1gastric Carcinoma

7/25/2019 1gastric Carcinoma

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GASTRIC CARCINOMA

Professor Ravi KantFRCS (England), FRCS (Ireland),

FRCS(Edin!rg"), FRCS(Glasgo#), MS, $N%,

FAMS, FACS, FICS,

Professor of S!r er


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GASTRIC NEOPLASM

E'it"elial

Mesen"&al

1.PrimaryAdenocarcinomaGastrointestinal stromaltumors GISTLym!"oma

#. Secondary$in%asion &rom ad'acent

tumors.

%enign Malignant


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Gastri Carinoa

55 year old Japanese male who is living in

Japan & working in industry.

$EFINITION Malignant lesion of t"e stoa"*

E'ideiolog& + Ris Fators

Can o!r at an& age%!t Pea inidee

Is -./0.&ears old*

It is ore aggressive

In &o!nger ages*

1a'an "as t"e #orld

"ig"est Rate ofgastri aner*

St!dies "ave onfiredt"at inidene deline in

1a'anese iigrant to

Aeria*

d!st ingestion

fro a variet&of ind!strial

'roesses

a& e a ris*

Twise more common

In male than in female

Inidene of GastriCarinoa2

1a'an 0.in3..,...4&ear

E!ro'e 5.in 3..,...4&ear

6K 3-in 3..,...4&ear

6SA 3.in 3..,...4&earIt is dereasing #orld#ide*


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Gastri Carinoa2

Ris Fators

Predis'osing 2

3*Perniio!s aneia

+ atro'"i gastritis

(a"lor"&dra)

7*Previo!s gastri

resetion

8*C"roni 'e'ti !ler

(give rise to 39)

5* Soing*

-*Alo"ol*

Environental2

3*:*'&lori infetion

Sero(;)'atients

"ave


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Clinial Presentation

Most 'atients 'resent #it" advaned stage**

#"&>

T"e& are often as&'toatiin earl& stages*

Coon linial Presentation2T"e 'atient o'lained ofT"e 'atient o'lained of loss of a''etiteloss of a''etitet"at #ast"at #as

follo#ed &follo#ed & #eig"t loss#eig"t lossof 3.Kg in 5 #ees*of 3.Kg in 5 #ees*

:e "ad notie:e "ad notie

e'igastri disofort + 'ost'randial f!llness*e'igastri disofort + 'ost'randial f!llness*

:e 'resented to t"e ER o'laining of:e 'resented to t"e ER o'laining of voitingvoiting ofof

large ?!antities of !ndigested food + e'igastrilarge ?!antities of !ndigested food + e'igastri

distension*distension*

$&s'e'sia

e'igastri 'ain

%loating

earl& satiet&

na!sea + voiting@d&s'"agia@

anoreia

#eig"t loss

!''er GI leeding

("eateesis, elena,

iron defiien& aneia)


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si(ns

-Anemia.

-Wt.loss cache!ia"

-#pigastric mass$%epatomegaly$Ascitis

-Jaundice.

-lumers shelf

-'irchows node

-(ister mary )oseph node-*ruken+erg tumor

-Irish node
http://srd.yahoo.com/S=96062857/K=Jaundice/v=2/l=II/R=5/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Jaundice&vm=i&n=20&fl=0&h=263&w=400&imgurl=catalog.cmsp.com/datav3/fl050011.jpg&name=fl050011.jpg&p=Jaundice&rurl=http://catalog.cmsp.com/datav3/im050011.htm&no=5&tt=629http://srd.yahoo.com/S=96062857/K=Jaundice/v=2/l=II/R=15/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Jaundice&vm=i&n=20&fl=0&h=450&w=600&imgurl=medicine.ucsd.edu/clinicalmed/jaundice.JPG&name=%3Cb%3Ejaundice%3C/b%3E.JPG&p=Jaundice&rurl=http://medicine.ucsd.edu/clinicalmed/abdomen.htm&no=15&tt=629


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Pat"olo(y)IO Classi*cation

LaurenClassi*cation$

1. Intestinal Gastric ca.

It arises in areas o& intestinalmeta!lasia to &orm !oly!oid tumors orulcers.

#. )i+use Gastric ca.It in*ltrates dee!ly in t"e stomac",it"out &ormin( o-%ious mass lesions -uts!reads ,idely in t"e (astric ,all LinitisPlastica/

0 it "as muc" more ,orse !ro(nosis


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Gastric cancer can be devidedinto:

Early$

Limited to mucosa 0 su-mucosa ,it" or,it"out LN 3T14 any N5

66 cura-le ,it" 7 years sur%i%al rate in89:.

