gastric cancer
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{{Gastric Cancer
By Gunchmaa.N
Brief AnatomyBrief Anatomy
Worldwide incidenceMale
16.4Female
8.2Male
36.3Female
16.9MaleMale
77.977.9FemaleFemale
33.333.3
Male10.8
Female4.9
Male43.6
Female19.0
Male5.9
Female2.6
Male11.5
Female 4.3
Male18.6
Female13.3
Male8.4
Female4.0
Eastern Eastern EuropeEurope
JapanJapan
Australia/Australia/New ZealandNew Zealand
China
Northern Northern AfricaAfrica
Southern Southern AfricaAfrica
Central Central AmericaAmerica
WesternWestern Europe Europe
NorthNorthAmericaAmerica
In terms of geographic distribution, high rates apply to Japan, China and Eastern Europe.
Prevalence of cancer in MongoliaPrevalence of cancer in Mongolia
Risk FactorsRisk Factors
Predisposing :
1. Pernicious anemia & atrophic gastritis2. Previous gastric resection3. Chronic peptic ulcer4. Smoking (doubled)5. Alcohol.
Environmental:
1. H.pylori infection2. Low socioeconomic Status3. Nationality4. Diet
Genetic:
1. Blood group A2. Hereditary diffuse gastric cancer syndrome.
Certain diets are implicatedCertain diets are implicated :: Rich in pickled vegetables, Rich in pickled vegetables,
salted fish, excessive dietary salted fish, excessive dietary salt, smoked meat.salt, smoked meat.
A diet that includes fruits and A diet that includes fruits and vegetables rich in vitamin C vegetables rich in vitamin C may have a protective effect.may have a protective effect.
DietDiet
Poorly understoodPoorly understood
The majority of The majority of gastric tumor are gastric tumor are sporadic in naturesporadic in nature
Genetic factorsGenetic factors
Epigastric painEpigastric pain BloatingBloating Early satietyEarly satiety Nausea & vomitingNausea & vomiting DysphagiaDysphagia AnorexiaAnorexia Weight loss Weight loss Upper GI bleeding (hematemesis, Upper GI bleeding (hematemesis,
melena) melena) Iron deficiency anemiaIron deficiency anemia
SymptomsSymptoms
SignsSigns
- - Anemia.Anemia.- Wt.loss ( cachexia)Wt.loss ( cachexia)- Epigastric massEpigastric mass- HepatomegalyHepatomegaly- Ascites Ascites - JaundiceJaundice- Virchows nodeVirchows node- Krukenberg tumorKrukenberg tumor
Defined as a tumor confined to the mucosal or Defined as a tumor confined to the mucosal or submucosal layer, with or without lymph node submucosal layer, with or without lymph node metastasismetastasis
Early gastric cancerEarly gastric cancer
Invasion depth beyond submucosal Invasion depth beyond submucosal layerlayer
Advanced gastric Advanced gastric cancercancer
Bormann Bormann classificationsclassifications
Lauren classificationLauren classification Intestinal type- Associated with most environmental risk factors- Carries a better prognosis
Diffuse type- Consists of scattered cell clusters with poor prognosis- Infiltrates deeply
Primary tumor: Primary tumor: depth of tumor invasiondepth of tumor invasion
Tx- cannot be assessedTx- cannot be assessedT0- no evidenceT0- no evidenceTis- carcinoma in situ, no invasion Tis- carcinoma in situ, no invasion
of laminaof laminaT1- invades lamina propria or T1- invades lamina propria or
submucosasubmucosaT2- invades muscularis or subserosaT2- invades muscularis or subserosaT3- penetrates serosa, no adjacent T3- penetrates serosa, no adjacent
structurestructureT4- invades adjacent structuresT4- invades adjacent structures
TNM classification TNM classification - - TT
Regional Lymph Regional Lymph NodesNodes
NX- cannot be assessedNX- cannot be assessedN0- no nodesN0- no nodesN1- mets in 1-6 regional N1- mets in 1-6 regional nodesnodesN2- mets in 7-15 regional N2- mets in 7-15 regional nodesnodesN3- mets in more than 15 N3- mets in more than 15 regional nodesregional nodes
TNM classification TNM classification - - NN
Distant metastasisDistant metastasisMX- cannot be assessedMX- cannot be assessedM0- no distant metastasesM0- no distant metastasesM1-distant metastasesM1-distant metastases
TNM classification - MTNM classification - M
Direct invasionDirect invasion Lymph node disseminationLymph node dissemination Blood spreadBlood spread Transperitoneal spreadTransperitoneal spread
Spread PatternsSpread Patterns
INVESTIGATIONSINVESTIGATIONSFull blood count Full blood count LFTLFTSerum tumor markers (CA 72-Serum tumor markers (CA 72-4,CEA,CA19-9) not specific4,CEA,CA19-9) not specificStool examination for occult bloodStool examination for occult bloodGastric acidityGastric aciditySerum gastrinSerum gastrinFetal sulfoglycoprotein antigenFetal sulfoglycoprotein antigenCarcinoembryogenic antigenCarcinoembryogenic antigen
Endoscopic Endoscopic screeningscreening -- general general population or high population or high risk personsrisk persons
Upper EndoscopyUpper Endoscopy
Endoscopic UltrasoundEndoscopic Ultrasound
Distal GC Proximal GC
Barium X-Ray
CT scanCT scan:: T,T,the lesionthe lesion N,N,neighboring lymph node neighboring lymph node
metastasismetastasis M,M,distant metastasisdistant metastasis
TreatmentTreatment
Surgical resection
ESD
Adjuvant therapy
Palliative therapy
BASIC SURGICAL BASIC SURGICAL PRINCIPLESPRINCIPLES
Types: total,subtotal,palliative Antral diseasesubtotal gastrectomy Midbody & proximal total gastrectomy
ChemotherapyChemotherapy the most widely used regimen is 5-FU, the most widely used regimen is 5-FU,
Oxaliplatin and Taxol, 6 cyclesOxaliplatin and Taxol, 6 cycles RadiotherapyRadiotherapy provides relief from bleeding, obstruction and provides relief from bleeding, obstruction and
pain in 50-75%. Median duration of palliation is pain in 50-75%. Median duration of palliation is 4-18 months4-18 months
Adjuvant TherapyAdjuvant Therapy
Stent placementStent placementEndoscopic tumor Endoscopic tumor ablationablation
G tube for nutritionG tube for nutrition
Stage 4Stage 4
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