GASTRIC CANCER

(STOMACH CANCER)
GASTRIC CANCER
DEVELOPS SLOWLY
Pre-cancerous changes often
occur in the mucosa of the
stomach.
Types of stomach cancers:
*Adenocarcinoma
Most (about 90% to 95%) cancers of the stomach
are adenocarcinomas.
These cancers develop from the cells that form
the innermost lining of the stomach (the mucosa).
*Lymphoma
These are cancers of the immune
system tissue that are sometimes found
in the wall of the stomach.
*Gastrointestinal stromal tumor
(GIST):
These rare tumors start in very
early forms of cells in the wall of the
stomach called interstitial cells of
Cajal. Although GISTs can be found
anywhere in the digestive tract,
most are found in the stomach.
Carcinoid tumor
 These tumors start in hormone-
making cells of the stomach. Most
of these tumors do not spread to
other organs.
 INCIDENCE:
United States, more than 11,000 deaths
annually.
The typical patient with gastric cancer is
between 40 and 70 yrs of age.
Men have a higher incidence of gastric
cancer than women.
 RISK FACTORS:
Nutrition
*

Obesity, GERD, poor drinking

water, lack of refrigeration, high
consumption of foods high in
nitrates, smoked or salt-cured food
preparation, low dietary intake of
Vitamins A and C, smoking and
alcohol intake.
RISK FACTORS
 *Environment
 occupational and infections disease-
related factors, metal worker, rubber
workers, those exposed to dust from wood
and asbestos have all been shown to have
 *Genetic
 *Helicobacter pylori infection
 *Epstein-Barr virus
 Adenocarcinoma

tumor infiltrates the surrounding

mucosa

penetrating the wall of stomach

Hemorrhage or perforation
 Presence of palpable mass, ascites,
or bone pain caused by metastasis

Abdominal Swelling or fluid

Poor (belly)
Heartburn or
appetite indigestion build-up in the
pain
abdomen

Weight Vague
discomfort in
Nausea & Blood in the
loss Vomiting
the abdomen, stool
usually above
the navel
CLINICAL MANIFESTATIONS:

Pain relieved by antacids

Dyspepsia (indigestion)
Early satiety
Weight loss
Nausea
CLINICAL FEATURES:
*GI Complaints
Dyspepsia
weight loss
anorexia
dysphagia
vomiting after meals
hematemesis
 Diagnosis:

*Gastroscopic exam is the diagnostic

method of choice.
*Upper GI series (Barium
roentgenogram).
*Computed tomography or CT scanning
of the abdomen
 TNM Clinical
Classification System for
Staging Gastric
Carcinoma
PTRIMARY TUMOR (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ intraepithelial tumor, without
invasion of the lamina propria
T1 Tumor invades lamina propria or submucosa
T2 Tumor invades muscularis propria or subserosa
T2a Tumor invades muscularis propria
T2b Tumor invades the subserosa
T3 Tumor penetrates serosa (visceral pentoneum)
without invasion of adjacent structures
T4 Tumor invades adjacent structures
 REGIONAL LYMPHNODES (N)
NX Regional lymph node(s) cannot be
assessed
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 6 regional lymph nodes
N2 Metastasis in 7 to 15 regional lymph nodes
N3 Metastasis in more than 15 regional lymph
nodes
 DISTANT METASTASIS
(M)
MX Presence of distant metastasis
cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
 Management:
*Surgery- remains the only curative therapy
for stomach cancer.

*Radiation therapy (also called radiotherapy)

may be used to treat stomach cancer, often
as an adjuvant to chemotherapy and/or
surgery.
BILLROTH SURGERY

 PREVENTION OF COMPLICATIONS
HEMORRHAGE
DUMPING SYNDROME
NUTRIONAL DEFICIENCIES
CHEMOTHERAPY

 5-FU(fluorouracil), often given along with

leucovorin (folinic acid)
 Capecitabine (Xeloda)
 Carboplatin
 Cisplatin
 Docetaxel (Taxotere)
CHEMOTHERAPY

 Epirubicin (Ellence)
 Irinotecan (Camptosar)
 Oxaliplatin (Eloxatin)
 Paclitaxel (Taxol)
 Trifluridine and tipiracil (Lonsurf)
COMBINATION OF CHEMOTHERAPY

 ECF (epirubicin, cisplatin, and 5-FU),which may be given

before and after surgery
 Docetaxel or paclitaxel plus either 5-FU or capecitabine,
combined with radiation as treatment before surgery
 Cisplatin plus either 5-FU or capecitabine, combined with
radiation as treatment before surgery
 Paclitaxel and carboplatin, combined with radiation as
treatment before surgery
CHEMORADIATION

 When chemotherapy is given with radiation after

surgery, a single drug such as 5-FU or
capecitabine
END