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Ca Stomach.pptx
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6. Etiology:Causes
• Partial gastrectomy
• Helicobacter pylori
• A family history of stomach cancer is a
further risk factor in the disease.
• People with blood type A also have an
increased risk.
• Pernicious anemia
• Diet deficient in fresh fruits and vegetables
and rich is smoked fish or meat and poorly
preserved foods
18. Demography
• Once the second most common cancer
worldwide, stomach cancer has dropped to
fourth place, after cancers of the lung,
breast, and colon and rectum.
• Highest in Asia and parts of South America
and lowest in North America.
• Japan most common cancer site in males.
• Most patients are elderly at diagnosis. The
median age for gastric cancer in the United
States is 69 years
19. Symptoms
Early disease has no associated symptoms; Most symptoms
of gastric cancer reflect advanced disease
20. Symptoms
Early disease has no associated symptoms; Most symptoms
of gastric cancer reflect advanced disease
• Indigestion
• Nausea or vomiting
• Dysphagia
• Postprandial fullness
• Loss of appetite
• Melena
• Hematemesis
• Weight loss
• Lump in abdomen
21. Late Symptoms
• Pathologic peritoneal and pleural effusions
• Obstruction of the gastric outlet
gastroesophageal junction, or small bowel
• Bleeding in the stomach from esophageal
varices or at the anastomosis after surgery
• Intrahepatic jaundice caused by
hepatomegaly
• Extrahepatic jaundice
• Weight loss resulting from starvation or
cachexia of tumor origin
23. Signs
All physical signs are late events.
• palpable enlarged stomach with succussion
splash;
• Hepatomegaly
• Periumbilical metastasis (Sister Mary Joseph
nodule
• Pallor from anemia
• Enlarged lymph nodes
– Virchow nodes (ie, left supraclavicular)
Troisier sign
– Irish node (anterior axillary).
– Blumer shelf (ie, shelflike tumor of the anterior
24. Signs
• Paraneoplastic syndromes such as
dermatomyositis, acanthosis nigricans, and
circinate erythemas are poor prognostic
features.
• Other associated abnormalities include
peripheral thrombophlebitis Troussaau sign
and microangiopathic hemolytic anemia.
•
32. Classification
• Adenocarcinoma of the stomach is
subclassified according to histologic
description
– Tubular
– Papillary
– Mucinous
– Signet-ring cells
– Undifferentiated lesions
•
33. Classification
• In about 5% of primary gastric cancers, a
broad region of the gastric wall or even the
entire stomach is extensively infiltrated by
malignancy, resulting in a rigid thickened
stomach, termed linitis plastica. Patients
with linitis plastica have an extremely poor
prognosis.
34. Classification
• The Lauren system classifies gastric cancer
pathology
– Type I (intestinal)
– Type II (diffuse).
39. Investigations
Laboratory Studies
• CBC: anemia
• Electrolyte panels
• Liver function tests
• Tumor markers such as CEA and CA 19-9:
Elevated CEA in 45-50% of cases; elevated
CA 19-9 in about 20% of cases
• HER2-neu testing if metastatic
adenocarcinoma is documented or
suspected
46. Operative Therapy
• Tis, or T1-- Endoscopic mucosal resection
or surgery are the standard treatment
options
• Stage IB to IIIC(resectable tumors)
preoperative chemotherapy or
chemoradiotherapy followed by surgery.
• Postoperative chemoradiation or
chemotherapy is indicated for patients who
have undergone primary D2 lymph node
dissection
64. Management of precancerous
conditions
• Magnification chromoendoscopy or narrow-
band imaging (NBI) endoscopy
• Biopsies
• Endoscopic surveillance every 3 years
• H pylori infection is present>eradication
• Polyps with high-grade dysplasia that
cannot be removed, or invasive cancer
detected on biopsy should be referred for
gastrectomy.
65. Management of precancerous
conditions: HDGC
• Mutations of the E-cadherin gene (CDH1)
• Prophylactic gastrectomy (without a D2
lymph node dissection) between the ages of
18 and 40 for asymptomatic carriers with a
family history of HDGC
• Women with CDH1 mutations are at
increased risk for breast cancer and should
be followed similar
to BRCA1/ BRCA2 mutation carriers
67. Breast Cancer Prevention
for BRCA1and BRCA2 Mutation Carriers
• For women who carry a mutation in
the BRCA1 or BRCA2 genes, the risk of
breast cancer by age 70 years is
approximately 65% and 45%,
respectively. Breast cancer prevention for
these women has predominantly focused on
surgical strategies, such as bilateral
mastectomy and endocrine ablation by
premenopausal bilateral salpingo-
oophorectomy (BSO).
68. Breast Cancer Prevention
for BRCA1and BRCA2 Mutation Carriers
• Who decline bilateral mastectomy, or
choose to delay it until they are older,
tamoxifen should be considered,
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