Oxford Handbook of Gastroenterology & Hepatology by Stuart Bloom;George Webster;Daniel Marks;

Author:Stuart Bloom;George Webster;Daniel Marks; [Marks;, Stuart Bloom;George Webster;Daniel]
Language: eng
Format: epub
ISBN: 9780198734956
Publisher: OxfordUP
Published: 2022-09-15T00:00:00+00:00

Clinical features

Usually presents late, with epigastric discomfort, weight loss, anorexia, nausea, early satiety, upper GI bleeding, or symptoms of anaemia. Symptoms may be indistinguishable from …… peptic ulceration. Vomiting may relate to pyloric obstruction, and tumour bulk may give early satiety. On examination, palpable epigastric mass may be found.

Investigation

• Blood results non-specific (no reliable tumour markers), but iron-deficiency anaemia may be present.

• Upper GI endoscopy most useful diagnostic tool. Tumour may have appearance of benign gastric ulcer (repeat endoscopy and biopsies until resolution of even ‘benign-looking’ gastric ulcers is essential), polypoid mass, or diffuse gastric wall involvement.

• CT scanning is the main imaging modality for assessing local and distant spread, and surgical resectability.

• EUS allows determination of depth of invasion with 80% accuracy. Gastric cancers usually staged according to TNM classification (see …… tumour staging); >90% accurate at distinguishing between stage T1 and T2, so is the best modality for distinguishing early from advanced cancer. EUS required as adjunct to CT in only a minority of cases. May be limited by stricturing disease, and operator dependent.

• PET has increasing role in detecting lymph node metastases.

• Combined imaging of CT, EUS, and PET-CT provides highest yield for identifying nodal involvement.

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