Gastric Carcinoma – Causes, Symptoms & Treatment

What is Gastric Carcinoma?

Gastric carcinoma is a malignant tumor that originates from the cells lining the stomach wall. In the vast majority of cases, it is an adenocarcinoma, meaning it develops from glandular cells of the stomach mucosa. Gastric carcinoma is among the most common cancers worldwide and remains one of the leading causes of cancer-related death globally. Men are affected more frequently than women, and the disease is most commonly diagnosed in people over the age of 50.

Causes and Risk Factors

The development of gastric carcinoma is usually multifactorial, involving a combination of environmental, lifestyle, and genetic factors. Key risk factors include:

• Helicobacter pylori infection: This bacterial infection is the most significant risk factor. Chronic infection leads to inflammation of the stomach lining, which can progress to precancerous changes over time.
• Dietary habits: Frequent consumption of heavily salted, smoked, or pickled foods is associated with increased risk.
• Smoking and alcohol: Both increase the likelihood of developing stomach cancer.
• Family history: Having a first-degree relative with gastric cancer raises personal risk.
• Chronic stomach conditions: These include atrophic gastritis, peptic ulcers, and certain types of gastric polyps.
• Genetic factors: Mutations in genes such as CDH1 are linked to hereditary diffuse gastric cancer syndrome.

Symptoms

In the early stages, gastric carcinoma often causes no or only nonspecific symptoms, which makes early detection challenging. Common symptoms include:

• Persistent upper abdominal pain or pressure
• Unintentional weight loss
• Loss of appetite and early satiety
• Nausea and vomiting, sometimes with blood
• Black, tarry stools (melena) indicating gastrointestinal bleeding
• Difficulty swallowing (especially with tumors near the gastroesophageal junction)
• Persistent fatigue and pallor due to anemia

Since these symptoms can also occur with benign conditions, medical evaluation is strongly recommended if complaints persist.

Diagnosis

The primary diagnostic tool for gastric carcinoma is upper endoscopy (gastroscopy), in which a thin, flexible camera is passed through the mouth into the stomach to directly visualize the mucosa. Suspicious lesions can be sampled via biopsy and analyzed in a laboratory to confirm malignancy.

Additional diagnostic procedures include:

• Computed Tomography (CT scan): Used to assess tumor extent and detect potential metastases in lymph nodes or distant organs.
• Endoscopic ultrasound (EUS): Evaluates the depth of tumor invasion into the stomach wall and nearby lymph nodes.
• PET-CT: May be used in selected cases to identify distant metastases.
• Laboratory tests: Tumor markers such as CEA and CA 72-4 can provide supportive information.

Treatment

Surgery

Surgical removal of the tumor remains the only potentially curative treatment. Depending on the location and extent of the tumor, either a partial stomach resection or a complete removal of the stomach (total gastrectomy) is performed, typically including surrounding lymph nodes.

Chemotherapy

Chemotherapy is commonly used before surgery (neoadjuvant) to shrink the tumor, and after surgery (adjuvant) to eliminate any remaining cancer cells. Common agents include epirubicin, cisplatin, oxaliplatin, and fluorouracil.

Targeted Therapy and Immunotherapy

For tumors with specific molecular characteristics, targeted therapies may be used. For example, the monoclonal antibody trastuzumab is effective in HER2-positive gastric cancers. Immune checkpoint inhibitors such as nivolumab and pembrolizumab are increasingly used in advanced stages of the disease.

Radiation Therapy

Radiation therapy plays a limited role in the treatment of gastric carcinoma but may be used in selected cases to relieve symptoms in advanced disease.

Prognosis

The prognosis of gastric carcinoma depends strongly on the stage at the time of diagnosis. When detected early, outcomes can be favorable. However, because most cases are diagnosed at an advanced stage, the overall 5-year survival rate is approximately 30 to 35 percent in Western countries, with significant variation depending on disease stage and treatment response.

Prevention

The following measures can help reduce the risk of developing gastric carcinoma:

• Eradication of confirmed Helicobacter pylori infection with antibiotic therapy
• A healthy, balanced diet rich in fruits and vegetables
• Reducing consumption of smoked, pickled, and heavily salted foods
• Avoiding smoking and excessive alcohol consumption
• Regular medical surveillance in individuals with a family history of gastric cancer

References

1. Lordick F. et al. - Gastric Cancer: Clinical Practice Guideline of the German Society for Gastroenterology (DGVS), updated edition 2019/2022.
2. World Health Organization (WHO) - Global Cancer Observatory: Stomach Cancer Fact Sheet (2020). Available at: https://gco.iarc.fr
3. Ajani J. A. et al. - Gastric Cancer, Version 2.2022 - NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 2022.