Definition and Symptoms
Gastric cancer is one of the major malignant tumours of the digestive system. Histopathologically, adenocarcinoma (95%) is the most common type and it is usually localised in the antrum (45%) and corpus (32%). It is approximately 2 times more common in men than in women and is particularly prevalent in the 50-70 age group. In the early stages, non-specific symptoms such as a feeling of fullness after meals, loss of appetite, chronic dyspepsia and epigastric pain may occur. In advanced stages, more severe symptoms such as significant weight loss, dysphagia, severe satiety and vomiting may occur.
Risk Factors and Diagnosis
The most important risk factor is H. pylori infection, which is the primary etiological factor in most cases. CagA-positive strains significantly increase the risk. Precancerous lesions such as chronic atrophic gastritis and intestinal metaplasia require close monitoring. Other important risk factors are excessive smoking, high salt intake and family history. According to the Lauren classification, it is examined in three main groups: intestinal type, diffuse type and mixed type. Upper gastrointestinal endoscopy and multiple biopsies are required for diagnosis. Dynamic contrast-enhanced CT, PET-CT and, if necessary, diagnostic laparoscopy are used for staging.
Surgical Treatment Methods
According to the current JGCA guidelines, the treatment approach is determined according to the stage. In early-stage tumours, endoscopic submucosal dissection or laparoscopic subtotal gastrectomy are preferred. In advanced stages, total gastrectomy and D2 lymph node dissection is the standard approach. Neoadjuvant chemotherapy increases the chance of R0 resection in advanced tumours. The laparoscopic approach provides a shorter hospital stay compared to open surgery. The most common complications are anastomotic leakage, pneumonia and wound infections. Most patients return to normal life within 6 weeks. Survival rates vary by stage; it is over 90% in Stage I, but dramatically decreases in Stage IV.