Stomach Cancer Presentation By Aakashs Chandrsekran

1. GASTROINTESTINAL TRACT DISEAESE
STOMACH CANCER
TO DEPARTMENT OF PATHOLOGY
BY:AAKASHS CHANDRASEKARAN
GRP-1754

2. • High incidence in japan, Chile, Northern Italy, China, Portugal, Russia.
• 2/3 men
• Associated with lower socioeconomic groups.
• In young patient, associated with radiation therapy or chemotherapy for
other malignancies.
• H.Pylori.
• Environmental and dietary factors.
• Precursor Lesions
• Gastric Dysplasia, adenomas, Chronic Gastritis, and Barrett’s esophagus.
EPIDEMIOLOGY:

3. The stomach wall is made up of 5
layers:
• mucosa
• submucosa
• muscularis layer
• subserosal layer
• serosal layer
Stomach carcinoma, also carcinoma of the stomach and gastric
carcinoma, is an epithelial derived malignant tumour that arises from
the stomach.
Many gastric carcinomas form glands and can thus be called gastric
adenocarcinoma or adenocarcinoma of the stomach.

4. CLASSIFICATION
• Gross
• Exophytic
• Ulcerated
• Endophytic
• Micro
• Intesinal
• Diffuse

5. GROSSLY

6. CLASSIFICATION
• Intestinal: Majority, arise from complete type intestinal
metaplasia;pattern of genetic alteration resembles colon carcinoma.
• Diffuse: Arise directly from gastric foveolar epithelium, poorer
prognosis.More often composed of signet-ring cells.
• The depth of invasion and the extent of nodal and distant metastasisi at
the time of diagnosis remain the most powerful prognostic indicators
in gastric cancer.

7. MICROSCOPICALLY
Intestinal
Linitis Plastica
Signet-Ring cells

8. TNM CLASSIFICATION
Primary Tumour (T)
T1 - Tumor invades lamina propria/Submucosa
T1a-Lamina propria
T1b-Submucosa
T2 – Tumor invades muscular propria
T3 – Tumor ivolves subserosa
T4a – Tumor perforates serosa
T4b – Tumor invades adjacents organs

9. Distant Metastasis (M)
M0: No distant Metastasis
M1: Distant metastasis (this includes
peritoneum and distant lymph
nodes)
Regional lymp Nodes (N)
N0: No lymph nodes
N1: Metastasis in 1-2 regional nodes
N2:Metastasis in 3-6 regional nodes
N3a:Metastasis in 7-15 regional
nodes
N3b:Metastasis in more than 15
regional nodes

10. COMPLICATIONS
• direct mortality rate within 30 days after a surgical
procedure for gastric cancer has been reduced substantially
over the last 40 years
• most major centers report a direct mortality rate of 1-2%
• early postoperative complications include anastomotic failure,
bleeding, ileus, transit failure at the anastomosis, cholecystitis (often occult
sepsis without localizing signs), pancreatitis, pulmonary infections, and
thromboembolism
• further surgery may be required for anastomotic leaks
• late mechanicophysiologic complications include dumping
syndrome, vitamin B-12 deficiency, reflux esophagitis, and
bone disorders, especially osteoporosis
• postgastrectomy patients often are immunologically
deficient, as measured by blastogenic and delayed
cutaneous hypersensitivity responses.

11. CAUSES
Gastric cancer may often be multifactorial:
• inherited predisposition
• environmental factors
• diet
• smoking
• Helicobacter pylori infection
• previous gastric surgery
• pernicious anemia
• adenomatous polyps
• chronic atrophic gastritis
• gastric ulcers
• radiation exposure
• obesity
• bisphosphonates

12. METASTASES
• Metastasis to regional lymph nodes:
• Supraclavicular sentinel lymph node (Virchow node),
• Periumbical Lymph node (Sister Mary Joseph nodule),
• The left axillary lymph node (Irish node),
• The Ovary (Krukenberg Tumor).
Lymph node Metastasis: To regionala lymph nodes in
small and large curvature of stomach, in omentum.
Distant Metastasis: More often in Liver and Lung

13. TREATMENT
• Surgical Care
• Adjuvant therapy
• adjuvant radiotherapy
• Intraoperative radiotherapy
• adjuvant chemotherapy
• advanced unresectable disease

14. Prognostic Features:
Stage, invasion and lymph node involvement are the
most significant prognostic factors.
Clinical classification:
Superficial cancer>Focal cancer>Infiltrative cancer.
Grade: High histologic grade- poor prognosis.