Stomach cancer- familial
Overview
Cancer of the stomach that tends to run in families
Symptoms
* Asymptomatic in early stages * Weight loss * Swallowing difficulty * Nausea * Indigestion * Acidity * Burping * Abdominal bloating * Abdominal pain * Nausea * Vomiting * Bleeding * Weight loss * Tiredness * Blood clots * Anemia * Blood in stool * Altered bowel habits * Poor appetite * Helicobacter pylori infection
Causes
The cause of gastric cancer is unknown. It's commonly associated with gastritis with gastric atrophy, which may result from gastric cancer and may not be a precursor state. Predisposing factors include environmental influences, such as smoking and high alcohol intake. Genetic factors have also been implicated because this disease occurs more commonly among people with type A blood than among those with type O; similarly, it's more common in people with a family history of gastric cancer. Dietary factors also seem related, including types of food preparation, physical properties of some foods, and certain methods of food preservation (especially smoking, pickling, or salting). There's a strong correlation between infection with Helicobacter pylori and distal gastric cancer. Gastric cancer is common throughout the world and affects all races; however, unexplained geographic and cultural differences in incidence occur — for example, a higher mortality in Japan, Iceland, Chile, and Austria. In the United States, during the past 25 years, incidence has decreased by 50% and the resulting death rate is one-third what it was 30 years ago. Incidence is higher in males older than 40. Hispanic, Native, and African Americans are twice as likely to develop gastric cancer than Whites. The prognosis depends on the stage of the disease at the time of diagnosis; however, the overall 5-year survival rate is approximately 19%. The decrease in gastric cancer in the United States has been attributed, without proof, to the balanced American diet and to refrigeration, which reduces nitrate-producing bacteria in food.
Diagnosis
* Colorectal Cancer Tests * Fecal Occult Bleeding Tests
Treatment
In many cases, surgery is the treatment of choice. Excision of the lesion with appropriate margins is possible in over one-third of patients. Even in patients whose disease isn't considered surgically curable, resection offers palliation and improves potential benefits from chemotherapy and radiation. The nature and extent of the lesion determine what kind of surgery is most appropriate. Common surgical procedures include subtotal gastric resection (subtotal gastrectomy) and total gastric resection (total gastrectomy). When carcinoma involves the pylorus and antrum, gastric resection removes the lower stomach and duodenum (gastrojejunostomy or Billroth II). If metastasis has occurred, the omentum and spleen may also have to be removed. If gastric cancer has spread to the liver, peritoneum, or lymph glands, palliative surgery may include gastrostomy, jejunostomy, or a gastric or partial gastric resection. Such surgery may temporarily relieve vomiting, nausea, pain, and dysphagia, while allowing enteral nutrition to continue. Chemotherapy for GI cancers may help to control symptoms and prolong survival. Adenocarcinoma of the stomach has responded to several agents, including fluorouracil, paclitaxel, doxorubicin, cisplatin, methotrexate, and mitomycin. Antiemetics can control nausea, which increases as the cancer advances. In the more advanced stages, sedatives and tranquilizers may be necessary to control overwhelming anxiety. Opioids are commonly necessary to relieve severe and unremitting pain. Radiation has been particularly useful when combined with chemotherapy in patients who have unresectable or partially resectable disease. It should be given on an empty stomach and shouldn't be used preoperatively because it may damage viscera and impede healing. Treatment with antispasmodics and antacids may help relieve GI distress.