History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include pernicious anaemia, Helicobacter pylori, and exposure to N-nitroso compounds.

abdominal pain

Tends to be epigastric and vague in early-stage disease.

weight loss

Weight loss is one of the most common presenting symptoms in patients with gastric cancer.[3]

uncommon

lymphadenopathy

Presence of left supraclavicular node (Virchow's node), periumbilical nodule (Sister Mary Joseph's nodule), or left axillary node (Irish node).

Other diagnostic factors

common

age 50-70 years

Peak incidence of gastric cancer occurs between ages 50 and 70 years.[43]

male sex (later-onset gastric cancer)

Men are more likely to have later-onset gastric cancer than women.​​​​​​[5][6]

female sex (early-onset gastric cancer)

While gastric cancer generally shows a higher prevalence in men compared with women, the reverse is true for early-onset gastric cancer, where women are more affected.[6]

smoking

One meta-analysis of 40 studies estimated that the risk of gastric cancer increased by approximately 1.5- to 1.6-fold in those who smoked tobacco, and was higher in men who smoked compared to women who smoked.[31]

family history

It is estimated that 1% to 3% of cases are familial.​​​[32][33]

uncommon

nausea

Some patients experience nausea.

dysphagia

More common in proximal and gastro-oesophageal junction tumours.

Risk factors

strong

Helicobacter pylori

Multiple studies have demonstrated an association between H pylori and gastric cancer.[16][17][18][19][20][21]​​​ The bacteria cause inflammation, which can result in atrophy, metaplasia, and carcinoma.

pernicious anaemia

A 2- to 3-fold excess risk of gastric cancer has been noted in patients with pernicious anaemia.[24]

immigration from high-incidence regions

Immigrants from high incidence regions have higher risks of incidence of and mortality from gastric cancer.[6][8][9][10][11]​​​

foods containing N-nitroso compounds

N-nitroso compounds are generated after consumption of nitrates. These are naturally found in vegetables and are used as a food additive in several cured meats. Oral bacteria can convert nitrate to nitrite, which can react with an amino compound to form N-nitroso compounds. An increase in gastric nitrite has been observed in patients with pre-cancerous gastric lesions.[25]

male sex (later-onset gastric cancer)

Men are more likely to have later-onset gastric cancer than women.[5][6]

female sex (early-onset gastric cancer)

While gastric cancer generally shows a higher prevalence in men compared with women, the reverse is true for early-onset gastric cancer, where women are more affected.[6]

weak

diet low in fruits and vegetables

Diets low in fruits and vegetables have been associated with an increased risk of stomach cancer. A high vitamin C content, found in certain fruits and vegetables, is thought to reduce the formation of N-nitroso compounds.[25]

high-salt diet

Multiple studies have reported that high salt intake increases the risk of stomach cancer.[15][28][29][30]

smoking

One meta-analysis of 40 studies estimated that the risk of gastric cancer increased by approximately 1.5- to 1.6-fold in those who smoked tobacco, and was higher in men who smoked compared with women who smoked.[31]

family history

It is estimated that 1% to 3% of gastric cancers are familial.[32]​ E-cadherin mutation has been linked to 25% of these cases, with an autosomal dominant predisposition to diffuse-type gastric cancer.[33]

Use of this content is subject to our disclaimer