Gastric Adenocarcinoma

Gastric carcinoma is the most common cancer in the world after lung cancer and is a major cause of mortality and morbidity. Only about five percent of all cases of the disease are lymphomas, carcinoids, squamous cell carcinomas, leiomyosarcomas, or other types of cancer. In previous studies, we have shown the clinical significance of arg tyrosine kinases in a colorectal cancer progression model. . Each year about 24,000 Americans are diagnosed with stomach cancer. Stomach cancer represents roughly 2% (21,500) cases of all new cancer ceases yearly in the United States, but it is much more common in Japan, Great Britain, South America, and Iceland. It is associated with high salt in th diet, smoking, and low intake of fruits and vegetables Scientists have not yet been able to develop a screening test that is specific for stomach cancer. Consequently, a variety of approaches are generally utilized by medical professionals to establish a diagnosis. However, higher levels of arg kinase immunoreactivity did show a statistically significant association with vessel invasion in gastric cancer tissues examined for most stomach cancer patients is surgery, the only means of possibly fully curing the disease. The specific type of operation that is utilized depends chiefly on the location and the extent of the tissue involved. Early-stage cancers, for instance, are sometimes suitable for endoscopic tumor removal techniques, whereas more advanced cancers may require partial or complete removal of the stomach ( gastrectomy ) as well as removal of nearby lymph nodes. . The death rate is 12,400 a year in the United States.

The pancreas is a rare but occasionally favored target for metastasis. Stomach cancer is unusual in that its incidence in the United States has declined considerably over the last hundred years, whereas many other malignancies have become more prevalent. Metastatic lesions in the pancreas have been described for various primary cancers, such as carcinomas of the lung, the breast, renal cell carcinoma and sarcomas. More than 22,000 new cases will be diagnosed this year in the United States, making gastric cancer the fourteenth most common cancer in this country. Hereditary Diffuse Gastric Cancer (HDGC) has only recently been identified and research is ongoing, For instance, fecal occult blood testing is often used to determine if there is any blood present in the stool, while the lining of the stomach may be examined via an endoscope.- However, higher levels of arg kinase immunoreactivity did show a statistically significant association with vessel invasion in gastric cancer tissues examined. Metastasis occurs in 80-90% of individuals with stomach cancer, with a five year survival rate of 75% in those diagnosed in early stages and less than 30% of those diagnosed in late stages.

Causes of Gastric Adenocarcinoma

The common causes of Gastric Adenocarcinoma :-

• A diet rich in pickled vegetables, salted fish, excessive dietary salt, and smoked meats correlates with an increased incidence of gastric cancer.
• However, the incidence of adenocarcinoma in the high part of the stomach where it connects with the esophagus has increased markedly, along with an increase in cancers of the lower esophagus.
• Retrospective studies demonstrate that a small percentage of patients who undergo gastric polyp removal have evidence of invasive carcinoma within the polyp.

Symptoms of Gastric Adenocarcinoma

• Difficulty swallowing , particularly difficulty that increases over time
• Premature abdominal fullness after meals
• chest and back pain
• Feeling full after a large meal, which is more likely if the cancer is blocking the region where the stomach empties into the intestines
• Pain, which may suggest peptic ulcer

Treatment of Gastric Adenocarcinoma

• Surgery, which involves removing most or all of the stomach and adjacent lymph nodes. In some situations, when a patient's quality of life can be improved, surgery to bypass an obstructing tumor may be done.
• The Dutch Gastric Cancer Trial could not prove the benefit of extended lymph node dissection, although some data suggest its benefit over limited dissection.
• Patients with and without readily measurable tumors each lived a median of 22 weeks.
• Combining chemotheraphy and radiation therapy, especially in gastric lymphoma

Gastric Adenocarcinoma Treatment by Curative Surgical Resection

Surgical resection is the only therapy with curative potential. After preoperative staging, about two-thirds of patients will be found to have localized disease (ie, stages I–III) and should undergo surgical exploration. At surgery, approximately 25% of these patients will be found to have locally unresectable tumors or peritoneal, hepatic, or distant lymph node metastases for which "curative" surgical resection is not warranted (see below). The remaining patients with confirmed localized disease should undergo radical surgical resection with curative intent. For adenocarcinoma localized to the distal two-thirds of the stomach, a subtotal distal gastrectomy should be performed. For proximal gastric cancer or diffusely infiltrating disease, total gastrectomy is necessary. Although lymph node dissection should be performed for curative resections, there has been ongoing debate about whether an extended (perigastric and regional) lymph node dissection or a limited (perigastric) dissection is needed. A recent study has demonstrated greater short-term morbidity and no long-term survival advantage for extended lymph node dissection. Adjuvant therapy following curative resection has not conferred a survival benefit for postoperative radio- or chemotherapy in most studies. One recent US multicenter trial has reported improved postoperative median survival from 27 to 36 months with use of adjuvant radiotherapy, 5-flourouracil, and leucovorin; however, the study has been criticized because many patients did not undergo adequate lymph node dissection.

Gastric Adenocarcinoma Treatment by Palliative Modalities

Many patients will be found either preoperatively or at the time of surgical exploration to have advanced disease that is not amenable to "curative" surgery due to peritoneal or distant metastases or local invasion of other organs. In many of these cases, palliative resection of the tumor nonetheless may be indicated. Such resection removes the risk of bleeding and obstruction, leads to improved quality of life, and improves survival. For patients with unresectable disease, gastrojejunostomy may be indicated to prevent obstruction. Bleeding or obstruction from unresected tumors may be treated with endoscopic laser or stent therapy, radiation therapy, or angiographic embolization. Although chemotherapy has not been shown to prolong life, single-agent or combination therapies with fluorouracil, doxorubicin, and cisplatin or mitomycin may provide palliation in up to 30%.

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