Stomach cancer ☼ An Overview

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☼ Introduction

leading cause of cancer related morbidity

• Second most common cause of cancer related deaths after Lung cancer (10.4% of all cancer related deaths).   • 60% cases occur in the developing world • linked to dietary habits and unhealthy food preservation practices

☼Causes• A/S/LElderly Male Asians and East Europeans. • DietFood preserved by drying, smoking, salting and pickling Dietary nitrites converted to carcinogenic N-nitroso compounds by bacteria in the stomach. • Helicobacter Pylori infection-People with H. Pylori bacteria infection of the stomach have greater risk.

Causes- contd
• Prior stomach surgery-People with a history of stomach surgery face a greater risk due to alteration in normal ph of the stomach. • Stomach Disorders- Pernicious anemia, achlorhydria and atrophic gastritis 6 times more prone. • Smoking • Hereditary- underlying genetic factors are poorly understood (KRAS mutation, c-met amplification) Rarely, some gastric ulcers may turn into cancer.

☼ Types
• 90% arise from the glandular cells of the stomach wall and are called Adenocarcinomas. • Others – Gastric Lymphomas (cancer of gastric lymphatic tissue) Soft tissue sarcomas (e.g. Leiomyosarcomas) Carcinoids

☼Clinical features
• Early stages asymptomatic. • non-specific symptoms like indigestion, nausea, vomiting and sometimes Pain. • bloated feeling after eating, loss of appetite, dark colored stools (due to presence of blood) and feeling of tiredness (due to anemia). • Late features- peritoneal and pleural effusions, Jaundice and cachexia. • Hepatomegaly usually occurs and presence of an enlarged left supraclavicular lymphnode (Virchow's sign) is a typical finding.

• Surgical intervention Partial/subtotal gastrectomy , Total gastrectomy + making of a new stomach from S.I • Radiation therapyexternal beam radiation (5 days/week*6 to 8 weeks). Tomotherapy HI-ART (Tomotherapy highly integrated adaptive radiotherapy) for specific reduced doses. • Chemotherapy – 5 fluorouracil, Cisplatin, Doxorubicin. • Immunotherapy

☼ Prognosis
• Indicators - Stage - Tumor Size - Histological Type - Degree of cytological atypia - Lymphatic/vascular invasion • Generally, five year survival is a poor 30%. • Younger patients have more aggressive disease.

Dr. Neelesh Bhandari MBBS(A.F.M.C), MD (Path.) PGP Human Rights.