Gastric cancer

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Gastric cancer

  1. 1. Dr. Amina Abdul Rahman Junior Resident Dept. of Radiotherapy
  2. 2.  Epidemiology  Anatomy  Classification  Pathology  Clinical Features  Staging  Prognosis
  3. 3. Epidemiology
  4. 4.  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
  5. 5. But the incidence of proximal gastric cancers is increasing in the west…
  6. 6.  Most common site was Antrum 48%  40% was found to be in the body  10% was found to be in the proximal stomach
  7. 7. GEJ Tumors Cardia Tumors
  8. 8.  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
  9. 9. 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
  10. 10.  Radiation exposure  Prior Gastric surgery for benign ulcer disease
  11. 11.  Genetic Factors Type A blood group Pernicious anemia Family history HNPCC Li-Fraumeni syndrome Peutz Jegher Syndrome BRCA2 mutation
  12. 12.  Fresh fruits and vegetables  NSAIDs
  13. 13.  CDH1mutation  Codes for E-Cadherin  Prophylactic gastrectomy
  14. 14. 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
  15. 15. ANATOMY
  16. 16. 12 – Hepatoduodenal ligament 13 – On the posterior surface of the head of pancreas 14 – Root of mesentery 15 – Para aortic 16 - Paracolic
  17. 17. Classification of Gastric Tumors
  18. 18. 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
  19. 19. Early Gastric Cancer •T1a and T1b, any N Advanced Gastric Cancer •T2 and above
  20. 20. PATHOLOGY
  21. 21. WHO Classification •On histologic appearance alone Lauren’s Classification •Histology and morphology
  22. 22.  Epithelial tumors Adenocarcinoma Small cell carcinoma Carcinoid tumor  Malignant Lymphoma Maltoma Mantle cell lymphoma DLBCL
  23. 23.  Non epithelial tumors Leiomyoma Schwannoma Granular cell tumor Leiomyosarcoma GIST Kaposi Sarcoma
  24. 24. ADENOCARCINOMA  Tubular  Papillary  Mucinous  Signet ring cell carcinoma  Undifferentiated
  25. 25. Intestinal type •54% Diffuse type •32%
  26. 26.  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
  27. 27. Chronic atrophic gastritis Intestinal metaplasia Dysplasia Carcinoma in situ
  28. 28.  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
  29. 29.  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
  30. 30. CLINICAL FEATURES
  31. 31.  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
  32. 32.  Adjacent organ invasion  Hematogenous spread  Peritoneal Seeding: Krukenberg tumor Blumer Shelf  Lymphatic spread: Virchow’s node (Troisier’s sign) Irish node
  33. 33. TNM Staging
  34. 34.  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
  35. 35.  Involving Lymph node stations 12 onwards  Omental deposits  Positive peritoneal cytology
  36. 36. Prognostic Factors
  37. 37.  Age  Sex  Primary tumor Site  Lauren Classification  Number of Positive and Negative lymph nodes  Depth of invasion
  38. 38. Disease specific survival
  39. 39. To Be Continued….

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