Upper GI & Hepatobiliary Surgery

Gastric Cancer

Gastric cancer is usually adenocarcinoma: early disease can be subtle, while alarm symptoms should trigger a current NICE suspected-cancer pathway, biopsy-based diagnosis, whole-body CT and specialist MDT staging before treatment is selected by resectability and tumour biology.

Definition

Gastric cancer is a malignant tumour of the stomach, most often adenocarcinoma. It may be asymptomatic or non-specific early and later cause weight loss, bleeding, anaemia, obstruction or metastatic disease.

First principles

Chronic mucosal injury creates a carcinogenic field

H. pylori-associated chronic gastritis can progress through atrophy, intestinal metaplasia and dysplasia to intestinal-type adenocarcinoma. This is an important pathway rather than an explanation for every gastric cancer: other risks include pernicious anaemia, smoking, high-salt or preserved-food intake, family history and inherited cancer syndromes.

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