An important factor in diagnosing GC is a high index of suspicion. Attention to signs and symptoms of gastric pathology, including dyspepsia, gastritis, ulcer disease, early satiety, and weight loss, is important. GC is rarely diagnosed on physical examination, except with widely metastatic disease. Upper endoscopy is the standard for establishing the diagnosis, and clinicians should have a low threshold to recommend endoscopy to patients with suspicious symptoms or from high risk populations. At endoscopy, any suspicious lesions, including ulcers, inflamed areas or masses, should be carefully examined and biopsies should be performed in multiple areas. Special attention to the stomach's shape, mucosal appearance, and distensibility is essential to pick up the more occult, diffuse-type GC, which may be confined to the submucosa and missed on endoscopy.

A number of serum markers have been described in GC, including CEA, CA19-9, and CA72-4 (Marrelli et al, 1999), though none have proven to be sensitive or specific enough to warrant routine use. Gene microarray analysis has implicated a number of gene products, including TP53 mutations, cell cycle regulators, and ribosomal and mitochondrial proteins, but are currently of research interest only. If the patient is young or has a significant family history, genetic counseling and testing for the CDH1 gene mutation should be considered.

After the histologic diagnosis of GC has been established, accurate staging of the patient is necessary to make appropriate treatment recommendations and provide definitive therapy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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