Klara Matijević Mentor: A. Žmegač Horvat

 adenocarcinoma  gastrointestinal stromal tumours (GIST)  primary gastric lymphoma  gastric polyps

 4th most common cancer world-wide  2nd leading cause of cancer-related mortality  incidence increases with age (rare under the age of 30)  highest incidence: Eastern Asia (Japan), Eastern Europe, South America  men:women = 2:1

 H.pylori infection (group 1 gastric carcinogen)  dietary factors  smoking tobacco  genetic abnormalities  increased risk after partial gastrectomy

Normal gastric mucosa H.Pylori infection Acute gastritis Chronic active gastritis Atrophic gastritis Intestinal metaplasia Dysplasia Advanced gastric cancer Diagram showing the development of gastric cancer associated with H.pylori infection

Lauren classification: intestinal type diffuse type diffuse carcinoma of linitis plastica type gastric adenocarcinoma of intestinal type

Borrmann classification: polypoid ulcerating ulceroinfiltrative infiltrative gastric adenocarcinoma of polypoid type gastric adenocarcinoma of ulcerative type

TNM classification:. Stage 0TisN0M0 Stage IAT1N0M0 Stage IBT1N1M0 T2a/bN0M0 Stage IIT1N2M0 T2a/bN1M0 T3N0M0 Stage IIIAT2a/bN2M0 T3N1M0 T4N0M0 Stage IIIBT3N2M0 Stage IVT4N1–3M0 T1–3N3M0 Any TAny NM1 Stage Grouping

 advanced disease at the time of presentation  symptoms at early stage: fullness in upper abdomen, nausea, anorexia  advanced disease symptoms: epigastric pain, nausea, vomiting, dysphagia weight loss anemia (because of bleeding) palpable lymph node – supraclavicular fossa (Virchow’s node)

1. patient history + physical examination  non-specific findings 2. lab findings  FBC + LFT 3. barium meal 4. ENDOSCOPY (EGD) !!! 5. staging: chest X-ray abdominal US CT scan

 endoscopic removal (only early non- ulcerated mucosal lesions)  surgery  chemotherapy  radiotherapy  palliative care

 GI mesenchymal tumors  asymptomatic, found by chance (ulceration, bleeding)  treatment: surgery chemotherapy if unresectable

 benign  rarely produce symptoms  types: hyperplastic adenomatous cystic gland polyps inflammatory fibroid polyps  treatment : endoscopic excision

 Kumar and Clark: Clinical Medicine (7th edition)  B.Vrhovac, B.Jakšić, Ž.Reiner, B.Vucelić: Interna medicina 