A CLINICAL STUDY ON INCIDENCE, PATHOLOGICAL PATTERN AND MANAGEMENT OF GASTRIC CARCINOMA IN RURAL SETUP (ADICHUNCHANAGIRI INSTITUTE OF MEDICAL SCIENCES), MANDYA

Abstract

BACKGROUND Stomach cancer or gastric cancer is when cancer develops from the lining of stomach. Early symptoms may include heartburn, upper abdominal pain, nausea and loss of appetite. Later symptoms may include weight loss, yellow skin, vomiting, difficulty swallowing and blood in the stool among others. The cancer may spread from the stomach to other parts of the body, particularly the liver, lungs, bones, lining of the abdomen and lymph nodes. The most common cause is infection by the bacteria Helicobacter pylori, which accounts for more than 60% of cases. About 10% of cases run in families and between 1% and 3% of cases are due to genetic syndromes inherited from a person's parents such as hereditary diffuse gastric cancer. AIMS AND OBJECTIVES 1) To study the prevalence of carcinoma stomach as occurring in Adichunchanagiri Institute of Medical Sciences and Research Centre, Mandya. 2) To study the clinical presentation including the anatomic site of occurrence and histological type. 3) To study the association of risk factors. 4) To study the surgical modalities of treatment. METHODS The tissue for diagnosis was obtained by endoscopy or following surgical resection. Patients presenting to Adichunchanagiri Hospital, Mandya, during the study period and those found eligible were included in the study. Sample Size Minimum of 50 cases meeting criteria of the present study. RESULTS Gastric carcinoma is more common in males with 56% of the cases being males in this study. The prevalence is more among the low socio-economic group, which is 80% of the population. Smoked foods is a risk factor in 15 (30%) of the patients and 40 (80%) in high spicy diet in everyday food. Tobacco smoking (44%), alcohol consumption (44%) are also risk factors. Blood Group A is associated with gastric cancer, 23 (46%) patients. Anorexia was the most common symptoms reported in 42 (84%) of the patients. Anaemia was the most common sign in 35 (70%) of the cases. The most common macroscopic subtype was Borrmann type II with 24 (48%). Majority of the cases were well differentiated adenocarcinoma, which is 30 (60%) cases of which females had higher percentage of poorly differentiated tumours, i.e. 6 (27.2%) cases. CONCLUSION This study was undertaken to study the prevalence of gastric cancer as occurring in Adichunchanagiri Hospital, Mandya, which is a rural hospital with a large input of cases from Mandya and its surrounding districts. In this study, gastric cancer was more prevalent in males. Majority of the patients belonged to the lower socioeconomic strata and had association of risk factor. Blood Group A was the prevalent blood group. The disease was more prevalent in patients above age of 45 with the oldest being 78. Majority presented in the advanced stage of the disease, although there were few cases which presented in the early gastric carcinoma stage. The pylorus remained the most common site of affliction in contrast to western countries, which have showed a consistent shift towards proximal tumours. The major percentage of the tumours was well differentiated. The finding of this study are comparable to other similar studies in India and proximal tumours continue to be the major subtype in this part of the world and association of risk factor increase the likelihood of an individual developing gastric cancer.