Gastric Carcinoma, as per the GLOBOCON 2018 data is the 5^th most common malignancy and 3^rd most lethal of all. It continues to be a significant cause of cancer specific morbidity and mortality [1]. Despite this, Gastric carcinoma is also the most behaviourally influenced malignancy, dependent heavily on our diet and associated Helicobacter Pylori infection. This makes it a preventable and curable malignancy [1]. Most of these patients present with non-specific symptoms and receive symptomatic treatment for the same. This delays the diagnosis, and hence patients are often diagnosed with progressive disease, and are usually inoperable. Hyponatremia is a common electrolyte abnormality that is encountered in clinically practice, and patients with malignancy as well [1,2]. Hyponatremia is when serum sodium is found to be lower than 135 mmol/L, with or without the presence of symptoms for the same [3-5]. Hyponatremia was further classified as mild 131-135 mmol/L, moderate 125-130 mmol/L, severe below 125 mmol/L, by Joint European Guidelines [6]. These values are a guide for hyponatremia assessment in the absence of symptoms. While in most cases, hyponatremia is often detected during the diagnosis of gastric carcinoma; in few cases it precedes the same. There are very few studies that demonstrate the association of sodium levels with the clinic-pathological features of gastric carcinoma.

Objectives

To determine the Serum Sodium levels in the patients of Gastric Carcinoma

To determine the association of Serum Sodium levels with the Clinico-Pathological features in Gastric Carcinoma

Methodology

This is a retrospective, record based cross sectional study was conducted on 112 patients admitted and diagnosed with Gastric Carcinoma during Jan 2016- April 2018 in Justice K.S. Hedge Charitable hospital, Mangalore. Based on the hospital database, details such as age, sex, complaints, upper GI endoscopy findings, biopsy report, serum sodium and haemoglobin reports on admission were collected. Any case record that had any of the above data missing was excluded from the study. The data was then recorded in a preformed, semi-structured pro forma. The serum sodium level was classified as mild 131-135 mmol/L, moderate 125-130 mmol/L, severe below 125 mmol/L. Any symptoms mentioned in the case history that was suggestive of hyponatremia were also noted. This study was approved by the institutional ethics committee of K. S. Hegde Medical Academy, Deralakatte, Mangalore. Statistical analysis- The data collected was analyzed using SPSS software version 20.0. Mean, median, Inter-quartile range and chi square and Spearman's correlation was calculated where appropriate. Any inference was considered to be statistically significant if the p value was found to be less than 0.05 in our study.

Results

The patients included in this study were diagnosed with carcinoma stomach following UGI scopy and biopsy. It was observed that 82 (73.2%) of the study participants were males and the median age of patients with carcinoma stomach was 60[54.0-65.0]. The most common presenting symptom among the patients was pain abdomen seen in 59(52.7%), followed by 30 (26.8%) with vomiting due to gastric outlet obstruction. The median duration of symptoms was found to 2 [1-4] months. Of the 112 patients, 72(62.6%) had no detectable abnormality on per abdomen examination. The most common feature found in Upper GI SCOPY findings was ulcero-proliferative lesion which was seen in 67(58.3%), with the most common site of the lesion was the pylorus – 42(36.5%) of the patient followed by the body of the stomach seen in 22(19.1%).

Of the 112 participants, 61 (54.5%) showed poorly differentiated adenocarcinoma on UGI scopy histopathology. Mean haemoglobin was 10.37±2.7 g, 56(50.5%) were anaemic. Mean sodium concentration was 134.35±7.0mEq/L; 54(48.2%) of the patients had hyponatremia of which 24(21.8%) of the patients experienced mild hyponatremia (Table 1,2 & Figure 1). Of the 60 patients with poorly differentiated adenocarcinoma, 28 (46.6%) experienced hyponatremia (Table 3 & Figure 2). Hyponatremia was significantly associated with and showed a weak correlation between pain abdomen, generalized weakness, duration of symptoms, haemoglobin. Hyponatremia was significantly associated with poorly differentiated adenocarcinoma.