Description

• May occur anywhere in the stomach
• Infiltration to lymph nodes, omentum, lungs, and liver is rapid.
• Uncommon in US natives
• Synonym(s): Linitis plastica

Pediatric Considerations
Rare

• Rarely diagnosed during pregnancy
• Prognosis is poor if diagnosed.

Epidemiology

• Predominant age: >55 (2/3 >65)
• Predominant gender: Male > Female (1.7:1)
• Incidence is decreasing globally, but it remains the 2nd-leading cause of cancer death.

• 5.9/100,000 males (North America)
• 2.5/100,000 females (North America)
• 21,130 new cases per year (US)

Risk Factors

• Helicobacter pylori infection
• Achlorhydria
• Atrophic gastritis/intestinal metaplasia
• Pernicious anemia
• Prior gastric resection
• Polyps or dysplasia anywhere in alimentary canal
• Familial polyposis
• Barrett esophagus
• Smoking/Tobacco abuse
• Patients in lower socioeconomic classes are at greater risk of developing gastric tumors.
• Diet rich in additives (e.g., smoked, pickled, or salted foods; highly spiced Asian foods)
• Low consumption of fruits and vegetables
• Overweight and obesity: Strength of association increases with increasing body mass index (BMI)
• Ethnic background: Hispanic, Japanese, Chilean, Costa Rican:
  • Migrants from high-incidence areas (e.g., Iceland, Chile, or Japan) to low-incidence areas maintain an increased risk, whereas their offspring have an occurrence rate that corresponds to that of the new location.

• More common in people with blood group A
• 2–4 times more common in 1st-degree relatives
• 1–3% of gastric cancers are associated with inherited gastric cancer predisposition syndromes, known as hereditary diffuse gastric cancer.
• Amplification or overexpression of the HER2 protein is associated with some gastric cancers:
  • May play a role in pathogenesis and progression

General Prevention

• A healthy lifestyle (not smoking, not consuming excess alcohol, avoiding obesity, and maintaining a good diet) is associated with reduced risk of gastric cancer:
  • Diets including 5–20 servings of both fruits and vegetables each week reduce the risk of gastric malignancy by ~50%.
• Insufficient data to establish that screening would decrease mortality in US population
• Screening may be of benefit in high-prevalence areas.

Etiology

Unknown

Commonly Associated Conditions

• Giant hypertrophic gastritis (Ménétrier disease)
• Intestinal metaplasia of the stomach
• Atrophic gastritis
• H. pylori infection