Ca pancreas Ca oesophagus Ca stomach

1. GIT malignancies
Ca Oesophagus
Ca Stomach
Ca Pancreas
Dr Nithin P

2. Ca Stomach
• There are 3 types of Ca stomach
1. Gastric adenocarcinoma
2. Primary gastric
lymphoma
3. Gastric sarcoma

4. Gastric adenocarcinoma
• It is the second most frequent cause of cancer
related deaths worldwide.
• The mortality rate of gastric cancer in the
United States has fallen from 28 to 5.8 per
1,00,000 in men and in women it has fallen
from 27 to 2.8 per 1,00,000
• Japan and China have the worlds highest rates

7. Etiology

13. • Other common etiology are
1. Pernicious anemia
2. Chr atrophic
gastritis
3. Intestinal
metaplasia

14. Pathology
• Adenocarcinomas constitute about 85% of all
gastric cancers.
• It can be divided into 2 types –
1. diffuse type
2. intestinal type

15. Diffuse type
• Here cell cohesion is absent so that individual
cells infiltrate and thicken the stomach wall
without forming a discrete mass.
• They develop throughout the stomach
resulting in leather bottle appearance
• They have poor intercellular adehesion due to
loss of expression of E-cadherin
• This type is common in younger patients
• Linitis plastica has a poor prognosis

18. Intestinal type
• Here cohesive neoplastic cells form glandlike
tubular structures
• They are more common in the antrum and
lesser curvature of stomach
• These are ulcerative lesions and are preceded
by a prolonged precancerous process often
triggered by H.pylori infection

21. Clinical features
• When the lesion is superficial and surgically
curable then it produces no symptoms
• Anorexia with nausea is common
• Weight loss
• Vomiting if involving pylorus
• Dysphagia in diffuse lesions

26. Metastasis
• Gastric carcinomas spread by direct extension
through the gastric walls
• Occasionally may involve pancreas, colon, and
liver

35. Diagnosis
• Double contrast CT scan
• Endoscopy

38. TNM Staging of Ca stomach

39. Treatment
• A subtotal gastrectomy is the treatment of
choice in distal carcinomas
• Total or near total gastrectomies are required
for proximal carcinomas
• It is a relatively radio resistant tumor
• However survival is prolonged when 5-FU +
leucovorin was given in combination with
radiotherapy

43. Prognosis
• The general prognosis is poor
• The five year survival rate is less than 5%

44. Primary gastric lymphoma
• It is relatively uncommon, <15% of all gastric
malignancies
• It is the most frequent site for extra nodal
lymphoma
• The incidence has been increasing in the last
35 years

45. Clinical features
• Epigastric pain
• Early satiety
• Generalised fatigue

46. Diagnosis
• Enodoscopy with deep biopsy
• Contrast radiographs

47. Treatment
• Antibiotic therapy to eradicte H.pylori
infection
• Subtotal gastrectomy with chemotherapy(
cyclophosphamide, doxorubicin, vincristine)
• Radiation therapy does not have a role

48. Gastric lymphoid sarcoma
• They make up 1-3% of all gastric carcinomas
• Most frequently involve the anterior and
posterior walls of the gastric fundus
• Gastric ulcers are a predisposing factors
• They do not metastatise to the lymph nodes
but it may spread to the liver and lungs

49. • The treatment of choice is surgical resection
• A combination of 5-FU with irenotecan is
given post surgery to patients with metastatic
spread.

51. • It is the fourth leading cause of cancer death
• The most common age group at diagnosis is
65-84
• Cancer pancreas continues to have a poor
prognosis which has not improved in the past
5 decades
• They have the lowest five year survival rate

54. The most common sites
for Ca Pancreas

56. Risk factors

64. Clinical features

68. • Other clinical features are –
abdominal discomfort
lethargy
nausea and vomiting
new onset DM
epigastric pain

72. Staging of Ca Pancreas
Primary tumor (T)
TX - Primary tumor cannot be assessed.
T0 - No evidence of primary tumor.
Tis - Carcinoma in situ.
T1 - Tumor limited to pancreas, 2 cm or less in greatest dimension.
T2 - Tumor limited to pancreas, more than 2 cm in greatest dimension.
T3 - Tumor extends beyond the pancreas but without involvement of the celiac axis or
the superior mesenteric artery.
T4 - Tumor involves the celiac axis or the superior mesenteric artery (unresectable
primary tumor).
Regional lymph nodes (N)
Nx - Regional lymph nodes cannot be assessed.
N0 - No regional lymph node metastasis.
N1 - Regional lymph node metastasis.
Distant metastasis (M)
M0 - No distant metastasis.
M1 - Distant metastasis.

74. Diagnosis
• Blood LFT – shows a pattern of obstructive
jaundice with raised serum alkaline
phosphatase and a very high serum bilirubin
• CECT abdomen – which shows the pancreatic
mass and metastatic spread e.g liver and
lymph nodes
• Tumor markers like CA19-9

77. Treatment
• The standard surgical procedure for pancreatic
head tumors is pancreaticodudenectomy or
also called as modified Whipple’s procedure
• Pancreatic tumors in the body and tail
undergo distal pancrectomy along with
splenectomy
• Splenectomy is preceded by a Pneumococcal
vaccination

80. Ca Oesophagus

81. • Ca oesophagus is an extremely common and
most lethal malignancies
• 5 years survival rate is 10%
• Ca oesophagus have 2 subtypes
1. Squamous cell carcinoma
2. Adenocarcinoma
• The subtypes have a similar clinical
presentation but different etiologic factors

82. Eitiology for squamous cell carcinomas

84. Fungal toxins in pickled vegetables

89. Etiology for adenocarcinoma
oesophagus
Obesity

92. Adenocarcinoma is more
common in males

94. • 5% occur in the upper third of oesophagus
• 20% in the middle third of oesophagus
• 75% in the lower third of oesophagus

96. Clinical features
• Patient presents with progressive dysphagia
i.e dysphagia initially occurs with solid foods
and gradually progresses to semi sloid and
liquid foods
• Dysphagia usually presents after 60% of
occlusion of the oesophagus
• Dysphagia is usually associated with
odynophagia with pain radiating to chest
and/or back

98. • Other clinical features are
`Nausea
Vomiting
Haematemesis

99. • The disease most commonly spreads to
supraclavicular lymph nodes, liver, lungs,
pleura and bone

102. Diagnosis
• Barium swallow
• Endoscopy along with biopsy and
histopathology
• CT scan
• PET scan to asses metastasis

106. Treatment

113. Thank you