Causes and risk factors
It has been shown that 10% of people with chronic atrophic gastritis develop gastric carcinoma 9-26 years after diagnosis. As chronic Helicobacter pylori gastritis can develop into mucosal atrophy over the years, it has been hypothesised that this infection is a predisposing factor in the development of gastric cancer. In fact, only a very small percentage of patients with chronic atrophic gastritis and Helicobacter pylori infection develop cancer. Therefore, Helicobacter pylori should be considered as only one risk factor, because this type of neoplasm is the result of the combined action of many different factors, not all of which are known. At present, gastric cancer is one of the five most common malignancies of the gastrointestinal tract. However, there is a decreasing trend in Italy.
Which are the symptoms?
Symptoms depend on the stage of the disease. In early cases there may be no symptoms, or dyspepsia may be present. In advanced cases there may be epigastric pain, alimentary vomiting, weight loss, melena (blackish stools), positive faecal occlusive blood and anaemia. Metastases (localisation of the disease in places other than the stomach, due to the spread of tumour cells), mainly in the liver, may be present.
How is it diagnosed?
Diagnosis is made by esophagogastroduodenoscopy or radiological examination of the upper digestive tract. Metastases are detected by ultrasound or computed axial tomography (CT).
How is it treated?
- Radical surgery: partial or complete removal of the stomach, with removal of the satellite lymph nodes, in the absence of metastases.
- Palliative surgery: removal of the tumour mass in the presence of metastases; performed only in cases of severe bleeding or complete obstruction of the stomach, when it is impossible to feed, and does not alter the course of the disease.
- Endoscopic palliation: performed as an alternative to surgery, by endoscopic insertion of a self-expanding endoprosthesis or laser treatment, in case of pyloric obstruction, to allow the patient to eat.
- Chemotherapy: carried out with cycles of drugs, either after surgery to prevent recurrence of the neoplasm and the appearance of metastases (adjuvant chemotherapy) or in preparation for surgery (adjuvant chemotherapy).