Gastric Cancer: Risk Factors, Symptoms, and Treatment
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1. Gastric cancer incidence varies globally, with the highest rates in Eastern Europe, Japan, and China. 2. Risk factors include H. pylori infection, low socioeconomic status, smoking, and diets high in salt/pickled foods. 3. Symptoms are non-specific but include epigastric pain, weight loss, vomiting, and anemia. Diagnosis involves endoscopy with biopsy. 4. Treatment depends on stage - surgery for early stages and palliative chemotherapy for advanced cases.
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Gastric Cancer: Risk Factors, Symptoms, and Treatment
- 4. Worldwide incidence Male 16.4 Female 8.2 Male 36.3 Female 16.9 MaleMale 77.977.9 FemaleFemale 33.333.3 Male 10.8 Female 4.9 Male 43.6 Female 19.0 Male 5.9 Female 2.6 Male 11.5 Female 4.3 Male 18.6 Female 13.3 Male 8.4 Female 4.0 EasternEastern EuropeEurope JapanJapan Australia/Australia/ New ZealandNew Zealand China NorthernNorthern AfricaAfrica SouthernSouthern AfricaAfrica CentralCentral AmericaAmerica WesternWestern EuropeEurope NorthNorth AmericaAmerica In terms of geographic distribution, high rates apply to Japan, China and Eastern Europe.
- 5. Prevalence of cancer in MongoliaPrevalence of cancer in Mongolia
- 6. Risk FactorsRisk Factors Predisposing : 1. Pernicious anemia & atrophic gastritis 2. Previous gastric resection 3. Chronic peptic ulcer 4. Smoking (doubled) 5. Alcohol. Environmental: 1. H.pylori infection 2. Low socioeconomic Status 3. Nationality 4. Diet Genetic: 1. Blood group A 2. Hereditary diffuse gastric cancer syndrome.
- 7. Certain diets are implicatedCertain diets are implicated ：： Rich in pickled vegetables, saltedRich in pickled vegetables, salted fish, excessive dietary salt, smokedfish, excessive dietary salt, smoked meat.meat. A diet that includes fruits andA diet that includes fruits and vegetables rich in vitamin C mayvegetables rich in vitamin C may have a protective effect.have a protective effect. DietDiet
- 8. Poorly understoodPoorly understood The majority of gastricThe majority of gastric tumor are sporadic intumor are sporadic in naturenature Genetic factorsGenetic factors
- 9. Epigastric painEpigastric pain BloatingBloating Early satietyEarly satiety Nausea & vomitingNausea & vomiting DysphagiaDysphagia AnorexiaAnorexia Weight lossWeight loss Upper GI bleeding (hematemesis, melena)Upper GI bleeding (hematemesis, melena) Iron deficiency anemiaIron deficiency anemia SymptomsSymptoms
- 10. SignsSigns -- Anemia.Anemia. - Wt.loss ( cachexia)Wt.loss ( cachexia) - Epigastric massEpigastric mass - HepatomegalyHepatomegaly - AscitesAscites - JaundiceJaundice - Virchows nodeVirchows node - Krukenberg tumorKrukenberg tumor
- 11. Defined as a tumor confined to the mucosal or submucosalDefined as a tumor confined to the mucosal or submucosal layer, with or without lymph node metastasislayer, with or without lymph node metastasis Early gastric cancerEarly gastric cancer
- 12. Invasion depth beyond submucosal layerInvasion depth beyond submucosal layer Advanced gastric cancerAdvanced gastric cancer
- 14. Lauren classificationLauren classification Intestinal type - Associated with most environmental risk factors - Carries a better prognosis Diffuse type - Consists of scattered cell clusters with poor prognosis - Infiltrates deeply
