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

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

1 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

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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 TisIntaepithelial tumour T1Tumour invades LP or submucosa T2Tumour invades muscularis propria or subserosa T3Tumour penetrates serosa without invasion of adjacent structures T4Tumour invades adjacent structures

17 Gastric Cancer TNM staging N0No regional lymph node metastases N1Metastasis in 1 to 6 regional lymph nodes N2Metastasis in 7 to 15 regional lymph nodes N3Metastasis in more than 15 regional lymph nodes

18 Gastric Cancer TNM staging M0No distant metastasis M1Distant 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

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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

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

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36 Lymphadenectomy

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

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

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


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