No

1. Gastric Cancer
By ; Waleed M. AbdelRahman

2. Introduction
•Tumors of the stomach :
 Benign : Epithelial tumors -Non-neoplastic polyps
-Neoplastic polyps
Mesenchymal tumors leiomyoma ,fibroma ,lipoma ,neuroma ,
glomus tumor.
 Malignant : - Adenocarcinoma 95%
- Lymphoma 4%
- GIST 1%
- Others as leiomyosarcoma, carcinoid and SCC .

3. As regard Gastric adenocarcinoma….
•1ST most common primary malignant tumor of the stomach is
GAC.
•2nd most common GIT tumor is GAC.
•3rd leading cause of cancer related death worldwide.
•5 year SR of GAC < 30%.
•30 % are metastatic at time of presentation.

4. Risk factors..
1. Smoking ,spiritsandspicyfoods.
2. Postgastrectomyandpostvagotomy.
3. Biliaryreflux.
4. Meneterier’sDisease.
5. BloodgroupA.
6. Perniciousanemia.
7. Atrophic gastritis.
8. H.pyloriandEBV.
9. Adenomatouspolyps.
10. HereditarysyndromesasFAP,HNPCC,PJS,Li..frauminisyndrome.

5. H.Pylori –Carcinoma
sequence.

6. Histological Classification”Lauren” (DIO)
 Intestinal type (well differentiated )
 Diffuse type (poorly differentiated )
 Otherwise ( Non diffuse non-intestinal )

8. BUT
The current histological and
anatomical classification has
been ineffective in guiding
therapy.

9. Molecular classification
according to The Cancer
Genome Atlas (TCGA ) and
Asian Cancer Research Group (
ACRG ).

11. HDGC
 AD with early onset of diffuse GAC .
 Mutation in CDH1 gene ( E-CADHERIN ).
 1 – 3 % of gastric cancer .
 Treated by prophylactic total gastrectomy .

12. TNM staging
(AJCC 8th ED ,2018)

13. Investigation
 For diagnosis : endoscopy and biopsy ---- Barium meal.
 for staging : CT triphasic---EUS ----PET..CT---Staging laparoscopy.
Preoperative assessment .
 Follow up: CEA—CA19-9 -----CA 72.4

14. Management
 Early GAC ( Tis or T1a ) : D1 gastrectomy and adjuvant CT.
 Locally advanced GAC (T1b to T4 ) : NACT then surgery
followed by adjuvant CT .
Unresectable or metastatic : Palliative symptomatic care .

16. D1 or D2 or
D3
lymphadenectomy

17. •Modified D2 lymphadenectomy is the standard of care
(NCCN 2018 ).
•Safety margin is 5 cm .
•Extent of lymphadenectomy is 15 LN or more .
•Most important prognostic factor depend on number of
LN not the anatomical distribution .

18. ‫ذ‬