1 / 39

THE GASTRIC CARCINOMA

THE GASTRIC CARCINOMA. Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE. Preamble. Epidemiology Aetiologic factors Pathology Clinical features Investigations Treatment. Adenocarcinoma -Epidemiology. Incidence  in USA/western Europe

brac
Download Presentation

THE GASTRIC CARCINOMA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE GASTRICCARCINOMA Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE

  2. Preamble • Epidemiology • Aetiologic factors • Pathology • Clinical features • Investigations • Treatment

  3. Adenocarcinoma -Epidemiology • Incidence  in USA/western Europe • Leading cause of death in Asia/Eastern Europe • Elderly • Blacks • Low SE status

  4. What causes Gastric Cancer?

  5. Gastric Cancer • Pernicious anaemia • Blood group A • Family history of gastric cancer

  6. Gastric Cancer Diet • High fat diet • Pickled, preserved food • Tobacco • Fresh fruit and vegetables • Vitamin C • Regular aspirin

  7. Gastric CancerGenetic Mutations • Deletion or suppression of p53 • Overexpression of COX-2 • CDH1

  8. Gastric Cancer Pre-malignant Conditions • Polyps • Atrophic gastritis • Benign gastric ulcer • Gastric ramnant

  9. Gastric CancerPathology

  10. Malignant Neoplasms of the Stomach

  11. Gastric CancerGross Appearance

  12. Gastric CancerHistology –Lauren Classification

  13. Gastric CancerTNM staging

  14. Gastric CancerTNM staging

  15. Gastric CancerTNM staging

  16. Gastric CancerClinical Manifestations

  17. Symptoms • Weight loss • Decreased food intake • Abdominal pain • Nausea, vomiting and bloating • Acute GI bleeding • Chronic GI bleeding • Dysphagia

  18. Trousseau’s syndrome(thrombophlebitis)

  19. Acanthosis Nigracans

  20. Clinical Signs • Cervical, supraclavicular and axillary lymphadenopathy • Pleural effusion • Aspiration pneumonitis • Abdominal mass • Sister Joseph’s nodule • Ascites • Rectal shelf of Blumer

  21. Rudolph Virchow

  22. Gastric CancerDiagnostic Evaluation

  23. Promptupper endoscopy if… • New onset of dyspepsia >45 years • Dyspepsia with alarm symptoms (weight loss, anaemia, recurrent vomiting, bleeding) • Dyspepsia & family h/o gastric carcinoma

  24. Preoperative Staging • Abdominal / pelvic CT scanning • Endoscopic ultrasound (EUS) • Depth of the tumour • Enlarged perigastric/coeliac lymph nodes

  25. Gastric CancerTreatment

  26. Surgical Resection & Adequate Lymphadenectomyis the only curative treatmentexcept • Metastases • Co-morbid

  27. Surgical Resection • Resection of tumour • Grossly negative margin of at least 5 cms • Partial gastrectomy • Confirmed on frozen section • En block resection of adjacent involved organs

  28. Extent of Gastrectomy • Radical subtotal gastrectomy (Distal tumour) • Total gastrectomy (Proximal tumour)

  29. Lymphadenectomy

  30. D1: stations 3-6 • D2: stations 1,2, 7,8 and 11 • D3: stations 9, 10 and 12

  31. Survival benefit to adjuvant radio-chemotherapy is marginal in patients who have undergone adequate resection

  32. In gross unresectable, metastatic tumour Role of palliative chemotherapy is uncertain

More Related