GASTRIC CARCINOMA

• Carcinoma of stomach is the second most common cause of cancer death.
• More common in males.
• Proximal stomach carcinoma is the most common site for gastric carcinoma.
• Gastric cancers can grow to an extent to cause damage to cells producing intrinsic factors and hence vitamin B12 deficiency.

Etiology-

1. Risk factors-

• Smoking, alcohol
• EBV, H. Pylori
• Pernicious anaemia

2. Genetic & familial

• E- cadherin gene
• CDH1 (90%)

3. Premalignant lesions-

• Chronic atrophic gastritis- most common precursor lesion
• Chronic gastric ulcer
• Intestinal metaplasia (H. Pylori)
• After Billroth II GJ or vagotomy GJ

Pathology–

I) Lauren classification is the most useful classification of gastric cancer- 

 II) According to the depth of invasion- 

Clinical features- 

• Vague epigastric discomfort after food.
• Pain
• Weight loss (most common symptom), anorexia, fatigue, vomiting.
• Melena, hematemesis
• Dysphagia
• Gastric carcinomas are often associated with hypochlorhydria and achlorhydria.

Investigations-

1. Complete blood picture- iron deficiency anaemia (microocytic, hypochromic)
2. Oesophagogastroduodenoscopy- extent of the lesion & confirms the diagnosis.
3. Ultrasound & CT scan- useful in detecting metastatic carcinoma.
4. Laproscopy- laproscopic peritoneal lavage for cytology is the best test.
5. Barium meal useful incase of linitis plastica.

Histopathalogy-

• Hourglass appearance of the stomach caused by carcinoma.

Treatment-

• Surgical resection of the stomach is the only curative treatment.
• Endoscopic mucosal resection – tumours
• Total radical gastrectomy with OG anastomosis of proximal stomach, linitis plastica.
• Lower radical gastrectomy- growth in pylorus
• Radical Gastrectomy perferred- early gastric cancer
• Neo- adjuvant chemotherapy- epirubicin, cis- platinum, 5- FU infusion.
• D2 gastrectomy refers to the extent of lymphadenectomy done along with the gastrectomy.

Exam Important

Don’t Forget to Solve all the previous Year Question asked on GASTRIC CARCINOMA