Gastric Cancer for the NP Exam
Gastric Cancer for the Nurse Practitioner Licensing Exam
- Epidemiology:
- Gastric cancer accounts for significant cancer mortality worldwide, particularly in East Asia.
- It primarily affects males over 50 years of age and is commonly diagnosed at advanced stages.
- Risk Factors:
- Helicobacter pylori infection: Strongly linked to gastric cancer development due to chronic inflammation.
- Dietary factors: High consumption of salted, smoked, and nitrate-rich foods increases risk.
- Smoking, alcohol use, and family history of gastric cancer contribute to higher incidence.
- Medical conditions: Chronic gastritis, gastric ulcers, and pernicious anemia increase risk.
- Pathophysiology:
- Gastric adenocarcinoma is the most common form, with two main types:
- Intestinal type: Associated with chronic inflammation and tends to be less aggressive.
- Diffuse type: Characterized by poorly cohesive cells (e.g., signet ring cells), often more aggressive and linked to genetic mutations (e.g., CDH1).
- Clinical Presentation:
- Symptoms are often vague, delaying diagnosis:
- Weight loss, abdominal pain, nausea, and early satiety are common complaints.
- Advanced cases may present with hematemesis, melena, or signs of metastasis (e.g., Virchow’s node).
- Paraneoplastic syndromes like acanthosis nigricans may be present.
- Diagnosis:
- Upper endoscopy with biopsy confirms the diagnosis.
- CT scan or endoscopic ultrasound (EUS) assists in staging, evaluating local invasion, and identifying metastases.
- Treatment:
- Surgical resection (subtotal or total gastrectomy) is the primary treatment for localized disease.
- Chemotherapy is used pre- and postoperatively in advanced cases.
- For metastatic cancer, palliative chemotherapy aims to improve quality of life.
Key Points
- H. pylori infection and a diet rich in salted or smoked foods are major risk factors.
- Gastric adenocarcinoma is the most common form, presenting with nonspecific symptoms like weight loss and early satiety.
- Upper endoscopy with biopsy is the diagnostic gold standard, while surgery is the primary treatment for localized disease.
- Chemotherapy plays a role in both adjuvant and palliative settings, particularly in advanced or metastatic disease.