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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
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THE GASTRICCARCINOMA 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 • Leading cause of death in Asia/Eastern Europe • Elderly • Blacks • Low SE status
Gastric Cancer • Pernicious anaemia • Blood group A • Family history of gastric cancer
Gastric Cancer Diet • High fat diet • Pickled, preserved food • Tobacco • Fresh fruit and vegetables • Vitamin C • Regular aspirin
Gastric CancerGenetic Mutations • Deletion or suppression of p53 • Overexpression of COX-2 • CDH1
Gastric Cancer Pre-malignant Conditions • Polyps • Atrophic gastritis • Benign gastric ulcer • Gastric ramnant
Symptoms • Weight loss • Decreased food intake • Abdominal pain • Nausea, vomiting and bloating • Acute GI bleeding • Chronic GI bleeding • Dysphagia
Clinical Signs • Cervical, supraclavicular and axillary lymphadenopathy • Pleural effusion • Aspiration pneumonitis • Abdominal mass • Sister Joseph’s nodule • Ascites • Rectal shelf of Blumer
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
Preoperative Staging • Abdominal / pelvic CT scanning • Endoscopic ultrasound (EUS) • Depth of the tumour • Enlarged perigastric/coeliac lymph nodes
Surgical Resection & Adequate Lymphadenectomyis the only curative treatmentexcept • Metastases • Co-morbid
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
Extent of Gastrectomy • Radical subtotal gastrectomy (Distal tumour) • Total gastrectomy (Proximal tumour)
D1: stations 3-6 • D2: stations 1,2, 7,8 and 11 • D3: stations 9, 10 and 12
Survival benefit to adjuvant radio-chemotherapy is marginal in patients who have undergone adequate resection
In gross unresectable, metastatic tumour Role of palliative chemotherapy is uncertain