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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