Gastric Cancer is more common in Eastern Asia

Gastric Cancer is a malignant epithelial tumor of the stomach, most commonly adenocarcinoma. It remains one of the leading causes of cancer related death worldwide especially in Eastern Asia, Europe and South America. 

Although the incidence has declined due to improve food preservation and decreased rate of Helicobacter pylori infection rates. But still it is present as a major health problem in worldwide because most cases diagnosed in an advanced stage. Early detection significantly improves prognosis but late diagnosis and aggressive biological behavior make gastric Cancer a major clinical and public health challenge globally. 

Risk factor of Gastric Cancer 

There are many risk factors of Gastric Cancer. Those are: 

1. Infection: Helicobacterpylori is the most important modifiable risk for gastric cancer. 

2. Dietary Factor: Smoked (Barbeque), pickled and salted foods are risk factor for gastric cancer. Moreover, low intake of fruits and vegetables are also the high risk for this cancer.

3. Lifestyle: Smoking and Alcohol are the factor for gastric cancer.

4. Genetic: CDH1 gene mutation is the high risk for gastric cancer. Those who have Lynch syndrome, has the high possibility for gastric cancer.

5. Previous Surgery: Those who have partial gastrectomy more than 15 years.

Types

1. Intestinal Type: It is gland forming tumor. It is associated with H. pylori and gastritis. Solid mass may be found in upper abdomen. It occurs in older age.

2. Diffuse Type: It is signet ring cell type tumor. It occurs in younger age due to gene mutation. It causes in leather bottle stomach.

Clinical Feature: 

Early signs are often asymptomatic. There are some symptoms which maybe help in diagnosis:

• Mild epigastric discomfort 

• Dyspepsia 

• Nausea and Vomiting 

• Early satiety 

In advanced stages

• Weight loss

• Persistent vomiting

• Anorexia 

• Dysphagia 

• Hematemesis or melena 

• Anemia

Diagnosis 

It is not detected in early stage. It detected and confirmed in late stage. There are many tests we can detect this cancer. 

1. Complete Blood Count: In this test, we can see the Red Blood Cell (RBC) count is decreased. It is probable diagnosis.

2. Liver Function Test: To see the liver has been metastasis or not.

3. Upper Gastrointestinal Endoscopy and Biopsy: It is gold standard for diagnosis the gastric cancer. It is confirmatory test for this disease.

4. Computed Tomography: To see the staging of the cancer.

5. Tumor Marker: CEA and CA19-9 may assist in monitoring the progression of gastric cancer.

Treatment 

Treatment strategies depends on the stage of the cancer. Early stage gastric cancer can be effective managed with endoscopic techniques such as endoscopic mucosal resection or endoscopic submucosal dissection. For resectable tumor, surgical intervention either subtotal or total gastrectomy with D2 lymphadenectomy remains cornerstone of curative treatment. In advanced stages require systemic chemotherapy, with regimens like FLOT, FOLFOX and ECF commonly used. Targeted therapies including trastuzumab for HER2 positive tumor and immunotherapy agents such as pembrolizumab for PD-L1 expressing cancer. 

Epidemiology

Gastric cancer remains a significant global health burden despite declining incidence in many regions. It is currently the 5^th most common cancer worldwide and 4^th leading cause of cancer related deaths, mainly because most patient at advanced stage. High incidence occurs in East Asia (Japan, South Korea and China), Eastern Europe, Central and South America. Sometimes, cases are also found in North America, North Europe and Africa. The striking geographical variation is strongly linked to difference in Helicobacter pylori prevalence, dietary patterns and socio-economic conditions. Most cases of gastric cancer are diagnosed in older age (More than 50 years age). However, the diffuse type of gastric cancer especially associated with CDH1 gene mutation which may appear in younger age.

Survival outcomes vary widely by region and are closely correlated with early detection. East Asia (Japan and South Korea) have population-based screening program for gastric carcinoma. It gives excellent result in survival rates and diagnosed early detection.

Bangladesh is also detected the gastric cancer. According to the Cancer Journal Bangladesh, gastric cancer represents frequent cases of gastric cancer. Not only that, in a recent study, 120 gastric cancer patients have been admitted in Bangladesh Medical University. Most of them are males and more than 50 years of age. In a pathology study conducted by Delta Medical College and Hospital, 636 samples found of gastric cancer out of 1538. So, Bangladesh is also high risk of gastric cancer. 

Conclusion

Gastric cancer is a public health problem of the worldwide. Bangladesh is not excluded also. So, we have to aware the disease nor it will be epidemic for the Bangladesh. It can be preventable and treatable when during early detection. We need to strengthen public health measures, improving awareness and expanding the early diagnosis and treatment facilities. It will reduce the morbidity and mortality of gastric cancer. 

Name: S. M. M. MUSABBIR UDDIN

UMC 07

Session: 2020-21

UNIVERSAL MEDICAL COLLEGE