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Klara Matijević Mentor: A. Žmegač Horvat
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adenocarcinoma gastrointestinal stromal tumours (GIST) primary gastric lymphoma gastric polyps
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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
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H.pylori infection (group 1 gastric carcinogen) dietary factors smoking tobacco genetic abnormalities increased risk after partial gastrectomy
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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
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Lauren classification: intestinal type diffuse type diffuse carcinoma of linitis plastica type gastric adenocarcinoma of intestinal type
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Borrmann classification: polypoid ulcerating ulceroinfiltrative infiltrative gastric adenocarcinoma of polypoid type gastric adenocarcinoma of ulcerative type
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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
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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)
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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
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endoscopic removal (only early non- ulcerated mucosal lesions) surgery chemotherapy radiotherapy palliative care
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GI mesenchymal tumors asymptomatic, found by chance (ulceration, bleeding) treatment: surgery chemotherapy if unresectable
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benign rarely produce symptoms types: hyperplastic adenomatous cystic gland polyps inflammatory fibroid polyps treatment : endoscopic excision
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Kumar and Clark: Clinical Medicine (7th edition) B.Vrhovac, B.Jakšić, Ž.Reiner, B.Vucelić: Interna medicina www.pathconsultddx.com
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