Early stage gastric adenocarcinoma patients have nonspecific symptoms, that usually do not trigger a consultation until the disease has advanced, such as dyspepsia, anorexia, low intensity, diffuse abdominal pain and weight loss [1]. As the disease progresses and the tumor occupies a larger part of the stomach or causes stomach distention, other symptoms, such as early satiety, nausea, vomiting, dysphagia, postprandial fullness appear [2]. With increasing progression, bleeding occurs, and the blood is expelled as hematemesis, melena or hematochezia. With the development of complications, the patient may experience jaundice and peritoneal or pleural effusions, due to metastases or hypoalbuminemia caused by inanition. Pedal edema may also develop due to the same cause [3] [4].

The tumor may cause metastasis in the ovary, the peritoneum or lymph nodes (supraclavicular, left axilla or periumbilical).

Paraneoplastic syndromes, such as acanthosis nigricans and dermatomyositis have been described.

The clinician taking patient history should inquire about previous Helicobacter pylori infection or autoimmune gastritis, knowing that these conditions are predisposing factors for gastric adenocarcinoma.

Workup should begin with a complete blood count, that might show anemia, due to blood loss or insufficient food intake due to lack of appetite. The clinician should also recommend liver function tests (keeping in mind that gastric adenocarcinoma may cause hepatic metastasis) and tumor markers such as carcinoembryonic antigen and cancer antigen 19-9. Even if these antigens are absent, the diagnosis cannot be excluded.

Imaging studies in association with histologic findings confirm or disprove the diagnosis. Upper digestive endoscopy is at this time the gold standard for gastric adenocarcinoma diagnosis [5], as it allows tumor detection and biopsy. Endoscopic methods even allow tumor excision if found in the early stages. Classical endoscopy limitation resides in incomplete staging evaluation, but this can be overcome with endoscopic ultrasonography [6].

Mucosal aspect can also be evaluated using upper gastrointestinal barium study, that involves a lower amount of irradiation than a computer tomogram. The latter can also evaluate invasion of neighboring structures and lymphadenopathy [7]. Liver, bone and peritoneal metastasis are better defined by magnetic resonance, so if symptoms dictate, this should be the method of choice [8]. However, MRI is not as useful in describing gastric lesions per se, because a contrast agent is unavailable [8]. Barium study accuracy can be improved by using double contrast or compressive views.

Once a lesion has been documented, it is important to evaluate the histologic aspect. Adenocarcinomas (tubular, mucinous, papillary, signet-ring cells or undifferentiated) are far more frequent than lymphomas, stromal tumors, carcinoids, adenoacantomas, and squamous cell carcinomas, and account for more than 90% of gastric cancers [9].

Recent studies have described the importance of certain serum glycan patterns as markers for the risk of gastric cancer development [10].

Treatment for gastric adenocarcinoma depends on the stage of the cancer and the patient's overall health. Options may include surgery to remove part or all of the stomach, chemotherapy to kill cancer cells, radiation therapy to target specific areas, or targeted therapy that focuses on specific characteristics of cancer cells. In some cases, a combination of these treatments may be used. The goal is to remove or destroy the cancer while preserving as much of the stomach's function as possible.

The prognosis for gastric adenocarcinoma varies based on several factors, including the cancer's stage at diagnosis, the patient's age, and overall health. Early-stage cancers have a better prognosis, with higher survival rates. However, if the cancer has spread to other parts of the body, the prognosis becomes less favorable. Advances in treatment have improved outcomes, but early detection remains crucial for the best possible prognosis.

The exact cause of gastric adenocarcinoma is not fully understood, but several risk factors have been identified. These include infection with Helicobacter pylori bacteria, a diet high in smoked, salted, or pickled foods, smoking, obesity, and a family history of stomach cancer. Chronic inflammation of the stomach, known as gastritis, and certain genetic conditions can also increase the risk.

Gastric adenocarcinoma is more common in older adults, with the majority of cases occurring in people over the age of 50. It is more prevalent in men than women and is more common in certain regions, such as East Asia, Eastern Europe, and parts of Central and South America. The incidence of gastric cancer has been declining in many parts of the world, likely due to changes in diet and the treatment of H. pylori infections.

Gastric adenocarcinoma develops from the glandular cells in the stomach lining. These cells produce mucus and other substances that protect the stomach lining from acid. When these cells undergo genetic mutations, they can begin to grow uncontrollably, forming a tumor. Over time, the tumor can invade deeper layers of the stomach wall and spread to nearby lymph nodes and other organs, such as the liver and lungs.

While not all cases of gastric adenocarcinoma can be prevented, certain lifestyle changes can reduce the risk. These include maintaining a healthy diet rich in fruits and vegetables, avoiding smoked and salted foods, quitting smoking, and managing body weight. Treating H. pylori infections and monitoring individuals with a family history of stomach cancer can also help in prevention. Regular medical check-ups and screenings are important for early detection, especially for those at higher risk.

If you or someone you know is experiencing symptoms like persistent stomach pain, difficulty swallowing, or unexplained weight loss, it is important to seek medical evaluation. Gastric adenocarcinoma is a type of stomach cancer that can be treated more effectively if caught early. Discuss any concerns with your healthcare provider, who can guide you through the necessary tests and potential treatment options. Remember, maintaining a healthy lifestyle and regular check-ups can play a significant role in prevention and early detection.

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10. Waknine Y. Researchers Discover 'Glycan Fingerprint' for Gastric Cancer. Medscape. http://www.medscape.com/viewarticle/818637. Published January 03, 2014. Accessed January 30, 2017