Carcinoma Stomach

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.

ETIOLOGY
Environment Diet Heredity H. Pyloric colonization Chronic gastric ulcer Atrophic gastritis Achlorhydria Adenomatous polyps Blood group previous gastric surgery (G-J)

symptoms

Often asymptomatic until late stage.

Marked weight loss Anorexia Feeling of abdominal fullness or discomfort Vomiting(GOO) Anemia Obstructive Jaundice (Secondary in porta hepatitis) Pelvic mass (Krukenberg)

Signs(late stages)
Epigastric mass. Visible gastric peristalsis Virchows node: left supraclavicular lymphadenopathy. Irishs node: axillary lymphadenopathy Sister Mary Josephs node: umbilical lymphadenopathy .

Sister Mary Josephs node

Investigations
Flexible endoscopy(gold standard) , biopsy needed for definitive diagnosis. Contrast radiology. Ultrasonography (endoscopic). Computerised tomography scanning and Magnetic resonance imaging. Diagnostic laparoscopy.

Early Gastric Carcinoma at lesser curvature

Late Gastric Carcinoma at lesser curvatu

Linitis plastica

Advanced malignacy at pylorus causing GO

Endoscopic ultrasound
Gastric cancer lesion confined to mucosa layer

Contrast Radiography
Distal

Proximal GC

Linitis plastica

TNM staging
Primary Tumor (T) T1 T1a -Tumor invades lamina propria or muscularis mucosae T1b Tumor invades submucosa T2 - invades the muscularis propria T3- invades the subserosal connective tissue T4 -invades the serosa (visceral peritoneum) or adjacent structures

Regional Lymph Nodes (N) N1 = 12 positive lymph nodes, N2 = 36 positive lymph nodes, N3 = 7 or more positive lymphnodes.

Distant Metastasis (M) M0 =No distant metastasis M1= Distant metastasis

Early Gastric Cancer:

Defined as cancer which is confined to the mucosa and submucosa regard-less of lymph nodes status.

Advanced Gastric Cancer: Defined as tumor that has involved the muscularis propria of the stomach wall.

Gastric Resections
Curative

Total gastrectomy Subtotal gastrectomy

Distal gastrectomy

palliative

For tumours distally placed in the stomach it appears unnecessary to remove the whole stomach

Billroth I vs Billroth II

Surgery for Palliation

palliative intestinal

resection bypass

enterostomy

Aims of palliative surgery

Relief of symptoms to improve quality of life prolongation of comfortable survival without producing new symptoms or incurring excessive mortality or morbidity

Thank you