H. pylori infection can cause acute gastritis, which may progress to chronic gastritis, which can progress to metaplasia, then dysplasia and then cancer
Gastric Cancer Clinical features:
Epigastric pain
Dyspepsia
Dysphagia
Weight loss
Nausea and vomiting
Lymphatic spread - left supraclavicular node (Virchow's node), periumbilical nodule (Sister Mary Joseph's node)
Gastric cancer investigations:
OGD with biopsy - sample should be sent for histology to look for signet ring cells, CLO test for H. pylori and HER2/neu protein expression for targeted monoclonal therapies
CT - chest, abdomen and pelvis to assess metastasis
PET scan is rarely used in gastric cancers as they do not take up the tracer well
Gastric cancer management
Proximal cancers - total gastrectomy
Distal cancers (in the antrum or pylorus) - subtotal gastrectomy
Chemotherapy
EMR or ESD (for early T1a tumors)
Gastrectomy complications:
Death
Anastomotic leak
Duodenal stump leak
Re-operation
Dumping syndrome
Vitamin B12 deficiency
Current NICE guidelines recommend referring for an urgent OGD for any patients presenting with new-onset dysphagia or aged >55 years presenting with weight loss and either upper abdominal pain, reflux, or dyspepsia.