{{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