The gastric carcinoma
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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

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THE GASTRICCARCINOMA

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

  • Leading cause of death in Asia/Eastern Europe

  • Elderly

  • Blacks

  • Low SE status


What causes Gastric Cancer?


Gastric Cancer

  • Pernicious anaemia

  • Blood group A

  • Family history of gastric cancer


Gastric Cancer Diet

  • High fat diet

  • Pickled, preserved food

  • Tobacco

  • Fresh fruit and vegetables

  • Vitamin C

  • Regular aspirin


Gastric CancerGenetic Mutations

  • Deletion or suppression of p53

  • Overexpression of COX-2

  • CDH1


Gastric Cancer Pre-malignant Conditions

  • Polyps

  • Atrophic gastritis

  • Benign gastric ulcer

  • Gastric ramnant


Gastric CancerPathology


Malignant Neoplasms of the Stomach


Gastric CancerGross Appearance


Gastric CancerHistology –Lauren Classification


Gastric CancerTNM staging


Gastric CancerTNM staging


Gastric CancerTNM staging


Gastric CancerClinical Manifestations


Symptoms

  • Weight loss

  • Decreased food intake

  • Abdominal pain

  • Nausea, vomiting and bloating

  • Acute GI bleeding

  • Chronic GI bleeding

  • Dysphagia


Trousseau’s syndrome(thrombophlebitis)


Acanthosis Nigracans


Clinical Signs

  • Cervical, supraclavicular and axillary lymphadenopathy

  • Pleural effusion

  • Aspiration pneumonitis

  • Abdominal mass

  • Sister Joseph’s nodule

  • Ascites

  • Rectal shelf of Blumer


Rudolph Virchow


Gastric CancerDiagnostic Evaluation


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

  • Abdominal / pelvic CT scanning

  • Endoscopic ultrasound (EUS)

    • Depth of the tumour

    • Enlarged perigastric/coeliac lymph nodes


Gastric CancerTreatment


Surgical Resection & Adequate Lymphadenectomyis the only curative treatmentexcept

  • Metastases

  • Co-morbid


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

  • Radical subtotal gastrectomy

    (Distal tumour)

  • Total gastrectomy

    (Proximal tumour)


Lymphadenectomy


  • 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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