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Gastric Cancer: Risk Factors, Diagnosis, and Treatment
Risk Factors
- Helicobacter pylori infection: Chronic
infection with the Helicobacter pylori bacteria (the same
bacteria that contributes to peptic ulcers) is a strong risk factor
for gastric cancer. Some studies suggest that these bacteria may
be responsible for up to 90 percent of gastric cancers.
- Age: The disease is rare before age 40, but
the incidence increases steadily thereafter.
- Genetics: A positive family history and blood
type A are associated with an increased risk. It is unclear if
there are specific genes that increase or decrease the risk.
- Gender: Males have twice the risk, compared
with females.
- Diet: High dietary intake of salted, smoked,
and pickled foods is known to increase risk. Higher intake of fruits
and vegetables lower the risk.
- Alcohol and tobacco use: Alcohol and tobacco
use are thought to increase the risk, but there is not yet conclusive
evidence for their roles.
- Diseases of the stomach: A history of chronic
gastritis, pernicious anemia, or partial gastrectomy increases
the risk.
Diagnosis
- A thorough history and physical examination are the first steps
of the evaluation for gastric cancer.
- The best test for diagnosis is endoscopy with biopsy. After administration
of anesthesia, a small fiberoptic cable is slowly placed down the
throat into the stomach. This allows for direct visualization of
the stomach walls and biopsy of the suspected tumor.
- A commonly used test, called an upper GI series with barium swallow,
involves a series of X–rays to evaluate the stomach and upper intestines.
Before the test, patients must drink a small amount of a contrast
agent to improve the accuracy of the X–ray pictures.
- In some cases, a CT scan or other testing may be necessary.
Treatment
- Surgery to remove the tumor is essential for cure. In the early
stages of the disease, surgery has a good success rate. Unfortunately,
most tumors are already advanced at diagnosis and cannot be completely
removed.
In some cases, a part of the stomach is removed (partial gastrectomy).
In others, the entire stomach must be removed (gastrectomy). In
still others, nearby organs must also be removed.
- Chemotherapy or radiation may be used in patients with severe
symptoms, but they will not cure the disease.
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