1 / 52

CARCINOMA STOMACH

CARCINOMA STOMACH . PROF.DR.V.SHRUTHI KAMAL. INCIDENCE. GLOBAL STATISTICS 640600 MEN 349000 WOMEN 50% adavanced carcinoma CA CANCER J.CLIN 2011 . Distal cancer Increase in proximal cancers Incidence remains high in Japan

lloyd
Download Presentation

CARCINOMA STOMACH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CARCINOMA STOMACH PROF.DR.V.SHRUTHI KAMAL

  2. INCIDENCE • GLOBAL STATISTICS 640600 MEN 349000 WOMEN • 50% adavanced carcinoma • CA CANCER J.CLIN 2011

  3. Distal cancer • Increase in proximal cancers • Incidence remains high in Japan • Their cure rates better due to screening/ survellance/early detection

  4. Age • Average age of onset 55 yrs

  5. Etiology • Diffuse cancer Proximal & hereditary • Intestinal type Distal cancers younger Endemic/ inflammatory changes with Helicobacter pylori infection

  6. DIET • Linked to High ingestion of Redmeat/cabbage/spices/fish/smoked Salt preserved/high carohydrates • Low ingestion of fruits vegetables Fat /protein/vitamins A,C,E

  7. Gastric Cancer – Dietary/Lifestyle Factors Carl-McGrath S, et al. Cancer Therapy (2007).

  8. Helicobacter pylori infection • Increased risk • HP organism found in 89% intestinal type/32% with diffuse type • Trials in eradicating HP infection

  9. Heredity & Race • African/Asian/Hispanic American >risk • Whites< risk

  10. Anemia –pernicious anemia • 3to18 times > risk • Achlorhydria • Atrophic gastritis

  11. Previous Gastric resection • Gastric stump ca > 15 to 20 yrs • Alakaline bile/dysplasia of gastric ca/ elevated gastrin levels > carry poor prognosis

  12. Mucosal dysplasia • Grade I to III • High grade dysplasia >marker for future gas .ca • Intestinal metaplasia/ replacement of • Glandular epithelium> intestinal type

  13. Gastric Cancer – “Correa Sequence”- pathophysiology Potentially reversible “Vogelgram” of CRC Not HGD Chronic gastritis Mucosal atrophy Intestinal metaplasia Intestinal-type carcinoma Normal Dysplasia Increasing risk http://www.hopkinscoloncancercenter.org Hartgrink HH, et al. Lancet (2009).

  14. Gastric polyps • FAP ( Familial adenomatouspolyposis) • Have > incidence of gas .ca/advised endoscopy/ survellence • Hyper plastic>do not have malig.potential

  15. Chronic gastritis • Atrophic gastritis( autoimmune) • Hypertrophic gastritis Menetriers

  16. Other risk factors • > 50 yrs • Blood group A • Lower socio economic status • Alcohol • Smoking • Obesity

  17. Histology • Adeno ca >95% • Leiomyo sarcoma • Lymphomas • Squamous ca >5% • Carcinoid

  18. Other risk factors contd E cadheringene mutation HNPCC LIFraumen EB virus

  19. Pathology • Gross types> cauliflower ulcerative Leather botttle (linitisplastica)

  20. Lauren’s • Intestinal type(53%) Good prognosis HP infection • Diffuse type(33%) Bld group A,Familial, signet ring,poor differentiation , younger bad prognosis

  21. Japanese classification • Early gastric > mucosa+ submucosa+ or - nodes • 1 protruded cure rate >95% • 2 superdicial • 3 Excavated

  22. Advanced gastric ca • Muscularis+serosa + or – nodes • Borrman’s classification • I single polypoid • II ulcerated ca + clear margin • III ,, ,, ,, + with out clear margin • IV diffuse & V unclassified

  23. MINGS classification • Expanding • Infiltrative

  24. WHO Histological( Microscopic) • Adeno ca>papillary,tubular mucinous ,signet Adenosuamous Squamous undifferentited

  25. Siewertclassifiaction • Proximal gas .ca • TypeI Ca of GE ( Barrets) • TypeII With in 2 cmsSquamo columnar junc • TypeIIISubcardial

