Professional Documents
Culture Documents
CANCER
DONE BY : MUSTAFA KHALIL IBRAHIM
TBILISI STATE MEDICAL UNIVERSITY
4th year, 1st semester, 2nd group
ANATOMY & PHYSIOLOGY
ANATOM
Y stomach J-shaped.
The It has two surfaces (the anterior &
posterior), two curvatures (the greater & lesser), two orifices (the
cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
It could be:
malignant or benign
primary or secondary
TYPES
Tumor Type Percent
Gross classification
• phymatoid type
• ulcerative type
• infiltrative ulcerative
• diffuse infiltrative type
TNM
T: Primary tumor
Tis Carcinoma in situ; intraepithelial tumor without invasion of
lamina propria
T1 Tumor invades lamina propria or submucosa
T2 Tumor invades muscularis propria or subserosa
T3 Tumor penetrates serosa (visceral peritoneum) without
invasion of adjacent structures
T4 Clinical Manifestations Tumor invades adjacent structures
Direct invasion
Lymph node
dissemination
Blood spread
Intraperitoneal
colonization
ETIOLOGY
Gastric cancer is more common Stomach su rger y for a n ulcer
in patients with Epstein-Barr virus infection
pernicious anemia. Working in coal, metal,
blood group A. timber, or rubber industries
Exposure to asbestos
Gastric ulcer .
Infection with Helicobacter
A family history of pylori
gastric cancer. Long-term stomach
Smoking inflammation
Being overweight or
Had a polyp larger than 2
obese centimeters in your stomach
A diet high in smoked,
pickled, or salty
foods
SIGNS AND SYMOTOMS
Early Gastric Cancer
Asymptomatic or silent 80%
Peptic ulcer symptoms 10%
Nausea or vomiting 8%
Anorexia 8%
Early satiety 5%
Abdominal pain 2%
Gastrointestinal blood loss <2%
Weight loss <2%
Dysphagia <1%
Advanced Gastric Cancer
Linitis plastica :
--- diffusely infiltrating with a rigid stomach
Virchow’s node :
--- left supraclavicular lymph node
Bleeding
LABORATORY TESTS
blood test
• check for anemia(may be caused by bleeding, liver dysfunction, or
poor nutrition.
• test for the presence of H. pylori bacteria.
Tumor markers
• CEA:carcino-embryonic antigen
• CA19-9:carbohydrate antigen
• CA724:carbohydrate antigen
The best way to stage the tumor locally is via endoscopic
ultrasound , it gives (80%) information about the depth of
tumor penetration into the gastric wall, and can usually show
enlarged (>5 mm) perigastric and celiac lymph nodes.
ENDOSCOPIC MUCOSAL RESECTION
Gastric cancer
lesion confined
to mucosa
layer
Endoscopic
ultrasound (EUS)
is helpful in
staging GC
ENDOSCOPIC FEATURES OF GASTRIC
CANCER
Esophagogastro
duodenoscopy
(EGD)
endoscopy has
become the
gold standard
for the
diagnosis of
gastric
malignancy.
Biopsy . taking a small piece of tissue from the stomach to look
at under a microscope for signs of cancer cells. It might done
during an endoscopy.
RADIOLOGIC DIAGNOSIS
Distal GC Proximal GC Linitis plastica
X-ray test. with barium. The fluid coats the stomach and
makes it show up more clearly on X-rays.
CT SCAN TEST
MRI : benign regional lymph nodes
Positron Emission Tomography Scanning
Whole-body PET scanning uses the principle that tumor
cells preferentially accumulate positron-emitting 18F-
fluorodeoxyglucose.
Gastric Gastric
Ulcer
Cancer
X-ray showing Gastric
ulcer With symmetrical
radiating Mucosal folds. X-ray showing Extensive
By histology, no evidence carcinoma involving
of the cardia & Fundus
Malignancies was
observed.
Pyloric stenosis
IF YOU SEE ULCER ASK UR SELF…BENIGN OR
MALIGNANT?
BENIGN MALIGNANT
Round to oval punched out Irregular outline with
lesion with straight walls & flat necrotic or hemorrhagic
smooth base base
Smooth margins with normal Irregular & raised margins
surrounding mucosa
The goal of curative surgical treatment is resection of all tumor. Thus, all
margins (proximal, distal, and radial) should be negative and an adequate
lymphadenectomy performed.
Treatment
Generally, the surgeon strives for a grossly negative margin of at least 5 cm.
Some gastric tumors, particularly the diffuse variety, are quite infiltrative and
tumor cells can extend well beyond the tumor mass; thus, gross margins
beyond 5 cm may be desirable.
More than 15 resected lymph nodes are required for adequate staging.
The primary tumor may be resected en bloc with adjacent involved organs
(e.g., distal pancreas, transverse colon, or spleen) during the course of curative
gastrectomy.
Subtotal gastric resection typically entails ligation of the left and right gastric
and gastroepiploic arteries at the origin, as well as the en bloc removal of
the distal 75% of the stomach, including the pylorus and 2 cm of
duodenum, the greater and lesser omentum, and all associated lymphatic
tissue.
Generally these are grouped into level D1 (i.e., stations 3 to 6), level D2 (i.e.,
stations 1, 2, 7, 8, and 11), and level D3 (i.e., stations 9, 10, and 12) nodes.
Generally, D1 nodes are perigastric, D2 nodes are along the hepatic and splenic
arteries, and D3 nodes are the most distant.
The standard operation for gastric cancer in Asia and specialized U.S. centers is
the D2 gastrectomy, which involves a more extensive lymphadenectomy (removal
of the D1 and D2 nodes).
Splenectomy and distal pancreatectomy are not routinely performed, because this
clearly has been shown to increase the morbidity of the operation. The purported
survival advantage of D2 gastrectomy in gastric cancer is shown in Table 26-20,
which shows the 5-year survival rates for gastric cancer stratified by pathologic
stage for the United States and Japan. Unfortunately, the randomized prospective
trials that have been performed have not confirmed this survival advantage, but
the morbidity and mortality in the D2 group was higher This was mostly
attributable to the splenectomy and distal pancreatectomy, which are no longer
routinely done as part of the D2 gastrectomy.
Gastric Cancer 5-Year Survival and
Operative Mortality in the USA and Japan
Maruyama (Japan), American College of
1971–1985 Surgeons, 1982–1987
• Small tumors (<3 cm) confined to the mucosa have an extremely low
chance of lymph node metastasis (3%), which approaches the operative
mortality rate for gastrectomy.
• Thus, some patients with early gastric cancer might be better treated
with the endoscopic technique.