Oncology
Gastric Cancer
위암
Gastric mucosal adenocarcinoma (mostly), H. pylori is key risk factor
- How common
- Common in Korea (male 4th, female 5th)
- Typical age
- Ages 50–70
What is it?
Chronic H. pylori infection drives atrophic gastritis → intestinal metaplasia → dysplasia → adenocarcinoma (Correa cascade).
Commonly affected: Stomach (antrum 60%, body, cardia). Peritoneum, liver, left supraclavicular node (Virchow)
How it develops
- Chronic H. pyloriCauses chronic gastric mucosal inflammation
- Atrophic gastritis & intestinal metaplasiaNormal mucosa replaced by intestinal-type epithelium
- Dysplasia & intramucosal carcinomaCDH1 mutation, p53 changes drive dysplasia
- Invasion & peritoneal/liver metsPeritoneal seeding (Krukenberg), nodal/liver mets
Symptoms
- Early satiety/anorexiaFull after small meals
- Weight lossCommon sign of advanced disease
- Melena/anemiaChronic bleeding causes IDA
- Virchow nodeHard left supraclavicular lymph node
- Epigastric pain/dyspepsiaDull pain unrelated to meals
How it is examined
- Abdominal examEpigastric tenderness, mass, hepatomegaly
- Lymph node evaluationVirchow (left SCV), Sister Mary Joseph (umbilical)
- Ascites/pelvic examBlumer shelf (rectal mass), Krukenberg tumor
Imaging
Upper GI series: linitis plastica (leather bottle). CXR for lung mets.
- Linitis plastica
- Filling defect
EGD + biopsy for diagnosis. CT, PET-CT, EUS for T/N staging. Diagnostic laparoscopy for peritoneal disease.
- Wall thickening
- EUS T-staging
- Krukenberg tumor
Non-surgical care
- HER2/MSI/PD-L1 testingHER2+: add trastuzumab; MSI-H: pembrolizumab; PD-L1 CPS≥5: add nivolumab
- Perioperative chemo (FLOT)Stage IB-III: FLOT (5-FU/LV/oxaliplatin/docetaxel) neo + adjuvant
- Advanced 1st-line5-FU + cisplatin/oxaliplatin ± trastuzumab (HER2+) ± nivolumab
- 2nd-line / laterRamucirumab (VEGFR2) + paclitaxel; T-DXd (HER2+); pembrolizumab (MSI-H)
- H. pylori eradicationPrevents recurrence after EMR/ESD for early cancer
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
All localized gastric cancer (EMR/ESD possible for early)
Procedures that may be discussed
- Endoscopic submucosal dissection (ESD, T1a)
- Subtotal gastrectomy (distal)
- Total gastrectomy (proximal/diffuse)
- D2 lymphadenectomy (KR/JP standard)
- Laparoscopic/robotic approach
Outlook
5-yr survival 77% in Korea (due to screening). Advanced 30%, metastatic 5–10%.