Download - Gastric Tumour (1)
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Dr. Saleh M. Al Salamah
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GASTRIC TUMOURS
Anatomy of the stomach
Aetiology of Gastric cancer
Types of Gastric cancer
Pathology of Gastric Cancer
Evaluation of Gastric Cancer
Treatment of Gastric Cancer
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ANATOMY:
The stomach J-shaped. The stomach
has two surfaces (the anterior &posterior), two curvatures (the greater &
lesser), two orifices (the cardia &
pylorus). It has fundus, body and pyloricantrum.
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BLOOD SUPPLY:
a.
The left gastric artery
b. Right gastric artery
c. Right gastro-epiploic artery
d.
Left gastro-epiploic artery
e. Short gastric arteries
The corresponding veins drain intoportal system. The lymphatic drainage
of the stomach corresponding its blood
supply.
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AETIOLOGY:
Gastric cancer is the second most
common fatal cancer in the world with
high frequency in Japan.
The disease presents most commonly in
the 5th and 6thdecades of life and affectmales twice as often as females.
o t
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The cause of the disease multistep processbut several predisposing factors attributedto cause the disease :
a.
Environment
e.
Atrophic gastritis
b. Diet f. Chronic gastric ulcer
c. Heredity g. Adenomatous polyps
d.
Achlorhydria
h.
Blood group A
i. H. Pyloric colonisation
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TYPES OF GASTRIC CANCER:
A. Benign Tumours
B. Malignant Tumours
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The benign groups includes:-
1. Non-neoplastic gastric polyps
2.
Adenomas
3. Neoplastic gastric polyps
4.
Smooth muscles tumours benign
(Leiomyomas)
5. Polyposis Syndrome (eg:- Polyposis coli,
Juvenile polyps and P.J. Syndrome)
6. Other benign tumours are fibromas, neurofibromas, aberrat pancreasand
angiomas.
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PATHOLOGY OF GASTRIC (MALIGNANT)TUMOURS:
The gastric cancer may arise in
the antrum (50%), the gastric
body (30%), the fundus or
oesophago-gastric juntion (20%).
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Types of Malignant Tumours:
a. Adenocarcinoma
b.
Leiomyosarcoma
c. Lymphomas
d.
Carcinoid Tumours
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1. Polypoid or Proliferative
2. Ulcerating
3. Ulcerating/Infiltrating
4.
Diffuse Infiltrating (Linnitus-
Plastica)
The macroscopic forms of gastric cancers are
classified by (Bormann classification)into:-
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Microscopically the tumours commonlyadenocarcinoma with range of
differentiation. The most useful to
clinician and epidemiologist is Lauren
Histological Classification:
a. Intestinal gastric cancer
b.
Diffuse gastric cancer
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Early Gastric Cancer: Defined ascancer which is confined to themucosa and submucosa regard-
less of lymph nodes status.
Advanced Gastric Cancer:Defined as tumor that has involved
the muscularis propria of the
stomach wall.
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STAGING OF GASTRIC CANCER:
a. TNM System
b. CT Staging
c. PHNS Staging System (Japanese)
P-factor (Peritoneal dissemination)
H-factor (The presence of hepatic metastases)
N-factor (Lymphnodes involvement)
S-factor (Serosal invasion)
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SPREAD OF GASTRIC CANCER:
The diffuse type spreads rapidly
through the submucosal and serosallymphatic and penetrates the gastric
wall at early stage, the intestinal variety
remains localized for a while and has less
tendency to disseminate.
The spread by:
1.
Direct (loco regional)
2. Lymphatic
3. Blood (Haematogenous)
4. Transcoelomic
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EVALUATION OF GASTRIC CANCER:
History
Clinical Examination
Investigations
The clinical features of gastric cancermay arise from local disease, its
complications or its metastases.
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INVESTIGATIONS:
A. Upper gastero intestinal endoscopy
with multiple biopsy and brush
cytology
B.
Radiology:
CT Scan of the chest and abdomen
USS upper abdomen
Barium meal
C. Diagnostic laparoscopy
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TREATMENTS OF GASTRIC CANCER:
Surgery(Early or Advanced Cancer)
Distal tumours which involve the lower (sub-total or
partial gasterectomy).
Proximal tumours which involve the fundus, cardia or
body (total gasterectomy).
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Inoperable tumours: Whenever possible it is advisable
to do even a limited gastric resection. If resection is impossible
an anterior gastrojejunostomy.
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Chemotherapy for gastric cancer
(Pre-operatve & post-operative)
Radiotherapy
(Pre-intra & post-operatively)
OTHER GASTRIC TUMOURS
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OTHER GASTRIC TUMOURS:
Gastric Lymphomas:
Primary lymphomas of the stomach of the non Hodgkins type
(NHL).
The symptoms are similar to those of
gastric cancer (adenocarcinoma).
The diagnosis is made principally from
endoscopic examination with biopsy and
cytology.
CT Scanning is important in staging the
disease.
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Treatment:
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Well-localized disease should be treatedwith resection (surgery) followed byradiotherapy or chemotherapy.
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Extensive disease by adjuvant chemo-
therapy & radiotherapy than surgery.
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Leiomyosarcoma:
Arise in the stomach representing 1 of gastric tumors.
They may be sessile or pedanculated projecting into the gastric
lumen or extragastrical or both (dumb-bell tumour).
Presentation due to blood loss anaemia or epigastric mass or vague
dyspepsia.
Malignancy is suggested by the size more than 5cm and confirmed
by noting increased mitosis on histology.
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Gastric Carcinoid Tumour:
Are very rare. There is established association between atrophic
gastritis & carcinoid & pernicious anemia.
Gastric carcinoids are best treated by local resection. If very small
by endoscopic resection.
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