1. Prepare by: Ahmad Rsheed Presented to: Fatima Harzallah
Gastric Cancer
Prepare by: Ahmad Rsheed
Presented to: Fatima Harzallah

2. Objective: Assessment and Diagnostic test. Medical Management.
At the end of this presentation the student will be able to:
Identify what is the meaning of gastric cancer.
Signs and symptoms.
Assessment and Diagnostic test.
Medical Management.
Complications.

3. Gastric Cancer
Stomach cancer is the second cause of death among cancers in the world.
The incidence of cancer of the stomach continues to decrease in the United States; however, it still accounts for 12,400 deaths occur in people older than 40 years of age, but they Sometimes occur in younger people.
Men have a higher incidence of gastric cancers than women do.
The incidence of gastric cancer is much greater in Japan, which has instituted mass screening programs for earlier diagnosis

4. Cont… Diet appears to be a significant factor.
A diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, anemia, gastric ulcers, H. pylori infection, genetics, Smoking, a diet poor in fiber, and Drink alcohol

5. Applied anatomy of the stomach

6. Pathophysiology
Most gastric cancers are adenocarcinomas and can occur in any portion of the stomach.
The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures.
The liver, pancreas, esophagus, and duodenum are often affected at the time of diagnosis.
Metastasis through lymph to the peritoneal cavity occurs later in the disease.

7. Clinical Manifestations
In the early stages of gastric cancer, symptoms may be absent.
Early symptoms are seldom definitive because most gastric tumors begin on the lesser curvature, where they cause little disturbance of gastric functions.
Some studies show that early symptoms, such as pain relieved with antacids, resemble those of benign ulcers.

8. Cont……
Symptoms of progressive disease may include anorexia, dyspepsia (indigestion), weight loss, abdominal pain, constipation, anemia, and nausea and vomiting.
These can be symptoms of other problems such as a stomach virus, gastric ulcer. Diagnosis should be done by a gastroenterologist or an oncologist

9. Staging Stage I Cancer has just begun to affect the inner stomach.
Stage II Cancer has begun to penetrate toward the outer layer of stomach. Nearby lymph nodes may be involved.
Stage III Cancer has progressed farther through tissue layers of stomach or more distant lymph nodes may be involved.
Stage IV Cancer has penetrated all tissue layers of stomach or distant lymph nodes may be involved.
Stage V Cancer has affected nearby organs and tissues. Cancer may even have been carried through the lymph system to distant parts of the body. This is known as metastasis. Mainly to the liver, lung & bone

10. Assessment and Diagnostic Findings
The first diagnostic tests performed for patients who complain of the symptoms above is radiography of the stomach.
Different radiographic appearance of tumors of the stomach are wide variations. May appear in the form of a block in the bright spot, ulcerated or not ulcerated, or be in the form of thickening of a non- stretch in the wall of the stomach.

11. Cont……
Is a gastroscopy with multiple biopsies taken from the area suspected the method adopted for the diagnosis of carcinoma of the stomach. Must be supported by taking swabs brushing during endoscopy and sent for testing cell, since the cytological may be positive (about 15% of cases) at the time the biopsies do not reveal the presence of carcinoma

12. Cont……
Because metastasis often occurs before warning signs develop, a computed tomography (CT) scan, bone scan, and liver scan are valuable in determining the extent of metastasis.
A complete x-ray examination of the GI tract should be performed when any person older than 40 years of age has had indigestion (dyspepsia) of more than 4 weeks’ duration

13. Medical Management
There is no successful treatment for gastric carcinoma except removal of the tumor.
If the tumor can be removed while it is still localized to the stomach, the patient can be cured.
If the tumor has spread beyond the area that can be excised, cure is impossible.
Palliative rather than radical surgery is performed if there is metastasis to other vital organs, such as the liver.

14. Cont…..
In many of these patients, effective palliation to prevent discomfort caused by obstruction or dysphagia may be obtained by resection of the tumor
If a radical subtotal gastrectomy is performed, the stump of the stomach is anastomosed to the jejunum, as in the gastrectomy for ulcer.

15. Cont……
When a total gastrectomy is performed, GI continuity is restored by means of an anastomosis between the ends of the esophagus and the jejunum.
If surgical treatment does not offer cure, treatment with chemotherapy may offer further control of the disease or palliation.
Commonly used chemotherapeutic medications include cisplatin, or a combination of 5- fluorouracil, doxorubicin, and mitomycin-C

16. Cont……
Some studies are being conducted on the use of chemotherapy before surgery.
Radioantitherapy also may be used for palliation.
Assessment of tumor markers (blood analysis for antigens indicative of colon cancer) such as carcinoembryonic antigen

17. Complications
death rates within 30 days after surgery stomach cancer declined over the last forty years, and most reports indicate that the rate is now 1-2%.
complications early after surgery include failure of connection at both ends of the grubber from the stomach anastomotic failure (may require the patient to additional surgery for the treatment of infusion), bleeding,, and inflammation of the gallbladder, and inflammation of the pancreas, and injury of the lung infection, and thromboembolism.

18. Cont…..
complications of late dumping syndrome, and a lack of vitamin B-12, and inflammation of the esophagus retrospective reflux esophagitis, and bone disorders, especially osteoporosis

19. Tha nks