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THE GASTRIC CARCINOMA. Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE. Preamble. Epidemiology Aetiologic factors Pathology Clinical features Investigations Treatment. Adenocarcinoma -Epidemiology. Incidence  in USA/western Europe

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The gastric carcinoma

THE GASTRICCARCINOMA

Prof. Faisal Ghani Siddiqui

FCPS; PGDip-bioethics; MCPS-HPE


Preamble
Preamble

  • Epidemiology

  • Aetiologic factors

  • Pathology

  • Clinical features

  • Investigations

  • Treatment


Adenocarcinoma epidemiology
Adenocarcinoma -Epidemiology

  • Incidence  in USA/western Europe

  • Leading cause of death in Asia/Eastern Europe

  • Elderly

  • Blacks

  • Low SE status


What causes gastric cancer
What causes Gastric Cancer?


Gastric cancer
Gastric Cancer

  • Pernicious anaemia

  • Blood group A

  • Family history of gastric cancer


Gastric cancer diet
Gastric Cancer Diet

  • High fat diet

  • Pickled, preserved food

  • Tobacco

  • Fresh fruit and vegetables

  • Vitamin C

  • Regular aspirin


Gastric cancer genetic mutations
Gastric CancerGenetic Mutations

  • Deletion or suppression of p53

  • Overexpression of COX-2

  • CDH1


Gastric cancer pre malignant conditions
Gastric Cancer Pre-malignant Conditions

  • Polyps

  • Atrophic gastritis

  • Benign gastric ulcer

  • Gastric ramnant


Gastric cancer pathology
Gastric CancerPathology



Gastric cancer gross appearance
Gastric CancerGross Appearance


Gastric cancer histology lauren classification
Gastric CancerHistology –Lauren Classification


Gastric cancer tnm staging
Gastric CancerTNM staging


Gastric cancer tnm staging1
Gastric CancerTNM staging


Gastric cancer tnm staging2
Gastric CancerTNM staging


Gastric cancer clinical manifestations
Gastric CancerClinical Manifestations


Symptoms
Symptoms

  • Weight loss

  • Decreased food intake

  • Abdominal pain

  • Nausea, vomiting and bloating

  • Acute GI bleeding

  • Chronic GI bleeding

  • Dysphagia


Trousseau s syndrome thrombophlebitis

Trousseau’s syndrome(thrombophlebitis)


Acanthosis nigracans

Acanthosis Nigracans


Clinical signs
Clinical Signs

  • Cervical, supraclavicular and axillary lymphadenopathy

  • Pleural effusion

  • Aspiration pneumonitis

  • Abdominal mass

  • Sister Joseph’s nodule

  • Ascites

  • Rectal shelf of Blumer



Gastric cancer diagnostic evaluation
Gastric CancerDiagnostic Evaluation


Prompt upper endoscopy if
Promptupper endoscopy if…

  • New onset of dyspepsia >45 years

  • Dyspepsia with alarm symptoms (weight loss, anaemia, recurrent vomiting, bleeding)

  • Dyspepsia & family h/o gastric carcinoma


Preoperative staging
Preoperative Staging

  • Abdominal / pelvic CT scanning

  • Endoscopic ultrasound (EUS)

    • Depth of the tumour

    • Enlarged perigastric/coeliac lymph nodes


Gastric cancer treatment
Gastric CancerTreatment


Surgical resection adequate lymphadenectomy is the only curative treatment except
Surgical Resection & Adequate Lymphadenectomyis the only curative treatmentexcept

  • Metastases

  • Co-morbid


Surgical resection
Surgical Resection

  • Resection of tumour

  • Grossly negative margin of at least 5 cms

  • Partial gastrectomy

  • Confirmed on frozen section

  • En block resection of adjacent involved organs


Extent of gastrectomy
Extent of Gastrectomy

  • Radical subtotal gastrectomy

    (Distal tumour)

  • Total gastrectomy

    (Proximal tumour)



  • D1: stations 3-6

  • D2: stations 1,2, 7,8 and 11

  • D3: stations 9, 10 and 12


Survival benefit to

adjuvant radio-chemotherapy

is marginal in patients who have undergone adequate resection


In gross unresectable, metastatic tumour

Role of palliative chemotherapy

is uncertain


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