Spectrum of Manifestations of Carcinoma Stomach: An Institutional Evaluation

INTRODUCTION: Despite a major decline in incidence and mortality over several decades, stomach cancer is still the fourth most common cancer and the second most common cause of cancer death in the world. There is a 10-fold variation in incidence between populations at the highest and lowest risk. The incidence is particularly high in East Asia, Eastern Europe, and parts of Central and South America, and it is about twice as high among men than among women. Prognosis is generally rather poor, with 5-year relative survival below 30% in most countries. AIM OF THE STUDY: 1. To study the epidemiology of cancer stomach. 2. To assess the influence of risk factors in the causation of cancer stomach. 3. To correlate the clinical features of cancer stomach with the site of lesion. 4. To assess the commonest anatomical site of lesion in cancer stomach. 5. To assess the incidence of operability of tumour at the time of presentation. 6. To assess the role of CECT in staging the cancer stomach. MATERIALS AND METHODS: Patients included in the study were recruited from the Department of Digestive Health and Diseases, Government Peripheral hospital, Anna Nagar, Chennai. The study period was from January 2008 to December 2009. Consecutive patients diagnosed to have cancer stomach were included in the study group. Only biopsy proven adenocarcinomas, were included in the study. A detailed proforma was compiled for the patients with cancer stomach. A detailed history about dietary habits, social habits such as smoking, alcohol, previous gastric surgery, previous history of gastric ulcer and family history of gastric cancer were recorded. Clinical history about dyspepsia, pain abdomen, anorexia and weight loss, vomiting, dysphagia and upper GI bleed were obtained and thorough clinical examination was done. Body mass index was calculated for all. Appropriate investigations such as haemoglobin, erythrocyte sedimentation rate, X ray chest, U G I Scopy & biopsy and CECT scan of the upper abdomen were done. Histopathological grading was done by the pathologist. Treatment was individualized according to the stage of the disease during presentation. STATISTICAL ANALYSIS: The statistical analysis of the data was done using SSPS 11. ‘ p’ value of < 0.05 was considered to be statistically significant. The p value was calculated using chi square test. Percentage calculation and cross analysis were done to identify significant data. RESULTS: During the study period of two years, a total number 12800 patients attended OPD. Endoscopy was performed for 5842 cases (31%). Among those, biopsy proven adenocarcinomas was 172. This accounts to 3% of total endoscopy and 1% of total OPD cases. Of these 172 cases, males were 72% and females 28% constituting a ratio of 3 : 1. The incidence of cancer stomach in patients below the age of 40 years was 13.95%. It slowly increased and reached a maximum in the 5th decade and then slowly declined. The incidence was 13.3% in patients above the age of 70. The mean age of the patient was 55.76. The minimum age was 28yrs and the maximum age was 77 years. Most of them were from places in & around Chennai (88%). Many of them were farmers and labourers. About 80% of the female patients were housewives. Majority of the patients were Hindus (89.5%), followed by Muslims (6%) and Christians (4.5%). CONCLUSION: Mean age of the patients with cancer stomach is 56 years. • Males outnumbered female cases probably due to increased smoking and alcohol consumption. • People with Low intake of vegetables and fruits and those who had no refrigerators lead to a higher risk of developing cancer stomach in both sexes. • Past history of gastric surgery still continues to be a risk factor. And gastric ulcer is not a significant risk factor. • Pain abdomen is the commonest presenting symptom. • Significant number of patients with Ball Rolling Movement were found to be operable in the pre-operative evaluation. • Dysphagia and vomiting immediately after taking food along with loss of appetite commonly present as OG Junction growth. • Cutaneous markers of intra abdominal malignancy are extremely rare. • Antral growth is more common than OG Junction growth. • Antral growth presents earlier and more amenable to surgery compared to OG Junction and diffuse gastric cancer. • Blood group “A” is a significant risk factor for cancer stomach particularly for diffuse gastric cancer and OG Junction growth. • CT Scan is a valuable modality of investigation preoperative evaluation. • Two thirds of patients were found to be inoperable during the time of diagnosis and hence underwent only palliative treatment