Gastric Cancer Prepared by: student of 15-007-1 group

Gastric Cancer Prepared by: student of 15-007-1 group Asan Sandugash Checked by: Rahmanova A.M

GASTRIC TUMOURS  Anatomy of the stomach  Aetiology of Gastric cancer  Types of Gastric cancer  Pathology of Gastric Cancer  Treatment of Gastric Cancer

ANATOMY:  The stomach J-shaped. The stomach has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.

BLOOD SUPPLY: a. The left gastric artery b. Right gastric artery c. Right gastro-epiploic artery d. Left gastro-epiploic artery e. Short gastric arteries The corresponding veins drain into portal system. The lymphatic drainage of the stomach corresponding its blood supply.

Anatomy Stomach has five layers: Mucosa Epithelium, lamina propria, and muscularis mucosae* Submucosa Smooth muscle layer Subserosa Serosa

AETIOLOGY:  Gastric cancer is the second most common fatal cancer in the world with high frequency in Japan.  The disease presents most commonly in the 5th and 6th decades of life and affect males twice as often as females. Contn…

 The cause of the disease multistep process but several predisposing factors attributed to cause the disease : a. Environment e. Atrophic gastritis b. Diet f. Chronic gastric ulcer c. Heredity g. Adenomatous polyps d. Achlorhydria h. Blood group A i. H. Pyloric colonisation

TYPES OF GASTRIC CANCER: A. Benign Tumours B. Malignant Tumours

TYPES OF GASTRIC CANCER: A. Benign Tumours B. Malignant Tumours

THE BENIGN TUMORS:  Although benign tumors can occur in the stomach most gastric tumours are malignant.

 The benign groups includes:- 1. Non-neoplastic gastric polyps 2. Adenomas 3. Neoplastic gastric polyps 4. Smooth muscles tumours benign (Leiomyomas) 5. Polyposis Syndrome (eg:- Polyposis coli, Juvenile polyps and P.J. Syndrome) 6. Other benign tumours are fibromas, neurofibromas, aberrat pancreas and angiomas.

PATHOLOGY OF GASTRIC (MALIGNANT) TUMOURS:  The gastric cancer may arise in the antrum (50%), the gastric body (30%), the fundus or oesophago-gastric juntion (20%).

 Types of Malignant Tumours: a. Adenocarcinoma b. Leiomyosarcoma c. Lymphomas d. Carcinoid Tumours

1. Polypoid or Proliferative 2. Ulcerating 3. Ulcerating/Infiltrating 4. Diffuse Infiltrating (Linnitus- Plastica)  The macroscopic forms of gastric cancers are classified by (Bormann classification) into:-

 Early Gastric Cancer: Defined as cancer which is confined to the mucosa and submucosa regard- less of lymph nodes status.  Advanced Gastric Cancer: Defined as tumor that has involved the muscularis propria of the stomach wall.

SPREAD OF GASTRIC CANCER:  The diffuse type spreads rapidly through the submucosal and serosal lymphatic and penetrates the gastric wall at early stage, the intestinal variety remains localized for a while and has less tendency to disseminate. The spread by: 1. Direct (loco regional) 2. Lymphatic 3. Blood (Haematogenous) 4. Transcoelomic

Clinical Manifestation: Weight loss due to anorexia and early satiety is the most common symptoms Abdominal pain (not severe) common Nausea / vomiting Chronic occult blood loss is common; GIT bleeding (5%) Dysphagia (cardia involvement)

Clinical Manifestation: Paraneoplastic syndromes ( Trousseau’s syndrome – thrombophlebitis; acanthosis nigricans – hyperpigmentation of axilla and groin; peripheral neuropathy) Signs of distant metastasis: Hepatomegally / ascites Krukenbergs tumor Blummers shelf (drop metastasis) Virchow’s node Sister Joseph node (pathognomonic of advances dse)

EVALUATION OF GASTRIC CANCER:  History  Clinical Examination  Investigations  The clinical features of gastric cancer may arise from local disease, its complications or its metastases.

Investigations for patients with gastric cancer Endoscopy & biopsy Performance status Physiological assessment Cardio-pulmonary function CT chest & abdomen EUS (endoscopic ultrasound) Laparoscopy

Laparoscopy Inspect peritoneal surfaces, liver surface. Identification of advanced disease avoids non-therapeutic laparotomy in 25%. Patients with small volume metastases in peritoneum or liver have a life expectancy of 3-9 months, thus rarely benefit from palliative resection.

Screening of Gastric Cancer Patients at risk for gastric CA should undergo yearly endoscopy and biopsy: Familial adenomatous polyposis Hereditary nonpolyposis colorectal cancer Gastric adenomas Menetrier’s disease Intestinal metaplasia or dysplasia Remote gastrectomy or gastrojejunostomy

Surgical Treatment

TREATMENT: SURGERY: Radical subtotal gastrectomy Standard operation for gastric cancer Organs resected: Distal 75% of stomach 2 cm of duodenum Greater & lesser omentum Ligation of R & L gastric artery and gastroepiploic vesels Billroth II gastojejunostomy

TREATMENT: SURGERY: Radical subtotal gastrectomy Standard operation for gastric cancer If gastric remnant left is small (<20%) do Roux-en-Y reconstruction

Surgical Treatment

References http://www.plaintest.com/general Пропедевтика внутренних болезней - Гребенев А.Л. – Учебник Пропедевтика внутренних болезней - Лис М.А. – Учебник www.google.com