Dr. Saleh M.

Al Salamah

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

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 pyloric
antrum.

BLOOD SUPPLY:
a.
b.
c.
d.
e.

The left gastric artery

Right gastric artery

Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
The corresponding veins drain into
portal system. The lymphatic drainage
of the stomach corresponding its blood
supply.

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 6th decades of life and affect
males twice as often as females.
Contn

The cause of the disease multistep process

but several predisposing factors attributed
to cause the disease :

a.
b.
c.
d.

Environment
Diet
Heredity
Achlorhydria

e. Atrophic gastritis
f. Chronic gastric ulcer
g. Adenomatous polyps
h. Blood group A
i. H. Pyloric colonisation

TYPES OF GASTRIC CANCER:

A. Benign Tumours
B. Malignant Tumours

THE BENIGN TUMORS:

Although benign tumors can

occur in the stomach most
gastric tumours are malignant.

 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,

and
angiomas.

neurofibromas, aberrat pancreas

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%).

 Types of Malignant Tumours:

a. Adenocarcinoma
b. Leiomyosarcoma
c. Lymphomas
d. Carcinoid Tumours

 The macroscopic forms of gastric cancers are

classified by (Bormann classification) into:-

1. Polypoid or Proliferative
2. Ulcerating

3. Ulcerating/Infiltrating
4. Diffuse Infiltrating (LinnitusPlastica)

Microscopically the tumours commonly

adenocarcinoma
with
range
of
differentiation.
The most useful to
clinician and epidemiologist is Lauren
Histological Classification:
a. Intestinal gastric cancer

b. Diffuse gastric cancer

Early Gastric Cancer: Defined as

cancer which is confined to the
mucosa and submucosa regardless of lymph nodes status.

Advanced

Gastric

Cancer:

Defined as tumor that has involved

the muscularis propria of the
stomach wall.

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)

SPREAD OF GASTRIC CANCER:

The diffuse type spreads rapidly

through the submucosal and serosal
lymphatic 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.
2.
3.
4.

Direct (loco regional)

Lymphatic
Blood (Haematogenous)
Transcoelomic

EVALUATION OF GASTRIC CANCER:

History
Clinical Examination
Investigations

The clinical features of gastric cancer

may arise from local disease, its
complications or its metastases.

SUMMARY:

Often asymptomatic until late stage.

Marked weight loss

Anorexia

Feeling of abdominal fullness or discomfort

Epigastric mass

Iron Deficiency Anaemia

Left supraclavicular mass (Troisiers Sign)

Obstructive Jaundice (Secondary in porta

hepatitis)

Pelvic mass (Krukenberg)

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

TREATMENTS OF GASTRIC CANCER:

Surgery (Early or Advanced Cancer)

Distal tumours which involve the

partial
gasterectomy).

lower (sub-total or

Proximal tumours which involve

body (total gasterectomy).

the

fundus, cardia or

Inoperable tumours: Whenever

possible it is advisable
to do even a limited gastric resection. If resection is impossible
an anterior gastrojejunostomy.

Chemotherapy for gastric cancer

(Pre-operatve & post-operative)

Radiotherapy
(Pre-intra & post-operatively)

OTHER GASTRIC TUMOURS:

Gastric Lymphomas:

Primary lymphomas of the stomach of

(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.

the

non Hodgkins type

Treatment:

- Well-localized disease should be treated

with resection (surgery) followed by
radiotherapy or chemotherapy.

- Extensive disease by adjuvant chemotherapy & radiotherapy than surgery.

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

dyspepsia.

or epigastric mass or vague

Malignancy is suggested by the size

by noting increased mitosis on histology.

more than 5cm and confirmed

Gastric Carcinoid Tumour:

Are very rare. There is established
gastritis & carcinoid & pernicious

Gastric carcinoids are best treated by

by endoscopic resection.

association between atrophic

anemia.
local resection. If very small