Gastric cancer is one of the lethal cancer. Regional variation varies with high incidence in japan. Recent molecular inventions sa her2neu amplification has resulted in somehow better OS

2. 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
pyloric antrum.

3. 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
into portal
drainage
system. The
of the
lymphatic
stomach
corresponding its blood supply.

4. Histology
Consist of four layers
serous layer
muscular layer
submucous layer
mucous layer

5. PHYSIOLOGY
Function:
1. Digestion of food, reduce the size of food
2. Acts as reservoir
3. Absorption of Vit. 12,iron and calcium
Stimulant of Gastricsecretion:
1. Gastrin -----> (+) parietal cell
2. Acetylcholine (vagus) ---> (+) gastric cells
3. Histamine (mast cells) ---> parietal &chief cells

6. Carcinomastomach
Clinical Presentation
Diagnosis
Staging
Treatment
Screening

8. Spectrum of gastriccancer
Proposed progression:
chronic gastritis -->
chronic atrophic gastritis -->
intestinal metaplasia-->
dysplasia -->
adenocarcinoma

10. RiskFactors for gastriccancer

15. Precursors of GastricCancer
Adenomatous polyps
Chronic atrophic gastritis
Pernicious gastritis
Menetries’s disease
Previous gastric surgery for non- cancerous
conditions

16. Symptoms at presentation

17. Signs
Palpable abdominal mass: most common physical
finding
If cancer spreads via lymphatics…
Left supraclavicular node (Virchow’s)
Periumbilical node (Sister MaryJoseph)
Left axillary node (Irish)
Enlarged ovary (Krukenberg's tumor)
Ascites

18. Investigations
Routine blood examination
low hemoglobin , high ESR
stool examination for occult blood
gastric function test - will reveal gross hypo / achlorhydria
Endoscopy– helpful in diagnosing early cases and taking biopsy
Ultrasonography - helps in assesing thickening of agstric wall,
local invasion, peritoneal involvement , ascitis
CT scan - extent of the disease , lymph node involvement , liver metastasis
Barium studies
Staging laproscopy

19. Diagnosis
Endoscopy
Gold standard
Single biopsy from ulcer -> sensitivity ~70%
Seven biopsies from ulcer -> sensitivity>98%
Brush cytology increases sensitivity of single biopsies,
aid in multiple biopsies unclear

21. Stagingof GastricCancer
Two systems:
Japanese classification (more elaborate and anatomic
based)
Western: developed by American Joint Committeeon
Cancer (AJCC) and International Union Against
Cancer (UICC) -- more widelyused
Tumors at GE junction of incardia of stomach
within 5cm of GEjunction
Classified using esophageal staging

22. Gastric carcinoma
CLASSIFICATION
Depth of invasion
EARLYGASTRIC CA- mucosa & submucosa
ADVANCED GASTRIC CA- into or through
muscularis propria
Macroscopic growth pattern – Ming classification
Expanding
Infiltrative - "linitis plastica"
Histologic subtype
Intestinal
Diffuse (gastric); poorly differentiated; "signet ring"
cells

23. Gastric carcinoma
CLASSIFICATION
WHO Classification:
1. Adenocarcinoma:
a. Papillary adenocarcinoma
b. Tubular adenocarcinoma
c. Mucinous adenocarcinoma
d. Signet-ring cell carcinoma
2. Adenosquamous carcinoma
3. Squamous cell CA
4. Small cell CA
5. Undifferentiated CA
6. Others
Lauren Classification:
1. Intestinal type (53%)
2. Diffuse type (33%)
3. Unclassified (14%)
Ming Classification:
1. Expanding type (67%)
2. Infiltrative type (33%)

24. Histologic type:
1. Papillary
2. Tubular
3. Mucinous
4. Signet ring
Mode of spread:
1. Direct
2. Lymphatic
3. Hematologic
4. Transcoelomic route

27. Linitis Plastica
Diffuse-type gastric cancer
Tumor often infiltrates thesubmucosa
and muscularis propria
Superficial biopsies may be falselynegative
Combination of strip and bite biopsy
needed if suspicious for linitis plastica

28. Linitis Plastica, “leather bottlestomach”

29. Stagingworkup
Serologic markers
CEA, CA-125, CA19-9, CA72-4 may be elevated but
have low sensitivity/specificity
None are diagnostic
Preoperative elevation in markers usually pretendshigh
risk of adverse outcome
No serologic finding should exclude surgical
consideration

30. AJCCStaging System

32. Treatment
Locoregional (stage I-III) disease
Potentially curable
multidisciplinary evaluation and considerationof
surgery
Advanced (stage IV) disease
Palliative therapy
Studies indicate longer survival and better quality of life
with systemic treatment

33. Screening
Mostly barium studies, EGD in concerning findings.
Some use serum pepsinogen testing for high risk
with EGD confirmation.
H. pylori: sensitivity 88%, specificity 41%(Japan).
5-year survival 74-80 in screened group, 46-56%
fornon- screened group.