Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations

Presentation on theme: "Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE"— Presentation transcript:

1 Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE
THE GASTRIC CARCINOMA 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 Cancer Genetic 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 Superficial gastritis Intestinal metaplasia
H.Pylori infection Superficial gastritis Atrophic gastritis Intestinal metaplasia Dysplasia Cancer



12 Gastric Cancer Pathology

13 Malignant Neoplasms of the Stomach
Primary Adenocarcinoma (94%) Lymphoma (4%) Malignant GIST (1%) Haematogenous spread Breast Malignant melanoma Direct invasion Pancreas; Liver; colon; ovary

14 Gastric Cancer Gross Appearance
Polypoid Fungating Ulcerative Scirrhous

15 Gastric Cancer Histology –Lauren Classification
Intestinal Diffuse Unclassified

16 Gastric Cancer TNM staging
Tis Intaepithelial tumour T1 Tumour invades LP or submucosa T2 Tumour invades muscularis propria or subserosa T3 Tumour penetrates serosa without invasion of adjacent structures T4 Tumour invades adjacent structures

17 Gastric Cancer TNM staging
No regional lymph node metastases 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

18 Gastric Cancer TNM staging
No distant metastasis M1 Distant metastasis

19 Gastric Cancer Clinical Manifestations

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

21 Trousseau’s syndrome (thrombophlebitis)

22 Acanthosis Nigracans

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


25 Rudolph Virchow

26 Gastric Cancer Diagnostic Evaluation

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

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


30 Gastric Cancer Treatment

31 Surgical Resection & Adequate Lymphadenectomy is the only curative treatment except
Metastases Co-morbid

32 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

33 Radical subtotal gastrectomy
Extent of Gastrectomy Radical subtotal gastrectomy (Distal tumour) Total gastrectomy (Proximal tumour)



36 Lymphadenectomy

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

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

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

Download ppt "Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE"

Similar presentations

Ads by Google