Gastric cancer is the second leading cause of cancer death worldwide. Risk factors include H. pylori infection, smoking, and diet low in fruits and vegetables. Genetic factors include certain gene mutations. Symptoms often include abdominal discomfort and weight loss. Diagnosis involves endoscopy with biopsy. Staging uses TNM classification and involves assessing tumor invasion and lymph node metastasis. Treatment depends on stage but commonly includes surgery such as gastrectomy with lymph node dissection, as well as chemotherapy and radiation therapy. Palliative options are used for advanced disease.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Carcinoma stomach presentation
1.
2.
3.
4.
5.
6. 2nd leading cause of cancer related death after lung cancer.
The highest incidences are found in East Asia (Japan and China)>
South America > Eastern Europe
RISK FACTORS
ACQUIRED FACTORS
H. Pylori infection ( 3-6 times)- distal gastric cancer and
intestinal type
High intake of smoked and salted foods
Nitrates
Diet low in fruits and vegetables
Smoking
Obesity proximal gastric lesions
Barrett esophagus/GERD
Prior subtotal gastrectomy (25%)
RT exposure
7. GENETIC FACTORS
E- cadherin (CDH-1 gene)
Type A blood group
Pernicious anemia (5-10%)
HNPCC
Li-Fraumeni syndrome
10. Type I, nodular polypoid tumor without
ulceration and usually with a broad
base;
Type II- fungating, exophytic,
circumscribed tumor with defined
sharp margins, devoid of ulceration
except at its dome
Type III- ulcerating tumor +
penetrating, infiltrating ulcer base;
Type IV - diffuse thickening of the
gastric wall with no discretely
marginated mass or ulceration,leather
bottle,linitis plastica
Type v - unabler to classify
11. 4 groups
Well differentiated (1) to anaplastic (4)
12. Intestinal Diffuse
Environmental
Gastric atrophy and
intestinal metaplasia
M>F
Increase incidence with
age
Gland formation
Haematogenous spread
Epidemic
Distal part of stopmach
Familial
Blood group A
F>M
Younger age
Poorly differentiated
signet ring cells
Transmural/lymphatic
Endemic
Proximal part of stomach
13. Abdominal discomfort
weight loss
Loss of appetite
Early satiety
Nausea and vomiting
Black Tarry stool
Duration of symptom is <3 months in almost 40% of patients
and > 1 year in 20%.
PHYSICAL EXAMINATION
Can reveal advanced disease
- Abdominal mass
-Epigastric or liver mass, periumbilical node (Sister Mary
Joseph node)
- Palpable left supraclavicular node (Virchow’s node)
- Rectal shelf (Blumer’s shelf)
- Left axilla lymphnode (Irish nodes)
14. TEST
ENDOSCOP
Y
Direct visualization /cytology. Biopsy usual in 90% cases
But linitis plastica & small<3 cm & cardia lesion is difficult to diagnose
DOUBLE
CONTRAST
STUDY
: small lesion limited to inner layer of stomach wall.
CECT SCAN: For both extent of spread & radiation portal (abdomen)
Mediastinal LN ( in case of distal esophageal junction and thoracic
mets.)
HELICAL
CT:
More useful In detection of smaller LN
LAPAROSC
OPIC
STUDY:
Helps in detection in metastatic disease in case of operable lesion in
preoperative imaging. Peritoneal fluid should be sampled in case of
+ve is considered as M1 disease.
• T staging is accurate enough in 86 % case by EUS. Whereas 43% by CT.
• EUS is 1st line imaging modality in T category
• Diffuse /mucinous tumors – pet has lower detection rate. As FDG accumulation is
lower in this cases
15. AJCC – TNM staging
Japanese gastric cancer staging
Staging for E G junction cancer
17. Regional Lymph Nodes (N)*
N1 Metastasis in 1-2 regional lymph nodes
N2 Metastasis in 3-6 regional lymph nodes
N3 Metastasis in 7 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
18.
19.
20.
21. Correction of anemia
Correction of nutritional status
Fluid and electrolytes
Cardiac, respiratory and renal status
Adequate blood
Pre operative stomach wash
Prophylactic antibiotics
23. Early gastric cancer
Tumor less than 2cm
Elevated well differentiated tumors
Without nodal involvement
Tumour less than 1cm in diffuse
lesion
28. SURGERY
Primary treatment of gastric cancer
OPTIONS-
Radical Total Gastrectomy –
Diffuse involvement
Proximal involvement.
