Clinico-Pathological Variation of Carcinoma Stomach at Different Age Group

Context: Carcinoma of the stomach in our country is not uncommon and shows a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage cancer. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis.

Objectives: To evaluate clinic-pathological variation of carcinoma stomach at different age group.

Methods: A prospective type of observational study was done of 58 patients diagnosed with carcinoma of the stomach treated at Dhaka Medical College Hospital and others tertiary level referral hospitals from 15.12.2013 to 14.06.2014. Clinical evaluation made by detailed history regarding presenting illness, dietary pattern, personal habits. Meticulous systematic physical examination done in each case. Investigation like Endoscopy, Ultrasonography finding recorded. Operative finding like tumor size, serosal involvement, hepatic metastasis, lymph node involvement, peritoneal metastasis and ascites recorded. Data were analyzed and compared by statistical tests.  Results: A total of 58 cases were included in this study. 10 were from below 40 years (young group) and 48 were above 40 years (elderly group). Young patients had less definitive symptoms than elderly group. Pain (80% vs 71%) and vomiting (70 % vs 72%) were the most prominent symptoms in both younger and older groups. But in elderly a significant number 48 (73.8%) of cases had anorexia. Lump and visible peristalsis were present in both groups in approximately similar proportion. Histopathologically younger patients had more aggressive disease than the elderly group. The operability in carcinoma of the stomach was more in young group probably due to physical fitness of patient. In both the groups’ lower part of stomach was the commonest site of malignancy. The incidence of malignancy in lower part of stomach was more in young patients. In young group tumor status was T 4 in 60% and in elderly group 62.5% was in T 4 stage. 50% vs 47% had lymph node involvement (N 2) in both younger and older groups.

Conclusion: The  incidence  of  carcinoma of the stomach in  patients  younger  than  40  years  was  more  common  than  Western world. Patients were presenting more with lesions in the distal stomach in our country than the Western world. Female predominance among young age group. Epigastric pain, vomiting and anemia were most common symptom in patients.