Gastric Cancer

Overview

Gastric cancer remains the 4th most common cancer globally. India sees a significant burden, especially in southern and northeastern states. D2 gastrectomy (with extended lymph node dissection) is the standard surgical treatment. Dr. Bhagat's MCh thesis on nasojejunal feeding in postoperative gastric cancer patients contributes to improving perioperative care.

Causes

• H. pylori infection (strongest risk factor)
• Diet high in smoked/salted/preserved foods
• Smoking
• Genetic factors (CDH1 mutation — hereditary diffuse gastric cancer)
• Previous gastric surgery
• Pernicious anemia
• Gastric polyps

Risk Factors

• H. pylori infection
• Male gender (2:1)
• Age over 50
• Family history
• Blood type A
• Low socioeconomic status
• High salt intake
• Smoking

Symptoms

Diagnosis

• Upper GI endoscopy with multiple biopsies
• CT chest/abdomen/pelvis (staging)
• Endoscopic ultrasound (T/N staging)
• PET-CT (distant metastasis)
• Diagnostic laparoscopy with peritoneal washings
• Tumor markers (CEA, CA 19-9)

Treatment Options

Surgical Treatment

Recovery

Subtotal gastrectomy: 6-8 days hospital stay. Total gastrectomy: 8-10 days. Jejunostomy feeding initially, oral diet progression over 2-3 weeks. Small frequent meals. B12 supplementation after total gastrectomy. Adjuvant chemotherapy begins 4-6 weeks post-surgery.

Prevention

• Test and treat H. pylori
• Reduce salt and preserved food intake
• High fruit and vegetable diet
• Quit smoking
• Surveillance for high-risk families
• Endoscopy for persistent dyspepsia in patients over 40

Frequently Asked Questions