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 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


Malignant neoplasms of the stomach

Malignant Neoplasms of the Stomach


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


The gastric carcinoma

Rudolph Virchow


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)


Lymphadenectomy

Lymphadenectomy


The gastric carcinoma

  • D1: stations 3-6

  • D2: stations 1,2, 7,8 and 11

  • D3: stations 9, 10 and 12


The gastric carcinoma

Survival benefit to

adjuvant radio-chemotherapy

is marginal in patients who have undergone adequate resection


The gastric carcinoma

In gross unresectable, metastatic tumour

Role of palliative chemotherapy

is uncertain


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