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PREVENTION
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EARLY
GASTRIC CARCINOMA
There has
been a
striking,
continuous,
but
unexplained
decline
in
the
reported
death
rate of gastric carcinoma in the
U.S., but
world
figures indicate
that
cancer
of the stomach
re-
mains
a
major health problem.
Men
are
affected twice
as often
as
women.
lt
attacks
all
ages,
although rarely before the third
decade and
the
risk
rises
pro-
gressively thereafter.
The
antrum
is
the
leading
site
of
gastric
carcinoma,
followed
by
the
lesser
curvature,
cardia,
and body
of
the
stomach.
It is
asymptomatic
during
early
growth of the
tumor.
The
ealry
carcinoma
may
be
frustratingly silent, and
the
late
manifestations extremely
vari-
able.
Anorexia
is
a
remarkably
constant feature,
and
patients
with
advanced
tumors
exhibit
abdominal
discomfort,
weight
loss,
anemia, weakness,
and
rapid
filling
on
eating.
Dis-
comfort
varies
from mild
inter-
mittent epigastric pain
to
con-
stant
severe
pain often
boring
into
the
back. Pain may
be
poorly
localized
and
may
re-
flect
a
sensation
of
fullness,
aching,
or
bloating
initiated or
aggravated
by
meals.
ln
ulcer-
ative
carcinoma,
the pain
may
mimic
ulcer
pain.
Diagnosis of
advanced
carci-
noma may
be
easy
when
the
clinical
and
roentgenographic
findings
are
clear-cut.
ln
other
cases,
the condition
defies analy-
sis
or
mimics
other
diseases.
Sudden
changes
in
upper
gastrointestinal
function,
particu-
larly
the
appearance
of
anorexia
in
men
over
forty
years
of
age,
should arouse suspicion.
lt
is de-
sirable
to
carry
out
semiannual
examinations
with
alternating
gastroscopy
and
roentgeno-
graphy in high
risk patients.
Per-
iodic
testing
of
the
stool for
occult
bleeding
is
also indicated.
Surgical
treatment to attempt
complete excision
of
the tumor
is
indicated
in
every patient
in
whom
careful clinical
investi-
gation fails
to
reveal evidence
of
spread beyond
the
stomach.
Factors which determine the out-
come
of
surgical therapy are the
duration
of the
disease,
location
and extent
of
the
tumor, condition
of
the
patient,
and
the
presence
of
matastasis (regional
or
lymph
nodes) at exploration.
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