Gastric tumours

Angl speak IV year

2012-2013 DEGHAS

Gastric tumours

Epidemiology and incidence Pathology Histology Symtpoms Diagnosis Therapy Prognosis Prevention

Incidence

Rapid decrease mortality in 80 years USA men 28/5 women 2.8/100 tis High incidence Japan,Chile,China,Ireland Dietary factors – poor people Study of migrants – eniviromental factors

(infection,freezing boxes)

Incidence stomach carcinoma

Stomach tumours patology/histology

Adenocarcinoma 85%– advanced– early

Lymphoma 15% Leiomyosarkoma and + GIST= (Gastro Intestinal Stromal Tumour)

celkem 1-3%

Patology/course of disease

Difuse type – less common (cca 10%)– Malignant cells infiltrates the whole stomach– linitis plastica– Younger patients– Diagnosis dificult by endoscopy – X-ray barium meal not

extendable stomach

Intestinal type– Polypoid-ulcerative changes antral and small curve– Long-term praekancerous proces– High risk areas

Aetiology

Nitrátes + bakteries = nitrites = cancerogeny– Smoked,tinned,salted preserved food

Helicobacter pylori Reduction of gastric acidity

– Gastric surgery– Medication - PPI,H2,

Blood group A- low mucus secretion Adenomatous polyps

Symptoms and course

Asymptomatic anemie Epigastric pain,anorexy,loww of weight

– Palpable mass –inoperable tumour Complications

– Pylorus – vomiting– Cardia - dysfagia

Metastasis – Per continuitatem – pancreas– Lymfonodes (Wirchov, umbilicus,,Douglas,ovarium,ascites)– Hematogenic – liver,pulmo

Borrmannś makroscopic clasification of advanced gastric cancer

I  Polypoid II  Ulcerative limited III Ulcerative with uneven margins IV  Infiltrative- only biopsy or X-ray or

CT,mostly non visible during endoscoopy

Early gastric carcinoma

Limited to mucosa and/or submucosa(infiltrated lymphonodes may or not may be present

Difficult diagnosis – small lesions Histology the basis Mostly in Japan Definitive diagnosis only after pathological

assesment of surgery tissue Early lesion (whioch can follow into advanced) or

another type of carcinoma?

Klasifikace karcinomu

Diagnosis

Endoscopy + biopsy Ulcus benign – malignant- biopsy in all

ulcers X-ray of the stomach double contrast

(leatherbottle) or CT Lymphoma and carcinoma loooks similarly in

endoscopy

Normal barium meal and rumorous infiltration of the stomach

Gastric cancer : polypoid

Benign and malignant ulcer

Biopsy in every gastric ulcer necessary – tumour ?

Malignant ulcer

Proximál gastric tumor

Gastric adenokarcinoma

Gastric lymphoma

Gastric leiomyosarcoma

Surgery gastric carcinoma

Resection Billroth I a II + lymphonodes!! Total gastrektomy rarely Gastroenteroanastomosis Laparotomy without resection (not common

now)

Surgery for gastric carcinoma

Surgery other types

Lymphonodes extirpation

Prognosis - 5 years survival

Depends on deep of wall infiltration, lymphonodes, histology and genetic abnormalities

Operable radically 20-30%– Distal tumor – 20%– Proximal tumor – 10%

Chemotherapy – cisplatina, epirubicin,5-Fluorouracil– Before and after surgery - different protocols

Prognosis of lymphoma

MALT H.pylori – antibiotics Surgery and chemotherapy – 5 years 40-60% survival

Prevention of gastric cancer

Follow-up of precancerous states– Pernicious anemia– Previous gastrectomy

Eradikation of H.Pylori Fruit and vegetable