Gastric Tumour (1)

8/10/2019 Gastric Tumour (1)

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Dr. Saleh M. Al Salamah


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GASTRIC TUMOURS

Anatomy of the stomach

Aetiology of Gastric cancer

Types of Gastric cancer

Pathology of Gastric Cancer

Evaluation of Gastric Cancer

Treatment of Gastric Cancer


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ANATOMY:

The stomach J-shaped. The stomach

has two surfaces (the anterior &posterior), two curvatures (the greater &

lesser), two orifices (the cardia &

pylorus). It has fundus, body and pyloricantrum.


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BLOOD SUPPLY:

a.

The left gastric artery

b. Right gastric artery

c. Right gastro-epiploic artery

d.

Left gastro-epiploic artery

e. Short gastric arteries

The corresponding veins drain intoportal system. The lymphatic drainage

of the stomach corresponding its blood

supply.


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AETIOLOGY:

Gastric cancer is the second most

common fatal cancer in the world with

high frequency in Japan.

The disease presents most commonly in

the 5th and 6thdecades of life and affectmales twice as often as females.

o t


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The cause of the disease multistep processbut several predisposing factors attributedto cause the disease :

a.

Environment

e.

Atrophic gastritis

b. Diet f. Chronic gastric ulcer

c. Heredity g. Adenomatous polyps

d.

Achlorhydria

h.

Blood group A

i. H. Pyloric colonisation


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TYPES OF GASTRIC CANCER:

A. Benign Tumours

B. Malignant Tumours


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The benign groups includes:-

1. Non-neoplastic gastric polyps

2.

Adenomas

3. Neoplastic gastric polyps

4.

Smooth muscles tumours benign

(Leiomyomas)

5. Polyposis Syndrome (eg:- Polyposis coli,

Juvenile polyps and P.J. Syndrome)

6. Other benign tumours are fibromas, neurofibromas, aberrat pancreasand

angiomas.


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PATHOLOGY OF GASTRIC (MALIGNANT)TUMOURS:

The gastric cancer may arise in

the antrum (50%), the gastric

body (30%), the fundus or

oesophago-gastric juntion (20%).


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Types of Malignant Tumours:

a. Adenocarcinoma

b.

Leiomyosarcoma

c. Lymphomas

d.

Carcinoid Tumours


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1. Polypoid or Proliferative

2. Ulcerating

3. Ulcerating/Infiltrating

4.

Diffuse Infiltrating (Linnitus-

Plastica)

The macroscopic forms of gastric cancers are

classified by (Bormann classification)into:-


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Microscopically the tumours commonlyadenocarcinoma with range of

differentiation. The most useful to

clinician and epidemiologist is Lauren

Histological Classification:

a. Intestinal gastric cancer

b.

Diffuse gastric cancer


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Early Gastric Cancer: Defined ascancer which is confined to themucosa and submucosa regard-

less of lymph nodes status.

Advanced Gastric Cancer:Defined as tumor that has involved

the muscularis propria of the

stomach wall.


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STAGING OF GASTRIC CANCER:

a. TNM System

b. CT Staging

c. PHNS Staging System (Japanese)

P-factor (Peritoneal dissemination)

H-factor (The presence of hepatic metastases)

N-factor (Lymphnodes involvement)

S-factor (Serosal invasion)


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SPREAD OF GASTRIC CANCER:

The diffuse type spreads rapidly

through the submucosal and serosallymphatic and penetrates the gastric

wall at early stage, the intestinal variety

remains localized for a while and has less

tendency to disseminate.

The spread by:

1.

Direct (loco regional)

2. Lymphatic

3. Blood (Haematogenous)

4. Transcoelomic


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EVALUATION OF GASTRIC CANCER:

History

Clinical Examination

Investigations

The clinical features of gastric cancermay arise from local disease, its

complications or its metastases.


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INVESTIGATIONS:

A. Upper gastero intestinal endoscopy

with multiple biopsy and brush

cytology

B.

Radiology:

CT Scan of the chest and abdomen

USS upper abdomen

Barium meal

C. Diagnostic laparoscopy


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TREATMENTS OF GASTRIC CANCER:

Surgery(Early or Advanced Cancer)

Distal tumours which involve the lower (sub-total or

partial gasterectomy).

Proximal tumours which involve the fundus, cardia or

body (total gasterectomy).


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Inoperable tumours: Whenever possible it is advisable

to do even a limited gastric resection. If resection is impossible

an anterior gastrojejunostomy.


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Chemotherapy for gastric cancer

(Pre-operatve & post-operative)

Radiotherapy

(Pre-intra & post-operatively)

OTHER GASTRIC TUMOURS


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OTHER GASTRIC TUMOURS:

Gastric Lymphomas:

Primary lymphomas of the stomach of the non Hodgkins type

(NHL).

The symptoms are similar to those of

gastric cancer (adenocarcinoma).

The diagnosis is made principally from

endoscopic examination with biopsy and

cytology.

CT Scanning is important in staging the

disease.


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Treatment:

-

Well-localized disease should be treatedwith resection (surgery) followed byradiotherapy or chemotherapy.

-

Extensive disease by adjuvant chemo-

therapy & radiotherapy than surgery.


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Leiomyosarcoma:

Arise in the stomach representing 1 of gastric tumors.

They may be sessile or pedanculated projecting into the gastric

lumen or extragastrical or both (dumb-bell tumour).

Presentation due to blood loss anaemia or epigastric mass or vague

dyspepsia.

Malignancy is suggested by the size more than 5cm and confirmed

by noting increased mitosis on histology.


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Gastric Carcinoid Tumour:

Are very rare. There is established association between atrophic

gastritis & carcinoid & pernicious anemia.

Gastric carcinoids are best treated by local resection. If very small

by endoscopic resection.


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