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SURGICAL: Stomach, Esophageal, and Duodenal Procedures, Age > 17 with CC

GGastric cancer is a relatively uncommon malignancy, accounting for approximately 2% of all cancers in the United States. It is estimated that almost 22,000 new cases of gastric cancer will be diagnosed in 2005, and that 11,550 will die from this disease. Gastric cancer is, however, more common in certain areas of the world including Japan, Chile, Costa Rica, Hungary, and Poland, and it is considered a major cause of cancer deaths worldwide.

Nearly 95% of gastric neoplasms are classified as adenocarcinomas; these tumors develop from the epithelial cells that form the innermost lining of the stomach's mucosa. The most common sites for cancer in the stomach include the antrum, the pylorus, and along the area of lesser curvature. According to the Lauren classification, gastric adenocarcinomas are divided into two main histologic types: diffuse and intestinal. The diffuse type is ill-defined, infiltrates the gastric wall, and lacks a distinctive mass. The intestinal type, by contrast, is composed of neoplastic cells that cluster together, resembling glands; it is associated with a better prognosis, as are tumors along the area of lesser curvature. A poor prognosis is associated with tumors of the cardia or the fundus.

Metastasis occurs via the lymphatics and the blood vessels by seeding of peritoneal surfaces or by direct extension of the tumor. Sites of metastasis are the liver, lungs, bone, adrenals, brain, ovaries, colon, and pancreas. Intestinal tumors are more likely to spread to the liver, whereas diffuse-type tumors are more likely to spread along peritoneal surfaces. Other complications include malnutrition, gastrointestinal (GI) obstruction, and iron deficiency anemia.

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