Gastric Cancer

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -Nick Goulooze & Corey Malone from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Definition
Stomach cancer (also known as gastric cancer) is a disease in which the cells forming the inner lining of the stomach become abnormal and start to divide uncontrollably, forming a mass called a tumor. (http://medical-dictionary.thefreedictionary.com/stomach+cancer)

Prevalence

Estimated new cases and deaths from stomach cancer in the United States in 2012:

New cases: 21,320
Deaths: 10,540
(http://cancer.gov/cancertopics/types/stomach)

Characteristics/Clinical Presentation

In the United States, about 25% of stomach cancer patients present with localized disease, 31% present with regional disease, and 32% present with distant metastatic disease; the remainder of cases surveyed were listed as unstaged.

Early disease has no associated symptoms; however, some patients with incidental complaints are diagnosed with early gastric cancer. Most symptoms of gastric cancer reflect advanced disease. Patients may complain of indigestion, nausea or vomiting, dysphagia, postprandial fullness, loss of appetite, melena, hematemesis, and weight loss.

Late complications include pathologic peritoneal and pleural effusions; obstruction of the gastric outlet, gastroesophageal junction, or small bowel; bleeding in the stomach from esophageal varices or at the anastomosis after surgery; intrahepatic jaundice caused by hepatomegaly; extrahepatic jaundice; and inanition resulting from starvation or cachexia of tumor origin.

All physical signs are late events. By the time they develop, the disease is almost invariably too far advanced for curative procedures.

Signs may include a palpable enlarged stomach with succussion splash; hepatomegaly; periumbilical metastasis (Sister Mary Joseph nodule); and enlarged lymph nodes such as Virchow nodes (ie, left supraclavicular) and Irish node (anterior axillary). Blumer shelf (ie, shelflike tumor of the anterior rectal wall) may also be present. Some patients experience weight loss, and others may present with melena or pallor from anemia.

Paraneoplastic syndromes such as dermatomyositis, acanthosis nigricans, and circinate erythemas are poor prognostic features.

Other associated abnormalities also include peripheral thrombophlebitis and microangiopathic hemolytic anemia.

http://emedicine.medscape.com/article/278744-clinical#a0217

Associated Co-morbidities

http://wjso.com/content/pdf/1477-7819-5-81.pdf

Medications

Drugs Approved for Stomach (Gastric) Cancer

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for stomach (gastric) cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries. There may be drugs used in stomach (gastric) cancer that are not listed here.

Adriamycin PFS (Doxorubicin Hydrochloride)
Adriamycin RDF (Doxorubicin Hydrochloride)
Adrucil (Fluorouracil)
Docetaxel
Doxorubicin Hydrochloride
Efudex (Fluorouracil)
Fluoroplex (Fluorouracil)
Fluorouracil
Herceptin (Trastuzumab)
Mitomycin C
Mitozytrex (Mitomycin C)
Mutamycin (Mitomycin C)
Taxotere (Docetaxel)
Trastuzumab

http://www.cancer.gov/cancertopics/druginfo/stomachcancer

Targeted drugs
Targeted therapy uses drugs that attack specific abnormalities within cancer cells. Targeted drugs are used to treat a rare form of stomach cancer called gastrointestinal stromal tumor. Targeted drugs used to treat this cancer include imatinib (Gleevec) and sunitinib (Sutent).

http://www.mayoclinic.com/health/stomach-cancer/DS00301/DSECTION=treatments-and-drugs

Xeloda

http://www.drugs.com/condition/stomach-cancer.html

Diagnostic Tests/Lab Tests/Lab Values

Tests and procedures used to diagnose stomach cancer include:

A tiny camera to see inside your stomach (upper endoscopy). A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy).
Imaging tests. Imaging tests used to look for stomach cancer include computerized tomography (CT) and a special type of X-ray exam sometimes called a barium swallow.
Determining the extent (stage) of stomach cancer
The stage of your stomach cancer helps your doctor decide which treatments may be best for you. Tests and procedures used to determine the stage of cancer include:

Imaging tests. Tests may include CT, positron emission tomography (PET) and magnetic resonance imaging (MRI).
Exploratory surgery. Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach within your abdomen. Exploratory surgery is usually done laparoscopically. This means the surgeon makes several small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.
Other staging tests may be used, depending on your situation.

Stages of stomach cancer
The stages of adenocarcinoma stomach cancer include:

Stage I. At this stage, the tumor is limited to the layer of tissue that lines the inside of the stomach. Cancer cells may also have spread to a limited number of nearby lymph nodes.
Stage II. The cancer at this stage has spread deeper, growing into the muscle layer of the stomach wall. Cancer may also have spread to more of the lymph nodes.
Stage III. At this stage, the cancer may have grown through all the layers of the stomach. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
Stage IV. This stage of cancer extends beyond the stomach, growing into nearby structures. Or it is a smaller cancer that has spread to distant areas of the body.

http://www.mayoclinic.com/health/stomach-cancer/DS00301/DSECTION=tests-and-diagnosis

Etiology/Causes

Doctors aren't sure what causes stomach cancer. There is a strong correlation between a diet high in smoked, salted and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

Types of stomach cancer
The cells that form the tumor determine the type of stomach cancer. The type of cells in your stomach cancer helps determine your treatment options. Types of stomach cancer include:

Cancer that begins in the glandular cells (adenocarcinoma). The glandular cells that line the inside of the stomach secrete a protective layer of mucus to shield the lining of the stomach from the acidic digestive juices. Adenocarcinoma accounts for the great majority of all stomach cancers.
Cancer that begins in immune system cells (lymphoma). The walls of the stomach contain a small number of immune system cells that can develop cancer. Lymphoma in the stomach is rare.
Cancer that begins in hormone-producing cells (carcinoid cancer). Hormone-producing cells can develop carcinoid cancer. Carcinoid cancer in the stomach is rare.
Cancer that begins in nervous system tissues. A gastrointestinal stromal tumor (GIST) begins in specific nervous system cells found in your stomach. GIST is a rare form of stomach cancer.
Because the other types of stomach cancer are rare, when people use the term "stomach cancer" they generally are referring to adenocarcinoma.
http://www.mayoclinic.com/health/stomach-cancer/DS00301/DSECTION=causes

Systemic Involvement

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Medical Management (current best evidence)

http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=847a47b5-19ea-4271-87dc-4237732cbddf%40sessionmgr113&vid=5&hid=108

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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