Radical Subtotal Gastrectomy –
Distal cancers,
Equivalent survival
Lesser complications
In proximal cancer, total
gastrectomy is not necessary when
subtotal gastrectomy will provide a
5 cm clearance of the gross tumour.
29. • Ligation of left and
right gastric and
gastro epiploic arteries
• En bloc removal of
75% of stomach
• Pylorus
• 2cm of duodenum
• Greater and lesser
omentum
• All associated
lymphatic tissue
35. • Adherent to pancreas or colon or mesocolon
• Ascites
• Para-aortic lymph nodes
• Secondaries in liver
• Palpable mass is incurable but can be resectable
surgically
• Blumer shelf
• Left supraclavicular nodes
• Sister Mary Joseph nodule
• Irish node (Left axillary lymph node secon daries)
36. Lymphadenectomy:
1. Adequate staging
2.Adequate therapy
At least 15 LN need to be retrieved.
Total gastrectomy
D0: Lymphadenectomy less than
D1
D1: Nos. 1–7
D1+:D1, Nos. 8a, 9, 11p
D2: D1+Nos. 8a, 9, 10, 11p, 11d,
12a.
Distal gastrectomy
D0: Lymphadenectomy less than
D1
D1: Nos. 1, 3, 4sb, 4d, 5, 6, 7
D1+:D1,Nos. 8a, 9
D2: D1+Nos. 8a, 9, 11p, 12a.
Japanese gastric cancer treatment guidelines 2010
37. Pylorus-preserving gastrectomy
D0: Lymphadenectomy less than
D1
D1: Nos. 1, 3, 4sb, 4d, 6, 7
D1+:D1,Nos. 8a, 9.
Proximal gastrectomy
D0: Lymphadenectomy less than D1
D1: Nos. 1, 2, 3a, 4sa, 4sb, 7
D1+:D1,Nos. 8a, 9, 11p
Japanese gastric cancer treatment guidelines 2010
38. Type Descriptions
D1 lymphadenectomy T1a tumors that do not meet the criteria for
EMR
cT1bN0 tumors that are differentiated type
and <1.5 cm
D1+lymphadenectomy cT1N0 tumors other than the above
D2 lymphadenectomy potentially curable T2-T4 tumors, &
cT1N+tumors.
complete clearance of No. 10 nodes by
splenectomy should be considered for
potentially curable T2-T4 tumors invading the
greater curvature of the upper stomach.
D2+lymphadenectomy Non standard
prophylactic para-aortic lymphadenectomy
Denied by jcog 9501
prognosis of this population is poor.
Japanese gastric cancer treatment guidelines 2010
A recent meta-analysisof 12 randomised, controlled trials (RCTs) confirmed
no overall
survival (OS) benefit for D2 lymphadenectomy, although a benefit was seen
among patients who had resection without a splenectomy and/or
pancreatectomy
39. Gastric cancer responds well to
combination cytotoxic
chemotherapy
Neo adjuvant therapy improves
outcome
First line treatment in inoperable
disease
Palliative in advanced disease
Trantuzumab – in HER2 positive
gastric cancer
40. Down staging of disease --- increase
resectability
Determine sensitivity to chemotherapy
Decreases micro-metastatic burden
Epirubicin + cis-platinum+ infusional
5-FU/ capecitabine
41. Post op XRT
Pre op XRT
Intraoperative RT
Palliative RT
Indications-
T3-4 resectable disease
Margins positive
Residual disease
LN +ve disease
Inoperable
42. Idealized portals from patterns of failure data need
modification individually for patient's initial extent of disease.
Gastric/tumor bed, anastomosis and gastric remnant, and
regional lymphatics should be included in most patients.
Major nodal chains at risk include
lesser and greater curvature;
celiac axis;
pancreaticoduodenal,
splenic,
suprapancreatic,
porta hepatis groups;
para-aortics to the level of L3.
Any tumor originating in the stomach has a high propensity of spread to
nodes along the greater and lesser curvature, although they are most
likely to spread to those sites in close anatomic proximity to the primary
tumor mass.