Malignant gastric tumors include gastric cancer and gastric lymphoma. Gastric cancer is the sixth most common cancer worldwide and risk factors include H. pylori infection and pernicious anemia. Early cancers are often asymptomatic, while advanced cancers present with vague epigastric pain, weight loss, dysphagia, bleeding, or anemia. Diagnosis involves endoscopy with biopsy for histology. Treatment is surgical resection with chemotherapy and radiation for localized disease. Gastric lymphoma presents similarly and is diagnosed with endoscopy and biopsy. Treatment involves chemotherapy alone. Gastrointestinal stromal tumors (GISTs) are submucosal gastric masses that may behave benignly or malignantly depending on size and mitotic rate

1. Malignant Gastric tumors
BY SABA SADEGHPOUR

2. ◆ Gastric cancer is the sixth most common cancer and the
third most common cause of cancer-related death in the
world.
◆ Rates of gastric cancer are higher in Asian and South
American countries.
EPIDEMIOLOGY

3. Risk Factors
✻ H. pylori infection
✻ Pernicious anemia
✻ Achlorhydria
✻ Gastric adenomatous polyps
✻ Chronic gastritis

4. *About 50% to 60% of all carcinomas of the stomach
occur in the pyloric region.

5. Classification
Based on tumor appearance at endoscopy:
u Ulcerated
u Polypoid
u Scirrhous
u Superficial spreading.

6. Classification
Based on histo-pathologic features:(Intestinal)
u +H.pylori infection
u Well differentiated(better prognosis)
u Regions with a high incidence of disease
u Older patients
u Spreads hematogenously

7. Based on histo-pathologic features:(Diffuse)
u +H.pylori infection
u Poorly differentiated
u Ring cells
u Younger patients
u Blood type A
u spreads via the lymphatics and local extension.
Classification

8. Classification

9. Linitis plastica
o diffusely infiltrate
o look like a leather bottle
o particularly poor prognosis

10. Clinical Presentation
Ø It depends on its stage.
Ø Early cancers are usually asymptomatic.
Ø In Japan, these cancers are diagnosed early because of
an aggressive endoscopic screening protocol.

12. More advanced disease leads to the development of
symptoms:
u Vague epigastric pain (similar to that produced by gastric ulceration)
u Unexplained weight loss
Clinical Presentation

13. more specific symptoms:
u Dysphagia
u Hematemesis
u Melena
u Nausea
u New-onset iron deficiency anemia
u Guaiac-positive stools.
Clinical Presentation

15. Clinical Evaluation
History
u Lack of energy
u Unintentional weight loss

16. Physical examination
u Left supraclavicular lymph node (Virchow’s node)
u Palpable umbilical nodule (Sister Mary Joseph’s nodule)
u Palpable rectal ridge (Blumer’s shelf)
u The presence of ascites suggests peritoneal dissemination
Clinical Evaluation

17. Diagnostic workup
• Upper endoscopy(location and extent of disease)
• Multiple biopsies of the lesion(to obtain a histologic
diagnosis)
• Endoscopic ultrasound(determine the depth of tumor
invasion and the presence of enlarged lymph nodes)
• CXR and CT of the abdomen and pelvis(screening
modalities)

18. • PET (detecting advanced disease)
• Laboratory investigations(blood cell count, electrolytes, creatinine
level, and liver function tests)
• Laparoscopy(metastasis to the peritoneum and the omentummay)
Diagnostic workup

20. Treatment
u Complete surgical resection (localized disease)
u Radical subtotal gastrectomy (distal lesions)
u Pre and postoperative chemotherapy( with or without radiation)
*The appropriate extent of lymph node dissection at the time of resection is
controversial.

22. Gastric lymphoma
! The stomach is the primary site of almost two-thirds of all
GI lymphomas.
! Patients with gastric lymphoma tend to be older.
! Gastric lymphoma usually is non-Hodgkin’s.
! Endoscopy with tissue biopsies provides the diagnosis.

23. symptoms
Symptoms in gastric lymphoma are similar to those seen in
gastric adenocarcinoma:
✘ Upper abdominal pain
✘ Unexplained weight loss
✘ Fatigue
✘ Bleeding

25. Workup
Workup should follow that undertaken for any lymphoma to
determine its stage, including :
ü Chest radiography
ü Abdominal CT
ü Bone marrow biopsy

26. Treatment
Most specialists advocate chemotherapy alone, citing high 5year
survival rates in early stage disease.
Such treatment, however, runs the risk of causing gastric
perforation or hemorrhage, necessitating surgical intervention.

28. Gastro-intestinal Stromal Tumor
Formerly known as leiomyomas and leiomyosarcomas,
gastrointestinal stromal tumors (GISTs) are submucosal
growths of the GI tract arising from a variety of cell types.
*The stomach is the most common
site for these masses.

29. GIST
GISTs can behave as either benign or malignant tumors:
★ Large tumor size (>6 cm) and tumor necrosis suggest the
likelihood of malignant behavior.
★ The finding of more than 10 mitotic figures per 50 high-
power fields is evidence for malignancy.

30. Clinical Evaluation
→ upper endoscopy(submucosal mass)
→ Abdominal CT (determines the tumor size & presence of invasion,
evidence of metastasis)

31. ✧ Biopsy is usually non diagnostic.
✧ The liver is the most common site for disseminated disease.
Spread to lymph nodes occurs infrequently.
Clinical Evaluation

32. Treatment
✙ Treatment of a stomach GIST involves local excision.
✙ For tumors that manifest malignant behavior, chemotherapy using
imatinib mesylate has been effective.
✙ Genetic testing to establish the c-KIT and PDGFRA mutation status
of the tumor helps to determine the relative efficacy of imatinib.

33. ✍ Essentials of general surgical specialties 2019
✍ Medscape
✍ Uptodate
✍ http://www.drsoumenroy.com/about
References

34. Thanks for your attention