Gastric Cancer

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Gastric Cancer

• Prepare by Ahmad Rsheed
• Presented to Fatima Harzallah

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Objective

• At the end of this presentation the student will
  be able to
• Identify what is the meaning of gastric cancer.
• Signs and symptoms.
• Assessment and Diagnostic test.
• Medical Management.
• Complications.

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Gastric Cancer

• Stomach cancer is the second cause of death among
  cancers in the world.
• The incidence of cancer of the stomach continues
  to decrease in the United States however, it
  still accounts for 12,400 deaths occur in people
  older than 40 years of age, but they Sometimes
  occur in younger people.
• Men have a higher incidence of gastric cancers
  than women do.
• The incidence of gastric cancer is much greater
  in Japan, which has instituted mass screening
  programs for earlier diagnosis

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Cont

• Diet appears to be a significant factor.
• A diet high in smoked foods and low in fruits and
  vegetables may increase the risk of gastric
  cancer.
• Other factors related to the incidence of
  gastric cancer include chronic inflammation of
  the stomach, anemia, gastric ulcers, H. pylori
  infection, genetics, Smoking, a diet poor in
  fiber, and Drink alcohol

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Applied anatomy of the stomach
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Pathophysiology

• Most gastric cancers are adenocarcinomas and can
  occur in any portion of the stomach.
• The tumor infiltrates the surrounding mucosa,
  penetrating the wall of the stomach and adjacent
  organs and structures.
• The liver, pancreas, esophagus, and duodenum are
  often affected at the time of diagnosis.
• Metastasis through lymph to the peritoneal
  cavity occurs later in the disease.

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Clinical Manifestations

• In the early stages of gastric cancer, symptoms
  may be absent.
• Early symptoms are seldom definitive because most
  gastric tumors begin on the lesser curvature,
  where they cause little disturbance of gastric
  functions.
• Some studies show that early symptoms, such as
  pain relieved with antacids, resemble those of
  benign ulcers.

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Cont

• Symptoms of progressive disease may include
  anorexia, dyspepsia (indigestion), weight loss,
  abdominal pain, constipation, anemia, and nausea
  and vomiting.
• These can be symptoms of other problems such as a
  stomach virus, gastric ulcer. Diagnosis should be
  done by a gastroenterologist or an oncologist

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Staging

• Stage I Cancer has just begun to affect the inner
  stomach.
• Stage II Cancer has begun to penetrate toward
  the outer layer of stomach. Nearby lymph nodes
  may be involved.
• Stage III Cancer has progressed farther through
  tissue layers of stomach or more distant lymph
  nodes may be involved.
• Stage IV Cancer has penetrated all tissue layers
  of stomach or distant lymph nodes may be
  involved.
• Stage V Cancer has affected nearby organs and
  tissues. Cancer may even have been carried
  through the lymph system to distant parts of the
  body. This is known as metastasis. Mainly to the
  liver, lung bone

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Assessment and Diagnostic Findings

• The first diagnostic tests performed for patients
  who complain of the symptoms above is radiography
  of the stomach.
• Different radiographic appearance of tumors of
  the stomach are wide variations. May appear in
  the form of a block in the bright spot, ulcerated
  or not ulcerated, or be in the form of thickening
  of a non-stretch in the wall of the stomach.

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Cont

• Is a gastroscopy with multiple biopsies taken
  from the area suspected the method adopted for
  the diagnosis of carcinoma of the stomach. Must
  be supported by taking swabs brushing during
  endoscopy and sent for testing cell, since the
  cytological may be positive (about 15 of cases)
  at the time the biopsies do not reveal the
  presence of carcinoma

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Cont

• Because metastasis often occurs before warning
  signs develop, a computed tomography (CT) scan,
  bone scan, and liver scan are valuable in
  determining the extent of metastasis.
• A complete x-ray examination of the GI tract
  should be performed when any person older than 40
  years of age has had indigestion (dyspepsia) of
  more than 4 weeks duration

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Medical Management

• There is no successful treatment for gastric
  carcinoma except removal of the tumor.
• If the tumor can be removed while it is still
  localized to the stomach, the patient can be
  cured.
• If the tumor has spread beyond the area that can
  be excised, cure is impossible.
• Palliative rather than radical surgery is
  performed if there is metastasis to other vital
  organs, such as the liver.

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Cont..

• In many of these patients, effective palliation
  to prevent discomfort caused by obstruction or
  dysphagia may be obtained by resection of the
  tumor
• If a radical subtotal gastrectomy is performed,
  the stump of the stomach is anastomosed to the
  jejunum, as in the gastrectomy for ulcer.

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Cont

• When a total gastrectomy is performed, GI
  continuity is restored by means of an anastomosis
  between the ends of the esophagus and the
  jejunum.
• If surgical treatment does not offer cure,
  treatment with chemotherapy may offer further
  control of the disease or palliation.
• Commonly used chemotherapeutic medications
  include cisplatin, or a combination of
  5-fluorouracil, doxorubicin, and mitomycin-C

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Cont

• Some studies are being conducted on the use of
  chemotherapy before surgery.
• Radioantitherapy also may be used for
  palliation.
• Assessment of tumor markers (blood analysis for
  antigens indicative of colon cancer) such as
  carcinoembryonic antigen

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Complications

• death rates within 30 days after surgery stomach
  cancer declined over the last forty years, and
  most reports indicate that the rate is now 1-2.
• complications early after surgery include failure
  of connection at both ends of the grubber from
  the stomach anastomotic failure (may require the
  patient to additional surgery for the treatment
  of infusion), bleeding,, and inflammation of the
  gallbladder, and inflammation of the pancreas,
  and injury of the lung infection, and
  thromboembolism.

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Cont..

• complications of late dumping syndrome, and a
  lack of vitamin B-12, and inflammation of the
  esophagus retrospective reflux esophagitis, and
  bone disorders, especially osteoporosis

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• Tha
• nks