- 15. Primary tumor:Primary tumor: depth of tumor invasiondepth of tumor invasion Tx- cannot be assessedTx- cannot be assessed T0- no evidenceT0- no evidence Tis- carcinoma in situ, no invasion ofTis- carcinoma in situ, no invasion of laminalamina T1- invades lamina propria orT1- invades lamina propria or submucosasubmucosa T2- invades muscularis or subserosaT2- invades muscularis or subserosa T3- penetrates serosa, no adjacentT3- penetrates serosa, no adjacent structurestructure T4- invades adjacent structuresT4- invades adjacent structures TNM classificationTNM classification -- TT
- 16. Regional Lymph NodesRegional Lymph Nodes NX- cannot be assessedNX- cannot be assessed N0- no nodesN0- no nodes N1- mets in 1-6 regionalN1- mets in 1-6 regional nodesnodes N2- mets in 7-15 regionalN2- mets in 7-15 regional nodesnodes N3- mets in more than 15N3- mets in more than 15 regional nodesregional nodes TNM classificationTNM classification -- NN
- 17. Distant metastasisDistant metastasis MX- cannot be assessedMX- cannot be assessed M0- no distant metastasesM0- no distant metastases M1-distant metastasesM1-distant metastases TNM classification - MTNM classification - M
- 18. Direct invasionDirect invasion Lymph node disseminationLymph node dissemination Blood spreadBlood spread Transperitoneal spreadTransperitoneal spread Spread PatternsSpread Patterns
- 19. INVESTIGATIONSINVESTIGATIONS Full blood countFull blood count LFTLFT Serum tumor markers (CA 72-4,CEA,CA19-Serum tumor markers (CA 72-4,CEA,CA19- 9) not specific9) not specific Stool examination for occult bloodStool examination for occult blood Gastric acidityGastric acidity Serum gastrinSerum gastrin Fetal sulfoglycoprotein antigenFetal sulfoglycoprotein antigen Carcinoembryogenic antigenCarcinoembryogenic antigen
- 20. EndoscopicEndoscopic screeningscreening -- general populationgeneral population or high risk personsor high risk persons Upper EndoscopyUpper Endoscopy
- 22. Distal GC Proximal GC BariumX-Ray
- 23. CT scanCT scan:: T,T,the lesionthe lesion N,N,neighboring lymph node metastasisneighboring lymph node metastasis M,M,distant metastasisdistant metastasis
- 25. BASIC SURGICAL PRINCIPLESBASIC SURGICAL PRINCIPLES Types: total,subtotal,palliative Antral diseasesubtotal gastrectomy Midbody & proximal total gastrectomy
- 27. ChemotherapyChemotherapy the most widely used regimen is 5-FU, Oxaliplatin andthe most widely used regimen is 5-FU, Oxaliplatin and Taxol, 6 cyclesTaxol, 6 cycles RadiotherapyRadiotherapy provides relief from bleeding, obstruction and pain inprovides relief from bleeding, obstruction and pain in 50-75%. Median duration of palliation is 4-18 months50-75%. Median duration of palliation is 4-18 months Adjuvant TherapyAdjuvant Therapy
- 28. Stent placementStent placement Endoscopic tumor ablationEndoscopic tumor ablation G tube for nutritionG tube for nutrition Stage 4Stage 4
Editor's Notes
- Linked to high starch diet. Some studies have shown that rice in Japan and China have talc which can cause cancer.
- Pernicious anemia linked to less IF, causing B12 deficiency. Previous surgery causes less gastric acid, enabling bacteria to be present. Reflux of bile can worsen this. H. Pylori makes it 6-9 times higher likely. Smoked foods, salted foods, pickled vegetables. Nitrates are converted into cancer by h.pylori. Vitamin c can prevent this.
- Pain may be relieved by eating, antacids, H2 receptor antagonist -> Pain worsens by eating -> Nausea that is relieved by vomiting -> Eats in small amount -> Weight loss. Dysphagia – first with solid food, later liquid and saliva. Hematemesis – vomiting of blood Melena – bloody stool
- Anemia, serum bilirubin, alkaline phosphatase, gastrin increases but if involves entire stomach then decreases.
- Looks at layer of stomach wall. To examine depth of invasion or metastasis to lymph nodes
- After surgery to cure cancer