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.[29]

male sex

Men are twice as likely to have gastric cancer.[5][6]​​

smoking

Smoking increases the likelihood of gastric cancers by approximately 1.5-fold.[20]

family history

Around 1% to 3% of cases are familial.[21]

uncommon

nausea

Some patients experience nausea.

dysphagia

More common in proximal and gastro-oesophageal junction tumours.

lower gastrointestinal bleeding

In an American College of Surgeons Study, 20% of patients presented with melaena.[3]

Risk factors

strong

pernicious anaemia

A 2- to 3-fold excess risk of gastric cancer has been noted in patients with pernicious anaemia.[15]

Helicobacter pylori

Multiple epidemiological studies have demonstrated an association between H pylori and gastric cancer.[9][10][11][12]​ The bacteria cause inflammation, which can result in atrophy, metaplasia, and carcinoma.

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.[16]

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.[16]

high-salt diet

Multiple studies have reported that high salt intake increases the risk of stomach cancer.[8][17][18][19]

smoking

One meta-analysis of 40 studies estimated that the risk was increased by approximately 1.5- to 1.6-fold and was higher in men.[20]

family history

1% to 3% of gastric cancers may be linked to genetic factors. E-cadherin mutation has been linked to 25% of these cases, with an autosomal dominant predisposition to diffuse-type gastric cancer.[21]

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