Ad%anced$

It in%ol%es t"e Muscularis.

It "as ; ty!es3


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T1 lamina propria & submucosa

T2 muscularis & subserosa

T3 serosaT4 Adjacent organs

N0 no lymph node

N1 Epigastric node

N2 main arterial trunk

0 No distal metastasis

1 distal metastasis

Staging of gastri anerS'read of Gastri Caner

$iret S'read

%lood/orne

etastasis

B&'"ati s'read

Trans'eritoneal

s'read

T!or 'enetrates t"e

!s!laris, serosa +Adaent organs

(Panreas,olon +liver)

D"at is i'ortant "ere is

ir"o#s node

(Trosiers sign)

6s!all& #it" etensive

$isease #"ere liver 3st

Involved t"en l!ng +

%one

T"is is oon

An"ere in 'eritoneal avit&

(Asitis)

Kr!energ t!or (ovaries)

Sister 1ose'" nod!le

(!ili!s)


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Com!lications

eritoneal and pleural effusion

0+struction of gastric outlet or small +owel

leeding

Intrahepatc )aundice +y hepatomegaly


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)i+erential )ia(nosis)i+erential )ia(nosis

1.2astric ulcer

3.0ther gastric neoplasms

4.2astritis

.2astric olyp

5.6rohns disease.

Fro "istor&,

Caner is not relieved & antaids

Not 'eriodi

Not releived & eating or voiting*


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IN=ESTIGATIONS

>ull -lood count ?I)A@

L>T4R>T

Amylase 0 li!ase.Serum tumor marers 3CA B#@;4CEA4CA18@85 not s!eci*c

Stool e2amination &or occult -lood

CR 4


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S!eci*c$DGI endosco!y ,it" -io!sy

)ou-le contrast study

CT4 MRI 0 DS

La!arosco!ry


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EG$ eso'"agogastrod!odenoso'&

$iagnosti a!ra& is =9 if !'to 0 io'sies is taen*

$o!le Contrast ari! !''er GI /ra&

$iagnosti a!ra& =.9

D:H>

$iagnosti st!d& of C"oie

3*Earl& s!'erfiial gastri !osal lesion

an e issed*

7* ant differentiate4# enign !ler +

6lerating adenoarinoa*


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/ra& s"o#ing Gastri !ler

Dit" s&etrial radiating

M!osal folds*

%& "istolog&, no evidene of

Malignanies #as oserved*

/ra& s"o#ing Etensive

arinoa involvingt"e ardia + F!nd!s

P&lori stenosis


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CT,MRI + 6S2

Ba'aroso'&2

%elp in assessment of wall thickness$

metastases peritoneum $liver & /7s"

8etection of peritonealmetastases


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T:E GOB$ STAN$AR$

It allows taking +iopsies

(afe in e!perienced hands"

UGI ENDOSCOPY


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UGI ENDOSCOPY,contd.

Ho! a& see an !ler (7-9),'ol&'oid ass (7-9), s!'erfiials'reading (3.9),or infiltrative(linnitis 'lastia)/diffi!lt to edeteted/

A!ra& -./=-9 it de'ends on

gross a''earane,siJe,loation +no* of io'sies


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IF YOU SEE ULCER ASK UR SELFBENIGN OR MALIGNANT?

BENIGN MALIGNANT Ro!nd to oval '!n"ed o!tlesion #it" straig"t #alls +

flat soot" ase

Irreg!lar o!tline #it"neroti or "eorr"agi

ase

Soot" argins #it"noral s!rro!nding

!osa

Irreg!lar + raised argins

Mostl& on lesser !rvat!re An"ere

Maorit&7 An& siJe

Noral adoining r!galfolds t"at etend to t"e

argins of t"e ase

Proinent + edeato!sr!gal folds t"at !s!all& do

not etend to t"e argins


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Mana(ement

, S!rger&

, C"eot"era'& NO PROVEN BENEFIT

, Radiot"era'&


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TreatentTreatent

Initial treatent2

3*I'rove n!tritionif

needed & 'arentral

or enteral feeding*7*Corret fl!id

+eletrol&te

+ aneia if t"e& are'resent*

Preo'erative Care

Preo'erative Staging is

i'ortant ea!se #edont #ant to s!et

t"e 'atient to radial

s!rger& t"at ant "el'