  26. Location of cancers • Distal >40% • Proximal>35% • Body>25%

  27. Spread • Local Ulcerative> gsatric wall> serosa • schirrous>submucosa/muscularis • Lymphatic • Virchows node ( left supraclavicular ) • Left axillary (Irish node) • Blood spread>liver 40%Lung 40% • Sclerotic bone mets/carcinomatous meningitis

  28. contd • Peritoneum 10% seedling of peritoneal surfaces • Umbilicus/falciform(sis Mary joseph nodule) • Krukenberg>mets to ovary • Blumer shelf ( rectal shelf in men)

  29. Paraneoplastic syndrome • Polymyosistis • Dementia • Venous thrombosis • Ectopic cushing • LeserTrelatsign( seborheickeratosis) • Acanthosis

  30. Diagnosis • Anorexia/early satiety/dyspepsia • Dyspagia/weakness/ • Abdominal pain>60% • Weight loss>50% • Nausea vomiting>40% • Palpable mass>30% • Haemetemis/ malena>25%

  31. Investigations • CBC/LFT/Chest x-ray • EGD( esophagogastroduodenoscopy) • USG/EUS(endo ultrasound) • CT • Diagnostic lap

  32. Staging • TNM Tx cant be assessed • T0 No eveidence of tumour • Tis in situ • T1 lamina propria or submucosa • T2 a –muscularispropria • T2 b—invades subserosa • T3 invades serosa T4 adjacent structure

  33. Gastric Cancer – Staging Systems • TNM: most important clinical prognostic factor http://www.hopkins-gi.org http://www.medscape.com/viewarticle/543068_3

  34. Nodes • Nx cant be assessed • No no nodes • N1 1-6 nodes • N2 7-15 nodes • N3 > 15 nodes

  35. Meatastasis • Mx Mets cant be assessed • Mo No mets • M1 distant mets

  36. Management • Surgery > Curative • 1 Endoscopic mucosal resection • 2 Subtotal gastrectomy distal 2cm & proximal 5 cm clearance(Billroth II) • 3 Total gastrectomy (Roux en y)

  37. Inoperable tumours • Multiple mets liver • Extensive invovolment adjacent organs • SMV/SMA • Carcinomatosisperitonei

  38. Resection • R0 resection > No residual disease • R1 >microscopic residual disease • R2> Macroscopic residual disease • R3> unresectable

  39. Nodal stations • First tier nodes 1-6 nodes • Second tier nodes 7-11 nodes • Third tier nodes 12-18 nodes • D1 dissection nodes are N0 (3-6) • D2 dissection(N1) 1-11 removed • D3dissection(N2)paraaortichepatodudenal D4 1-18 stations

  40. Surgery -contd Palliation • Palliative resection • Palliative by pass Anterior Gastrojejunostomy/feeding jejunostomy • Laser ablation/ stenting • Pain relief

  41. Chemotherapy Adjuvant chemo therapy 5 FU225mg/m2/days 1-5/1-21 Epirubicin50mg/m2 day1 Cisplatin60mg/m2/day1

  42. Chemo for advanced ca • ECF epirubicin/5 FU/Doxorubicin • EOX epirubicin/0xaliplatin/capecitabine • DCF Docetaxel/cisplatin/5FU

  43. Radio therapy-Role • Helpful in palliation for unrsectable tumors(4000cgy 4wks) • IORT (tumour bed)

  44. Prognosis • Early 5 yr survival 70- 90% • Advanced ca less than 20% • Recurrence with in 3 yrs

  45. Gastric lymphoma • Primary- elderly/NHL-B cell type • Mucosal associated lymphoid tissue (MALTOMA)/H.pylori Loss of appetite/pain abdomen/wt loss Mass abdomen Associated SLE/HIV/Ch gastritis etc

  46. complications • Obstruction • Perforation • Bleeding • metastasis

  47. treatment • Treat HP infection • Surgery for obstruction • Chemo same as NHL

  48. GIST-gastroinestinalstromal tumor • Non epithelial /equal sex incidence • 50-70 yrs • Arises from interstitial cell of cajal • Treat surgery • Chemo sunitinib • imatinib

More Related