This document summarizes different types of gastric tumors and their treatment approaches. It discusses chemotherapy and radiation for stage II-IV gastric cancer. It describes endoscopic resection for small, confined gastric tumors. It also outlines treatments for gastric lymphoma, gastrointestinal stromal tumors, gastric carcinoid tumors, pancreatic neuroendocrine tumors, and gastrinomas. Surgical resection, targeted drug therapies, and radiation are discussed as treatment options depending on the tumor type and stage.

2. Chemotherapy and Radiation
1. Postoperative adjuvant therapy for stage II and III.
2. Preoperative neoadjuvant therapy to downstage advanced tumours
3. Palliative chemotherapy for stage IV.

3. Endoscopic Resection
1. Small tumors (<2 cm)
2. Confined to the mucosa by EUS
3. No detectable LN metastasis
4. No ulceration

4. Gastric Lymphoma
The stomach is the most common site of primary GI lymphoma
Over 95% are non-Hodgkin's type
Most are B-cell type
Thought to arise in MALT (Mucosa- associated lymphoid tissue)
It is divided into two distinctive types: low and high grade Maltomos

5. Low-grade gastric lymphoma
• When the H. pylori is eradicated and the gastritis improves, the low-
grade MALT lymphoma often disappears.
• If low-grade lymphoma persists after H. pylori eradication, Radiation
should be considered for disease clinically confined to the stomach
(stage I),
Chemotherapy with/without radiation is used for more advanced lesions

6. High-grade gastric lymphoma
TREATMENT
currently treated with chemotherapy and radiation, without surgical resection.
For disease limited to the stomach and regional nodes, radical subtotal D2
gastrectomy may be performed, especially for bulky tumors with bleeding and/or
obstruction.

7. Gastrointestinal Stromal Tumor (GIST)
• GISTs arise from interstitial cells
of Cajal (ICC)
• Almost all GISTs express CD117
and CD34
• GISTs smaller lesions are usually
asymptomatic.
• Larger lesions: weight loss,
abdominal pain, fullness, early
satiety, and bleeding or an
abdominal mass.

8. Treatment options
• 1-Surgical resection is the best treatment option in form of wedge
resection, partial or total gastrectomy with no lymphadenectomy as LN
metastasis are rare.
• 2- Anti- CD117 as imatinib (Gleevec R), sunitinib, Sorafenib,
dasatinib, erlotinib, and everolimus.

9. IMATINIB & SUNITINIB

10. SORAFENIB & DASATINIB

11. Gastric Carcinoid Tumors
• Carcinoids commonly involve
• the appendix followed by ileum and rectum.
• Gastric carcinoids comprise about 1% of all carcinoid tumors and less
than 2% of gastric neoplasms.
• They arise from gastric enterochromaffin-like (ECL) cells
• Clearly have malignant potential.

12. TYPES
• Type I (75% ) occurring in those with chronic hypergastrinemia secondary to pernicious
anemia or chronic atrophic gastritis
• Type II gastric carcinoids are associated with MEN1 and ZES.
• Type III gastric carcinoids are sporadic tumors. They are usually solitary (usually >2 cm) .
They are not associated with hypergastrinemia.

13. • Gastric carcinoids should be resected. Small lesions confined to the
mucosa (typically type I or type II lesions) may be treated
endoscopically with EMR.
• Larger lesions should be removed by D1 or D2 gastrectomy.
• Because somatostatin has an antiproliferative effect on gastric ECL
cells, there may be a possible primary treatment role for octreotide, and
lanreotide.
Gastric Carcinoid Tumors

14. OCTREOTIDE & LANREOTIDE

15. PANCREATIC NEOPLASM

16. NEUROENDOCRINE TUMOURS
Insulinomas are the most common
Arising from B-cells
Secrete insulin.
Evenly distributed throughout the
head, body, and tail of the pancreas.
(90%) of insulinomas are benign and
solitary,
10% are malignant or multiple

17. Whipple's triad
The triad consists of
1. Symptomatic fasting
hypoglycemia
1. A documented serum
glucose level <50 mg/dL
2. Relief of symptoms with
the administration of
glucose.

18. DIAGNOSIS
Whipple triad + elevated C-peptide ( to rule out factitious
hypoglycaemia)
LOCALIZATION
Combination of CT scanning and endoscopic ultrasound (EUS).

19. Treatment
1- Simple enucleation for those < 2 cm
2- However, tumors located close to the main pancreatic
duct or large (>2 cm) tumors may require a distal
pancreatectomy or pancreaticoduodenectomy.

20. NONFUNCTIONING ISLET CELL TUMORS
•Second common
•Malignant
•Stain positive for pancreatic polypeptide (PP),

21. GASTRINOMA
Zollinger-Ellison syndrome (ZES) is caused by a gastrinoma, a G-cell
endocrine tumor that secretes gastrin
Although most of the ulcers are solitary, any patient presenting with
• Recurrent
• Persistent
• Multiple
• Giant
• Unusually sited ulcers
• Having associated hypercalcaemia or diarrhoea