Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Gastric Adenocarcinoma Gastric Carcinoids 605

management

What to Do First

■stage disease:

➣CXR and CT scans to rule out distant disease

➣endoscopic ultrasound is most accurate to stage for local disease

General Management

■assess candidacy for surgery

specific therapy

Indications

■surgery:

➣to cure if non-metastatic (fewer than 40% are candidates)

➣to palliate bleeding or obstruction

■endoscopy:

➣to cure early superficial disease

➣to palliate obstruction (stent placement)

■chemotherapy

➣30% response rate but minimal survival benefit

■radiation

➣often insensitive

Side Effects & Contraindications

■gastrectomy or gastrojejunostomy have significant morbidity and

mortality

follow-up

■B12 replacement; may develop Fe deficiency

■no specific protocol: recurrence is usually untreatable

➣regular blood tests q3mos, and endoscopy and CT scans q12mos

complications and prognosis

■5-yr. survival: Stage I – 80%; Stage II – 50%; Stage III – 20%

■signet cell type has poorer prognosis

Gastric Carcinoids....................................

LYN SUE KAHNG, MD and ROY SOETIKNO, MD, MS

history & physical

■asymptomatic; can cause abdominal pain, dyspepsia, bleeding.

■carcinoid syndrome (flushing, facial edema, wheezing) with hepatic

metastasis