Layke John C, Lopez Peter P
University of Illinois Metropolitan Group Hospitals, Chicago, Illinois, USA.
Am Fam Physician. 2004 Mar 1;69(5):1133-40.
Although the overall incidence of gastric cancer has steadily declined in the United States, it is estimated that more than 12,000 persons died from gastric cancer in 2003. The incidence of distal stomach tumors has greatly declined, but reported cases of proximal gastric carcinomas, including tumors at the gastroesophageal junction, have increased. Early diagnosis of gastric cancer is difficult because most patients are asymptomatic in the early stage. Weight loss and abdominal pain often are late signs of tumor progression. Chronic atrophic gastritis, Helicobacter pylori infection, smoking, heavy alcohol use, and several dietary factors have been linked to increased risks for gastric cancer. Esophagogastroduodenoscopy is the preferred diagnostic modality for evaluation of patients in whom stomach cancer is suspected. Accurate staging of gastric wall invasion and lymph node involvement is important for determining prognosis and appropriate treatment. Endoscopic ultrasonography, in combination with computed tomographic scanning and operative lymph node dissection, may be involved in staging the tumor. Treatment with surgery alone offers a high rate of failure. Chemotherapy and radiotherapy have not improved survival rates when used as single modalities, but combined therapy has shown some promise. Primary prevention, by control of modifiable risk factors and increased surveillance of persons at increased risk, is important in decreasing morbidity and mortality.
尽管在美国胃癌的总体发病率一直在稳步下降，但据估计2003年有超过12000人死于胃癌。远端胃肿瘤的发病率已大幅下降，但包括胃食管交界处肿瘤在内的近端胃癌报告病例有所增加。胃癌的早期诊断很困难，因为大多数患者在早期没有症状。体重减轻和腹痛往往是肿瘤进展的晚期症状。慢性萎缩性胃炎、幽门螺杆菌感染、吸烟、大量饮酒以及一些饮食因素都与胃癌风险增加有关。食管胃十二指肠镜检查是评估疑似胃癌患者的首选诊断方法。准确分期胃壁侵犯和淋巴结受累情况对于确定预后和适当治疗很重要。内镜超声检查结合计算机断层扫描和手术淋巴结清扫可能参与肿瘤分期。单纯手术治疗失败率很高。化疗和放疗作为单一治疗方式时并未提高生存率，但联合治疗已显示出一些希望。通过控制可改变的风险因素以及加强对高危人群的监测进行一级预防，对于降低发病率和死亡率很重要。
