiographs show carcinoma of stomach very well for larger growths. Diagnostic endoscopy is done for all people suspected to be having carcinoma of stomach. This is useful to see the growth directly and to take out a piece of the growth for microscopic examination.
Management: Treatment of carcinoma of stomach in early stages is essentially surgical. It is most amenable to surgical resection when the growth is restricted to a particular region in the stomach without involvement of lymph nodes or other organs. Partial or total gastrectomy with or without removal of various groups of lymph nodes is done. For later stages of carcinoma, where the symptoms are those of obstruction and if the growth is not resectable, a palliative operation, gastro jejunostomy is done. It may be supplemented with chemotherapy with 5 fluoro uracil. Palliative chemotherapy and radiotherapy without surgery are indicated for symptomatic relief for late stages of carcinoma stomach.
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