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GASTRICCARCINOMA

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Outline1. Overview

2. Risk Factor

3. Clinical Feature4. Investigation

5. Management

6. Conclusions

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Overview1. Worlwie! 4t" most common cancer an 2n most

common cause o# eat"

2. More common in male! age $5% &ears ol

3. '"e etiolog& is multi#actorial (ut ). *&lori is anim*ortant #actor #or istal not *ro+imal gastriccancer

4. ,oor *rognosis

 – earl& gastric cancer - 5 &ears survival rate $%/

 – avance gastric cancer- 5 &ear survival rate02%/.

5.  '"e incience in  1% cases *er 1%% %%%*o*ulation! In a*an t"e isease is muc" more

common % cases *er 1%% %%% *o*ulation.

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Risk Factor

1. Diet  "ig" nitrate! "ig" salt! low #at 7 *rotein

2. Environmental  raiation e+*osure!

occu*ational8 coal mining! ru((er or as(estosrelate9! low socioeconomic grou*! smoker!nitrosamine e+*osure

3. Medical  ).*&lori in#ection! *rior gastric

surger&! gastritis! aenematous *ol&*!*ernicious anemia! "&*ogammaglo(ulinaemia

4. Family history o# gastric cancer

5. Others

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Clinical #eatureSymptoms

• Inigestion 8:&s*e*sia9

• ;ausea or vomiting

•:&s*"agia

• ,ost*ranial #ullness

•

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Clinical #eatureSigns

• ,al*a(le enlarge stomac"

• =nlarge l&m*" noes suc" as >irc"ow

noes 8ie! le#t su*raclavicular98'roisiersign9 an Iris" noe 8anterior a+illar&9

•  '"rom(o*"le(itis 8trousseaus sign9

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Classi?cation1. The most se!l classi"cation is

the #aren classi"cation

2. $ntestinal gastric cancer and

di%se gastric cancer.

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=arl& gastric carcinoma vance gastric carcinoma

-When the cancer invasion is confined to

mucosa or submucosa. (T1, with or

without lymph node involvement)

-Is curable but if it is associated withlymph node it have 9! survival rate

- "se the #apanese

classification(protrudin$, superficial,

or e%cavated)

-When there is invasion into muscularis

 propria and beyond

- &acroscopic appearance have been

classified by 'ormann into fourtypes.

- Type and are commonly

incurable.

"sually within the lower *+rd ofstomach

! confined to the antrum

ave e%cellent pro$nosis-year survival

rate of 9!

ecurrence rate is *! due to/ esidual or remnant tumor  emato$enous spread

5 &ear survival rate 02%/.

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$nvestigation 1. **er gastrointestinal

enosco*& 8O@:9 wit"(io*s&

2. :ou(le contrast (arium mealto ?n an& irregular ?llinge#ect! ela&e em*t&ing or

istorte outline o# stomac".

3. =nosco*ic ultrasoun to "el*in staging (& ienti#&ing localstomac" invasion an noal

status.

4. Ot"er moalities suc" as CAR!C' scan an la*arasco*&.

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taging 7 =valuation1. &ltrasond o! a'domen etect liver

metastases! ascites! *elvic e*osition!kruken(erg tumour

2. #iver !nction test etect livermetastases

3. (hest )*ray lung metastases

4. #aparoscopy ienti#&macromatastases smaller t"an 5mm in*eritoneum an liver

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tumor noe metastasis '1 - 'umour involves lamina

*ro*ria

 '2 - 'umour invae muscularis

or su(serosa

 '3 - 'umour involves serosa

 '4 - 'umour invaes aBacent

organs

;+ - regional

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ManagementSrgery

 – Raical gastrectom&

 – 'otal gastrectom&

 –

u(total gastrectom&

-alliative therapy

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Conclusion1. astric cancer is one o! the most

common cases o! cancer death in the/orld.

2. The aetiology o! gastric cancer ismlti!actorial 't 0.pylori is animportant !actor !or distal gastric(ancer.

3. (an 'e classi"ed into intestinal and

di%se types. +#aren classi"cation,4. Early gastric cancer is associated /ith

high cre rates

5. The de"nitive treatment is gastrectomy.

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Com*lications8**er@it lee9

COM,

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;=MI

loo cellloses #rom(o&

o& tissue lacko# o+&gen an

nutrients su**l&

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)&*ovolemic s"ock

evere(leeing

:ecreasevolume o#

(loo

)eart neeto *um* tocom*ensate

)&*o*er#usion to organs

)&*otension

&m*toms o#"ock-

19Cool 7 clamm&skin

29

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C'= M;@=M=;' OF COM,

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