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GASTRIC CARCINOMA.
       UNIVERSIDAD DE GUADALAJARA
CENTRO UNIVERSITARIO DE CIENCIAS DE LA SALUD

          Surgical Clinics.

          Dr. Benjamín Robles Mariscal
          Profesor Dr. Hector Virgen
          Ayala


                                 Luis Gerardo Caballero Romero.
                                           EPG MCPA
•   Helicobacter pylori



    3.6 a 18 fold risk of
    developing carcinoma.




    Proportional Risk
    serum antibodies to the
    bacteria.
GASTRIC CARCINOMA
• Ulcerative Carcinoma 25%
• Polypoid carcinomas 25%
• Surface diffusion Carcinoma 15%
• Plastic linitis 10%
• Advanced Carcinoma 35%
Ulcerative Carcinoma   Advanced Carcinoma




                        Polypoid carcinomas
 Plastic linits
CLINICAL MANIFESTATIONS
• Postprandial heaviness. (pain)
• Anorexia
• Weight loss up to 6 kgs
• Vomiting in coffee grounds.
PHYSICAL EXAMINATION
• Epigastric mass 25%
• Hepatomegaly 10%
• FOBT 50%


• Abnormal manifestations of tumor dissemination. (Virchow node).
• Blumer shelf sign (rectal exam)
DISEMINATIONS
• Ovaries (Krukenberg tumor)
  liver
  lung
  brain
  bones
LABORATORY AND IMAGING STUDIES.
• 40% have anemia.
• 65% High concentrations of CEA.

• Gastroscopy
• Gastric biopsy - minimum 6
TREATMENT
• Surgical resection (only treatment).
  85% of operable patients.
  50% lesions can be removed.

• Gastrectomy and splenectomy


• Esophagogastrectomy.


• Palliative therapy.


• An adjunct chemotherapy.
FORECAST
• Five year survival rate depending on the degree.
  70% Stage I
  30% Stage II
  10% Stage III
  0% Stage IV
GASTRIC POLYPS
HISTOLOGICAL CLASSIFICATION
• Hyperplastic 80%
• Adenomatous 30%
• Inflammatory

   Total gastrectomy in multiple polyposis cases.
GASTRIC LYMPHOMA AND PSEUDOLYMPHOMA
• The 2nd most common cancer of the stomach.
• non-Hodgkin
• MALT




• Low and high grade.
SYMPTOMS
• Epigastric pain and weight loss


• Palpable epigastric mass 50%
TREATMENT
• Low-grade lymphoma
  chemotherapy with cyclophosphamide

• high Grade
  Surgical Resection with total abdominal radiation.
MENETRIER DISEASE
• Hypertrophic gastritis.

• TGF - α

• Evolution to atrophic gastritis
MANIFESTATIONS
• Edema
• Diarrhea
• Anorexia
• Weight Loss
• exanthema
TREATMENT
• Lost control of protein
• Eradicating H. pylori
• H2 blockers
• omeprazole

• In children is benign and only refers
PROLAPSE OF THE GASTRIC MUCOSA
• Rare lesion.
• Prepyloric ulcers accompanied
• Vomiting
• pain.
TREATMENT
• reserved

• Billroth I anastomosis Antrecotmia
GASTRIC VOLVULUS
ACUTE
• severe pain
• Borchardt triad
TREATMENT
BEZOARS
• Concretions within the stomach.

• Trichobezoars
• Phytobezoars
• Candida albicans

• Postsurgical state by reduction of acid and pepsin secretion
TREATMENT
• Defragmentation and dispersal by endoscopy .
THANKS!!!

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Gastric Carcinoma