Clinicopathological Profile of 66 Patients with Carcinoma Stomach in North-East Part of Bangladesh

Background: There is wide variation in the prevalence of carcinoma stomach throughout the world. In some parts of the world it is decreasing whereas in the other parts it is increasing. Also there are variations in the risk factors of the disease. Objective: To see clinicopathological profile of patients of carcinoma stomach in North-East part of Bangladesh. Materials and Methods: Consecutive new patient diagnosed as carcinoma of stomach were interviewed and data was recorded in a data sheet. Results: Total 66 cases, age varying from 26−77 (mean 52) years, male 45 (68.2%) and female 21 (31.8%) were enrolled. Out of them 44 (66.7%) were above 45 years. People from lower economic group (51, 78.8%) and rural area (39, 59.1%) were predominantly affected. Commonest presenting symptoms were weight loss, abdominal pain and vomiting. Common site of lesion was antrum and common histopathological type was adenocarcinoma (64, 97%). Conclusion: Carcinoma stomach is a disease of older age group and male are predominantly affected. Smoking, tobacco and betel nut chewing are risk factors. Lower income group and rural people are more affected.


Introduction
In 2012, in the world estimated incidence of carcinoma stomach was 951594 and causing death of 723,073 individuals worldwide. 1 Overall it is the second most common cause of death in some Asian countries. [2][3] Worldwide the incidence of new cases of gastric cancer in 2002 was 934,000 of which 56% were from Asia. The incidence of gastric carcinoma is decreasing in western countries whereas increasing in the rest of the world. 4 There is a wide variation in the prevalence of gastric cancer throughout the world. It has been hypothesized that incidence of gastric cancer is determined by environmental factors rather than gastric factor. 5 Recognized dietary risk factors for gastric cancer are smoked foods, salted fish and meat, pickled vegetables. Smoking is another important risk factor. [6][7][8][9] Gastric cancer is three times common among male. 9 Person working in coal mine, nickel refinery rubber and timber processing industries and those exposed to asbestos fibers are more affected. 10 In this background this cross-sectional study was designed to see the profile of patients of carcinoma of stomach as well as associated risk factors in North East part of Bangladesh.

Materials and Methods
All consecutive patients of carcinoma of stomach newly diagnosed by endoscopy of UGIT and histopathology in North East Medical College & Hospital, Sylhet were enrolled in this study. History, clinical examination and laboratory findings along with demographic features were recorded in a predesigned data sheet. Statistical analysis was done using SPSS 17. χ 2 test was done to see the difference and p value <0.05 was taken as significant. Sample size was calculated using Fruchere and Guilford formula. Estimated sample size was 66.

Results
Total 66 patients, age varying from 26−77 years (mean 52.0, SD 11.30 years) were enrolled in this study. Among them 45 (68.2%) were male and 21 (31.8%) were female with male female ratio 2.1:1. Among them 44 (66.7%) were above 45 years age group while 22 (33.3%) were in 26−45 years age   13,14 Smoking, betel nut and tobacco chewing have been found as potential risk factors. In this study 41 (62.1%) subjects were smoker and 52 (78.8%) were tobacco chewer. It is also consistent with reports from India. 15,16 In this small group of patients housewives and farmers were mostly affected. Farmers are exposed to chemical fertilizer and insecticides which may be risk factors. But higher incidence in housewives could not be explained. This result is not consistent with reports from India. 17 In our study 39 (59.1%) patients are from lower economic group followed by 21 (31.8%) from middle class. Environment, food habit and nutrition may have a causal role here. This finding is consistent with reports from Addis Ababa. 18 Most gastric cancers occur sporadically 19 and it can occur in family occasionally. 20 In current study 3 (4.5%) patients had family history of gastrointestinal malignancy. In this group, 25 (7.8%) had blood group B followed by O group (21, 31.8%). But previous reports show that carcinoma of stomach is more common in people with blood group A. 21,22 These contradictions may be due to small sample size. Common presenting symptoms in our series are weight loss (74.2%), anaemia (72.7%), abdominal pain (62.1%) and vomiting (51.5%). Features of gastric outlet obstruction are more common in our series than in western country reports. 23 This may be explained as our people seek medical service late due to economic constrain and ignorance. In this series site of involvement is mostly antrum (62.1%) which is consistent with reports from other Asian countries (48%). But incidence of proximal gastric carcinoma is increasing in western countries with simultaneous decrease in distal lesion. 24,25 Commonest histopathological type in this series is adenocarcinoma (97%), which is similar to another Asian report. 26 Incidence of metastasis is 19.7% in our series, which is consistent with another report. 27 Due to routine screening gastric cancer is detected earlier in Japan. 28 But in our country such screening is absent. In addition poor socio-economic status and less awareness lead to delayed medical consultation in our country.
In this study, features of gastric outlet obstruction and antral lesion are common findings in age group more than 45 years. Further study with large sample size may be done in future for proper assessment of demographic features as well as planning for early detection and treatment.

Limitations
Sample size was small. Presence of H. pylori infection was not looked for as a causal factor.