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Gastric cancer
 

Gastric cancer

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    Gastric cancer Gastric cancer Presentation Transcript

    • Dr. Amina Abdul Rahman Junior Resident Dept. of Radiotherapy
    •  Epidemiology  Anatomy  Classification  Pathology  Clinical Features  Staging  Prognosis
    • Epidemiology
    •  Fourth most common cancer in the world  Second most common cause of cancer related death  Marked geographic variation  High risk areas : Japan, Korea, Latin America, USSR  Low risk areas: USA, Israel, Kuwait, Canada
    • But the incidence of proximal gastric cancers is increasing in the west…
    •  Most common site was Antrum 48%  40% was found to be in the body  10% was found to be in the proximal stomach
    • GEJ Tumors Cardia Tumors
    •  Acquired High salt consumption High nitrate consumption Poor food preparation (smoked, salt cured) Lack of refrigeration Diet low in Vit A and C Smoking, heavy alcohol consumption
    • Helicobacter pylori  3 to 6 times increase in risk of gastric cancer  intestinal type of cancer in the distal stomach  Decreases acid production causing chronic atrophic gastritis
    •  Radiation exposure  Prior Gastric surgery for benign ulcer disease
    •  Genetic Factors Type A blood group Pernicious anemia Family history HNPCC Li-Fraumeni syndrome Peutz Jegher Syndrome BRCA2 mutation
    •  Fresh fruits and vegetables  NSAIDs
    •  CDH1mutation  Codes for E-Cadherin  Prophylactic gastrectomy
    • Proximal Gastric Cancer Distal Gastric Cancers Includes GEJ, Tumors of the Cardia Includes Body and Antrum Rapidly increasing incidence in the west World wide incidence is declining steadily Mainly diffuse type Mainly intestinal type M:F = 1:1 M>F Younger age Older age More aggressive Less aggressive More in the developed countries More in developing countries Not associated with H. pylori Associated with H. pylori Associated with GERD Associated with atrophic gastritis
    • ANATOMY
    • 12 – Hepatoduodenal ligament 13 – On the posterior surface of the head of pancreas 14 – Root of mesentery 15 – Para aortic 16 - Paracolic
    • Classification of Gastric Tumors
    • Type I : Adeno Ca Distal Esophagus, infilt GEJ from above Type II : Adeno Ca of the real cardia, true GEJ Type III : Subcardial Gastric Adenoca, infilt GEJ from above
    • Early Gastric Cancer •T1a and T1b, any N Advanced Gastric Cancer •T2 and above
    • PATHOLOGY
    • WHO Classification •On histologic appearance alone Lauren’s Classification •Histology and morphology
    •  Epithelial tumors Adenocarcinoma Small cell carcinoma Carcinoid tumor  Malignant Lymphoma Maltoma Mantle cell lymphoma DLBCL
    •  Non epithelial tumors Leiomyoma Schwannoma Granular cell tumor Leiomyosarcoma GIST Kaposi Sarcoma
    • ADENOCARCINOMA  Tubular  Papillary  Mucinous  Signet ring cell carcinoma  Undifferentiated
    • Intestinal type •54% Diffuse type •32%
    •  Form exophytic or ulcerated growth  More in the distal stomach  Due to H. pylori  This type is declining worldwide  Older patients with a male preponderance  M:F = 2:1  Better prognosis  Form glandular elements in histology
    • Chronic atrophic gastritis Intestinal metaplasia Dysplasia Carcinoma in situ
    •  Mainly affects cardia  Form infiltrative lesions  No precancerous lesions  Loss of CDH1 gene  Discohesive cells that do not form glands  Signet ring cells  Younger age, M = F  Worse prognosis
    •  Her2-neu amplification in 12 to 27%  More in intestinal type than diffuse type  Prognostic significance has not been identified  4 tier scoring  Trastuzumab in Her2-neu 3+ or FISH positive locally advanced or metastatic stomach cancer
    • CLINICAL FEATURES
    •  Lesions of proximal stomach – Dysphagia  Diffuse infiltrative lesions produce early satiety  Gastric outlet obstruction  Trousseau sign  Blumer’s Shelf  Virchow’s node (Troisier’s sign)  Irish node  Sister Mary Joseph Nodule
    •  Adjacent organ invasion  Hematogenous spread  Peritoneal Seeding: Krukenberg tumor Blumer Shelf  Lymphatic spread: Virchow’s node (Troisier’s sign) Irish node
    • TNM Staging
    •  N0 : No regional lymph node metastases  N1 : 1to 6 regional lymph node metastases  N2 : 7 to 15 regional lymph node metastases  N3 : More than 15 regional lymph node metastases
    •  Involving Lymph node stations 12 onwards  Omental deposits  Positive peritoneal cytology
    • Prognostic Factors
    •  Age  Sex  Primary tumor Site  Lauren Classification  Number of Positive and Negative lymph nodes  Depth of invasion
    • Disease specific survival
    • To Be Continued….