Gastric Carcinoma

Background
Gastric carcinoma is the most common cancer in
the world after lung cancer and is a major cause of
mortality and morbidity.
 Gastric Carcinoma

• Background
Adenocarcinomas account for approximately 95% of all
malignant gastric neoplasms.

The remaining 5% of tumors are :

Lymphomas
leiomyosarcomas
carcinoids
or sarcomas
 Gastric Carcinoma

• Background
• Though a marked reduction has been observed in the
incidence of gastric carcinoma in North America and
Western Europe in the last 50 years, 5-year survival
rates are less than 20%, as most patients present late
and are unsuitable for curative, radical surgery.
 Gastric Carcinoma

• Pathophysiology
• The accepted pathway involves transitions from:
• ► gastritis
►to gastric atrophy

► to metaplasia

• ► to dysplasia ►

• and finally ► to cancer.

 Gastric Carcinoma

• Pathophysiology

• ► Several dietary and environmental factors

may influence this pathway.

• ►Dietary nitrates

• ►Hypochlorhydria

• ►Helicobacter pylori
 Gastric Carcinoma
• Pathophysiology
• ► Several dietary and environmental factors
may influence this pathway.

• ►Certain foods
e.g. (Starch, pickled vegetables, salted fish
and meat, smoked foods, and salt have all
been implicated in the development of
gastric carcinoma).
 Gastric Carcinoma

• Cigarette smoking:
• Those who smoke more than 30 cigarettes per
day have a 5-fold increased risk of gastric
carcinoma.
 Gastric Carcinoma
• Several precancerous conditions are recognized
►Chronic atrophic gastritis
 Gastric Carcinoma
• Several precancerous conditions are recognized

• ► Pernicious anemia
• ► Previous partial gastrectomy
• ► Ménétrier disease
• ► Gastric dysplasia
• ► Adenomatous polyps (20% of all gastric polyps)
• ► Hereditary factors
 Gastric Carcinoma

• ►Gastric adenocarcinomas are divided into

2 types:

• 1) An intestinal type (type 1), with well-formed

glandular structures:

• This type is more likely to involve the distal stomach

and occur in patients with atrophic gastritis. It has a
strong environmental association.
 Gastric Carcinoma

• ►Gastric adenocarcinomas are divided into 2

types

• 2) A diffuse type (type 2), with poorly cohesive

cells that tend to infiltrate the gastric wall:
• Tumors of this type may involve any part of the
stomach, especially the cardia, and have a worse
prognosis than the intestinal type.

• Unlike type 1 gastric cancers, type 2 cancers have

similar frequencies in all geographic areas.
 Gastric Carcinoma

• ► With gastric carcinomas, advanced lesions will

have already invaded the muscularis propria.

• They are associated with metastases to regional

lymph nodes or to local or distant structures.
 Gastric Carcinoma

• ►Early gastric lesions are confined to the mucosa or

submucosa.

• Patients with these tumors have a 5-year survival rate

of 90%.

• Most reports are from Japan as a result of mass

screening in that country.
 Gastric Carcinoma
• Before 1950, most gastric tumors detected were
located in the antrum.

• Since then, the location has gradually shifted from the

antrum to the body and fundus because of the rapidly
increasing incidence of carcinoma in the gastric cardia
and lower esophagus.

• Today, 30% of gastric lesions are found in the antrum,

30% are in the body, and 40% are in the fundus and
cardia.
• Illustration
 Gastric Carcinoma
• Frequency
• Incidence
• ► Low incidence: North America, Western Europe,
Australia, and New Zealand

• ► High incidence: Japan, Russia, China, South

America, and Eastern Europe.

• ► In India (highest rate in Mumbai, lowest

Maharashtra state)
• ► by Dr; MD.; Radhika Bobba
 Gastric Carcinoma
• Frequency
• Incidence

• ► In India
• Highest rate in Mumbai.
• Lowest Maharashtra state. ► by Dr. MD.;
Radhika Bobba
 Gastric Carcinoma

• Mortality/Morbidity

Most patients present late, and the 5-year survival rate is

approximately 20%.

• Sex
• Gastric carcinoma is 2 times more common in men than in
women.
 Gastric Carcinoma
• Age
• Gastric carcinoma has a peak incidence in those
aged 50-70 years.

• however, approximately 5% of patients with

gastric cancer are younger than 35 years, and 1%
are younger than 30 years.

• Younger patients have more aggressive lesions

with a worse prognosis.
 Gastric Carcinoma
• Anatomy Recall
• (They need not)
 Gastric Carcinoma

• Clinical Details
• History
• Most patients present with advanced disease because they
are often asymptomatic in the earlier stages.
 Gastric Carcinoma
• Clinical Details
• History
• Common presenting features include:
epigastric pain bloating
early satiety nausea
vomiting dysphagia
anorexia weight loss (weakness, fatigue)
and upper GI bleeding:
Hematemesis, melena
iron deficiency anemia
positive results with fecal occult blood tests.
 Gastric Carcinoma

• Clinical Details
• Physical examination
• Looking for signs of disease such as:
Skin and eyes (jaundice)
Lumps
Changes in the abdomen (fluid or swelling)
Swollen lymph node

► ♂ Pelvic and Rectal examination

 Gastric Carcinoma

• Differential diagnosis
• Because peptic ulcers and gastritis cause similar
findings, diagnosis is often delayed.

• Jaundice and hepatomegaly may be due to hepatic

metastases.

• Pelvic masses may be the result of ovarian

metastases (Krukemberg’s tumors).
 Gastric Carcinoma

• Differential diagnosis
• Other Problems to be Considered
• Gastric lymphoma
• Gastric metastases
• Gastric varices
• Gastric polyps
 Gastric Carcinoma

• Prognosis and staging

• The prognosis is related to the stage of the disease at

the time of diagnosis and to the histologic grade of the
carcinoma.
Stage TNM Stage 5-Year Survival

–
1 T1N0M0, 88%
T1N1M0, or
T2N0M0

2 T1N2M0, T2N1M0, 65%

or T3N0M0

3a T2N2M0, 35%
T3N1M0, or
T4N0M0

3b T3N2M0 35%
4 T4N1-3M0, 5%
 Gastric Carcinoma
• Lab examination
• Perform blood tests including
• full blood count determination

• Liver, and kidneys function tests.

• Inspect the stool, and test for occult blood.

 Gastric Carcinoma
• Imaging evaluation

• Endoscopy.
• Biopsy samples obtained during endoscopy.
• Fiberoptic endoscopy or a double-contrast study
of the upper GI tract.
• CT scan
• MRI
• Ultrasonography (US)
 Gastric Carcinoma

• Treatment
• Neoadjuvant therapy
• Curative surgery
• Adjuvant therapy
• Palliative surgery
• Chemotherapy
• Radiation therapy
• Biological therapy (natural substances)