"i*


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PRE-OPERATIVE CARECaref!l 'reo'erative staging

Sreen for an& n!tritional defiienies +onsider n!tritional s!''ort

S&'toati ontrol

%lood transf!sion in s&'toati aneia

:&dration

Pro'"&lati antiiotis

A%O + rossat"

As ao!t !rrent ediations + allergiesCessation of soing


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BASIC SURGICAL PRINCIPLES

8 THPES2

TOTAB,S6%TOTAB,PABBIATIE

ANTRAB $ISEASES6%TOTAB

GASTRECTOMH

MI$%O$H + PROIMAB TOTAB

GASTRECTOMH


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TOTAL RADICAL! GASTRECTOMY

o Reove t"e stoa" ;distal 'artof eso'"ag!s; 'roial 'art of

d!den! ; greater + lesseroenta ; BNs

o Oeso'"agoe!nosto& #it" ro!/

en/& *


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SUBTOTAL GASTRECTOMY

Siilar to total one ee't t"at t"e

PROIMAB PART of t"e stoa"

is 'reserved

Follo#ed & reonstr!tion +

reating anastoosis

( & gastroe!nosto&,illrot" II )


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PALLIATIVE SURGERY

, For 'ts #it" advaned (ino'erale)disease + s!ffering signifiants&'tos e*g* ostr!tion,

leeding*, Palliative gastreto& not

neessaril& to e radial, reove

resetale asses + reonstr!t(anastoosis4int!ation4stenting4

reanalisation)


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POSTOPERATIVE ORDERS

, Adit to PAC6

, $etailed n!tritional advise (sall

fre?!ent eals)


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Post/O'erative Co'liations

3*3*Beaage fro

d!odenal st!'*

7*7*Seondar&

"eorr"age*

8*8*N!tritional

defiien& in long

ter*


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2.Chemotherapy:

Res!onds ,ell4 -ut t"ere is no e+ect onser%i%al.

Marsden Re(imen

E!iru-icin4 cis!latin 07@urouracil 3 ,s5

F cyclesRes!onse rate $ ;9: .

3. Radiotherapy:ostperative-radiotherpy9may decrease the

recurrence.


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reventive measuresreventive measures

%& diet%& dietConvining2Convining2

vegetale + fr!its*

Proale2Proale2

it*C +E

PossilePossile

Carotenoids,#"ole grean ereals and green tea*Soing essation

Cessation of alo"ol intae

Earl& diagnosis reains t"e Ke&

Prole


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PROGNOSTIC FEATURES

7 i'ortant fators infl!ening s!rvival inresetale gastri aner2

de't" of aner invasion

'resene or asene of regional BNinvolveent

, -&rs s!rvival rate23.9 in 6SA

-.9 in 1a'an


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Gastrointestinal Stromal TumorGIST

Pre%iously leiomyoma ! leomyosarcoma.

1 :

Rarly cause -leedin( or o-struction.

T"e ori(ion$ Intestinal Cells o& Ca'al ICCHs

autonomic ner%ous system.T"e distinction -, -eni(n 0 mali(nant is

unclear. In (eneral terms4 t"e lar(er t"etumor 0 (reater mitotic acti%ity4 t"e moreliely to metastases.

T"e stomac" is t"e most common site o&GIST.


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Dsually are disco%ered incidentallyon endosco!y or -arium meal

T"e endosco!ic -io!sies may -eunin&ormati%e -cJ t"e o%erlyin(mucosa is usually normal

Small tumors,ed(e resection

Lar(er ones(astrectomy


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Gastric Lymphoma

Most common !rimary GILym!"oma .

Its increasin( in &reKuency.

"resentation:

Similar to (astric carcinoma.

May re%eal !eri!"eral adeno!at"y4a-dominal mass or s!leenome(aly.


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$iagnosis2

1.EG) #.contrast GI 2@ray.

.CT (uided *ne needle -io!sy.Treatment $

1.sur(ery$total or su-total (astrectomy,it" s!leenectomy or !alliati%e resection.

#.Ad'unct radiot"era!y$ may im!ro%e 7year sur%i%al

.Ad'unct C"emot"era!y$may !re%ent

recurrance.

Bailey & Loves short


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E-medicine web siteThe Washington ManualSurgery

yractice of surgery!linical surgery" #$cuschieri%$

1gastric Carcinoma

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