1 / 23

GASTRIC CA

GASTRIC CA. Ruanto , M.T., Sabalvaro , D.K., Salac , C.N., Salazar, J. References: Harrison’s Principle of Internal Medicine 17 th edition www.cancer.org. EPIDEMIOLOGY. GASTRIC ADENOCARCINOMA Decrease incidence and mortality rates for gastric CA during past 75 years (unclear reasons)

ventana
Download Presentation

GASTRIC CA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. GASTRIC CA Ruanto, M.T., Sabalvaro, D.K., Salac, C.N., Salazar, J. References: Harrison’s Principle of Internal Medicine 17th edition www.cancer.org

  2. EPIDEMIOLOGY GASTRIC ADENOCARCINOMA • Decrease incidence and mortality rates for gastric CA during past 75 years (unclear reasons) • Risk: lower > higher socioeconomic classes • Development: • Environmental exposure beginning early in life • Dietary carcinogens

  3. EPIDEMIOLOGY PRIMARY GASTRIC LYMPHOMA • Uncommon: <15% of gastric malignancies ~2% of all lymphomas • Stomach – most frequent extranodal site for lymphoma • Increased in frequency during the past 30 days • Detected during the 6th decade of life

  4. EPIDEMIOLOGY GASTRIC (NONLYMPHOID) SARCOMA • Leiomyosarcomas & GIST: 1-3% of gastric neoplasms

  5. CLINICAL FEATURES ADENOCARCINOMA • Asymptomatic - superficial & surgically curable • insidious upper abdominal discomfort (vague, postprandial fullness to severe steady pain) - extensive tumors • Anorexia with slight nausea • Weight loss, nausea & vomiting - tumors of the pylorus • dysphagia & early satiety - diffuse lesions originating in cardia • No early physical signs • Palpable abdominal mass – long-standing growth, regional extension

  6. CLINICAL FEATURES ADENOCARCINOMA • Metastases: • intraabdominal lymph nodes • supraclavicular lymph nodes • Ovary (Krukenberg’s tumor) • Periumbilical region (“Sister Mary Joseph node”) • Peritoneal cul-de-sac (Blumer’s shelf): palpable on rectal or vaginal examination • Malignant ascites • Liver – most common site for hematogenous spread of tumor • Unusual clinical features: migratory thromboplebitis, microangiopathic hemolytic anemia & acanthosisnigrans

  7. CLINICAL FEATURES PRIMARY GASTRIC LYMPHOMA • Epigastric pain, early satiety & generalized fatigue • Ulcerations with ragged, thickened mucosal pattern by contrast radiographs GASTRIC (NONLYMPHOID) SARCOMA • Anterior and posterior walls of gastric fundus • most frequently involved • Ulcerate and bleed • Rarely invade adjacent viscera • Do not metastasize to lymph nodes • May spread to liver and lungs

  8. DIAGNOSIS • Double contrast radiographic examination • Simplest procedure – epigastric complaints • Helps detect small lesions by improving mucosal detail • Stomach should be distended  decreased distensibility may be the only indication of diffused infiltrative carcimoma • Gastroscopy • Not mandatory if: • Radiographic features are typically benign • Complete healing can be visualized by x-ray within 6 weeks • Follow-up contrast radiograph obtained several months later shows a normal appearance

  9. DIAGNOSIS • Gastroscopic biopsy and brush cytology • Should be made as deeply as possible • Recommended in all patients with gastric ulcers  to exclude malignancy • Malignant ulcers must be recognized before they penetrate into surrounding tissues • Rate of cure of early lesions limited to mucosa and submucosa is >80%

  10. Staging system for gastric ca

  11. Risk factors

  12. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  13. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  14. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  15. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  16. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  17. Reference: Harrison’s Principles of Internal Medicine, 17th ed. www.cancer.org

  18. TREATMENT

  19. SURGICAL TREATMENT • Complete surgical removal of the tumor with resection of adjacent lymph nodes • Only chance for cure • Possible in <1/3 of patients • Subtotal gastrectomy – distal carcinomas • Total or near-total gastrectomies – more proximal tumors • Extended lymph node dissection – an added risk for complications, do not enhance survival

  20. SURGICAL TREATMENT • Prognosis depends on the degree of tumor penetration into the stomach wall. • Adversely influenced by regional lymph node involvement, vascular invasion, and abnormal DNA content • Probability of survival after 5 years • ~20% for distal tumors • <10% for proximal tumors • Recurrences continuing for at least 8 years after surgery • For patients whose disease is “incurable” by surgery with no ascites or extensive hepatic or peritoneal metastasis: • Resection of the primary lesion should still be offered. • Reduction of tumor bulk – best form of palliation; enhance probability of benefit from subsequent therapy

  21. Radiation Therapy • Major role: palliation of pain • Gastric adenocarcinoma is a relatively radioresistanttumor. • Control of tumor requires doses of irradiation exceeding the tolerance of surrounding structures (eg., bowel mucosa and spinal cord). • Survival in the setting of surgically unresectable disease limited to the epigastrium was slightly prolonged when 5-FU was given in combination with radiation therapy. • 5-FU: radiosensitizer

  22. Pharmacologic Therapy • Cisplatin + epirubicin & infusional 5-FU or + irinotecan • Complete remissions are uncommon. • Partial responses in 30-50% of cases are transient. • Overall influence on survival has been unclear. • Adjuvant chemotherapy alone following complete resection has only minimally improved survival. • Perioperativetreatment and postoperative chemotherapy + radiation therapy reduce the recurrence rate and prolongs survival.

  23. Thank You!

More Related