Gastric Carcinoma

GASTRIC CARCINOMA


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

  • 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

Premalignant lesions-

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

Clinical features- 

  • Gastric carcinomas are often associated with hypochlorhydria and achlorhydria.

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
  • D2 gastrectomy refers to the extent of lymphadenectomy done along with the gastrectomy.
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