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Gastric cancer


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Gastric cancer

  1. 1. Gastric cancer
  2. 2. Malignant tumors Adenocarcinoma 95% Lymphoma 4% GIST 1%
  3. 3. symptoms Symptom Percent Weight loss 62 Abdominal pain 52 Nausea 34 Dysphagia 24 Melena 20 Early satiety 18 Ulcer-type pain 17 anorexia ?
  4. 4. Physical exam - Normal PH/E except for metastasis. - The most common metastatic distribution is to the liver, peritoneal surfaces, and nonregional or distant lymph nodes. Less commonly, ovaries, central nervous system, bone, pulmonary or soft tissue metastases occur.
  5. 5. lymphatycs left supraclavicular adenopathy : Virchow's node periumbilical nodule :Sister Mary Joseph's node left axillary node : Irish node
  6. 6. peritoeal Metastatic signs Peritoneal spread can present with an enlarged ovary Krukenberg's tumor or a mass in the cul-de-sac on rectal examination Blumer's shelf .
  7. 7. liver palpable liver Jaundice ascites
  8. 8. Paraneoplastic signs seborrheic keratoses (sign of Leser-Trelat)
  9. 9. Paraneoplastic signs acanthosis nigricans
  10. 10. who should go under further evaluations? - Age > 45 or - Alarming sign or - Family history
  11. 11. screening Atrophic gastritis Gastric epithelial polyps Gastric metaplasia and dysplasia Pernicious anemia and gastric carcinoid tumors Postgastric surgery Familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (Lynch syndrome)
  12. 12. classifications Histologic classification Vienna classification: Category 1: Negative for neoplasia/dysplasia Category 2: Indefinite for neoplasia/dysplasia Category 3: Noninvasive low-grade neoplasia (low-grade adenoma/dysplasia) Category 4: Noninvasive high-grade neoplasia 4.1: High-grade adenoma/dysplasia 4.2: Noninvasive carcinoma (carcinoma in situ) 4.3: Suspicion of invasive carcinoma Category 5: Invasive neoplasia 5.1: Intramucosal carcinoma (invasion into the lamina propria or muscularis mucosae) 5.2: Submucosal carcinoma or beyond
  13. 13. classification Morphology: Lauren classification intestinal (well-differentiated) diffuse (undifferentiated)
  14. 14. Intestinal vs. diffuse morphology: intercellular adhesion molecules differences are attributable to intercellular adhesion molecules, which are well preserved in intestinal-type tumors and defective in diffuse carcinomas. In intestinal tumors, the tumor cells adhere to each other, and tend to arrange themselves in tubular or glandular formations. Molecular : expression of E-cadherin Epidemiology: high risk population vs. genetic defect
  15. 15. H pylori and intestinal gastric cancer precancerous process or cascade: Nonatrophic gastritis Atrophic gastritis Intestinal metaplasia Dysplasia
  16. 16. Macroscopic classification Borrmann system: Polypoid Fungating Ulcerated diffusely infiltrating tumors
  17. 17. staging Primary tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria T1 Tumor invades lamina propria, muscularis mucosae, or submucosa T1a Tumor invades lamina propria or muscularis mucosae T1b Tumor invades submucosa T2 Tumor invades muscularis propria* T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures T4 Tumor invades serosa (visceral peritoneum) or adjacent structures T4a Tumor invades serosa (visceral peritoneum) T4b Tumor invades adjacent structures Regional lymph nodes (N) NX Regional lymph node(s) cannot be assessed N0 No regional lymph node metastasis◊ N1 Metastasis in 1-2 regional lymph nodes N2 Metastasis in 3-6 regional lymph nodes N3 Metastasis in seven or more regional lymph nodes N3a Metastasis in 7-15 regional lymph nodes N3b Metastasis in 16 or more regional lymph nodes Distant metastasis (M) M0 No distant metastasis M1 Distant metastasis