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GASTRIC CARCINOMA
Professor Ravi KantFRCS (England), FRCS (Ireland),
FRCS(Edin!rg"), FRCS(Glasgo#), MS, $N%,
FAMS, FACS, FICS,
Professor of S!r er
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GASTRIC NEOPLASM
E'it"elial
Mesen"&al
1.PrimaryAdenocarcinomaGastrointestinal stromaltumors GISTLym!"oma
#. Secondary$in%asion &rom ad'acent
tumors.
%enign Malignant
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Gastri Carinoa
55 year old Japanese male who is living in
Japan & working in industry.
$EFINITION Malignant lesion of t"e stoa"*
E'ideiolog& + Ris Fators
Can o!r at an& age%!t Pea inidee
Is -./0.&ears old*
It is ore aggressive
In &o!nger ages*
1a'an "as t"e #orld
"ig"est Rate ofgastri aner*
St!dies "ave onfiredt"at inidene deline in
1a'anese iigrant to
Aeria*
d!st ingestion
fro a variet&of ind!strial
'roesses
a& e a ris*
Twise more common
In male than in female
Inidene of GastriCarinoa2
1a'an 0.in3..,...4&ear
E!ro'e 5.in 3..,...4&ear
6K 3-in 3..,...4&ear
6SA 3.in 3..,...4&earIt is dereasing #orld#ide*
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Gastri Carinoa2
Ris Fators
Predis'osing 2
3*Perniio!s aneia
+ atro'"i gastritis
(a"lor"&dra)
7*Previo!s gastri
resetion
8*C"roni 'e'ti !ler
(give rise to 39)
5* Soing*
-*Alo"ol*
Environental2
3*:*'&lori infetion
Sero(;)'atients
"ave
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Clinial Presentation
Most 'atients 'resent #it" advaned stage**
#"&>
T"e& are often as&'toatiin earl& stages*
Coon linial Presentation2T"e 'atient o'lained ofT"e 'atient o'lained of loss of a''etiteloss of a''etitet"at #ast"at #as
follo#ed &follo#ed & #eig"t loss#eig"t lossof 3.Kg in 5 #ees*of 3.Kg in 5 #ees*
:e "ad notie:e "ad notie
e'igastri disofort + 'ost'randial f!llness*e'igastri disofort + 'ost'randial f!llness*
:e 'resented to t"e ER o'laining of:e 'resented to t"e ER o'laining of voitingvoiting ofof
large ?!antities of !ndigested food + e'igastrilarge ?!antities of !ndigested food + e'igastri
distension*distension*
$&s'e'sia
e'igastri 'ain
%loating
earl& satiet&
na!sea + voiting@d&s'"agia@
anoreia
#eig"t loss
!''er GI leeding
("eateesis, elena,
iron defiien& aneia)
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si(ns
-Anemia.
-Wt.loss cache!ia"
-#pigastric mass$%epatomegaly$Ascitis
-Jaundice.
-lumers shelf
-'irchows node
-(ister mary )oseph node-*ruken+erg tumor
-Irish node
http://srd.yahoo.com/S=96062857/K=Jaundice/v=2/l=II/R=5/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Jaundice&vm=i&n=20&fl=0&h=263&w=400&imgurl=catalog.cmsp.com/datav3/fl050011.jpg&name=fl050011.jpg&p=Jaundice&rurl=http://catalog.cmsp.com/datav3/im050011.htm&no=5&tt=629http://srd.yahoo.com/S=96062857/K=Jaundice/v=2/l=II/R=15/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Jaundice&vm=i&n=20&fl=0&h=450&w=600&imgurl=medicine.ucsd.edu/clinicalmed/jaundice.JPG&name=%3Cb%3Ejaundice%3C/b%3E.JPG&p=Jaundice&rurl=http://medicine.ucsd.edu/clinicalmed/abdomen.htm&no=15&tt=6297/25/2019 1gastric Carcinoma
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Pat"olo(y)IO Classi*cation
LaurenClassi*cation$
1. Intestinal Gastric ca.
It arises in areas o& intestinalmeta!lasia to &orm !oly!oid tumors orulcers.
#. )i+use Gastric ca.It in*ltrates dee!ly in t"e stomac",it"out &ormin( o-%ious mass lesions -uts!reads ,idely in t"e (astric ,all LinitisPlastica/
0 it "as muc" more ,orse !ro(nosis
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Gastric cancer can be devidedinto:
Early$
Limited to mucosa 0 su-mucosa ,it" or,it"out LN 3T14 any N5
66 cura-le ,it" 7 years sur%i%al rate in89:.
Ad%anced$
It in%ol%es t"e Muscularis.
It "as ; ty!es3
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T1 lamina propria & submucosa
T2 muscularis & subserosa
T3 serosaT4 Adjacent organs
N0 no lymph node
N1 Epigastric node
N2 main arterial trunk
0 No distal metastasis
1 distal metastasis
Staging of gastri anerS'read of Gastri Caner
$iret S'read
%lood/orne
etastasis
B&'"ati s'read
Trans'eritoneal
s'read
T!or 'enetrates t"e
!s!laris, serosa +Adaent organs
(Panreas,olon +liver)
D"at is i'ortant "ere is
ir"o#s node
(Trosiers sign)
6s!all& #it" etensive
$isease #"ere liver 3st
Involved t"en l!ng +
%one
T"is is oon
An"ere in 'eritoneal avit&
(Asitis)
Kr!energ t!or (ovaries)
Sister 1ose'" nod!le
(!ili!s)
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Com!lications
eritoneal and pleural effusion
0+struction of gastric outlet or small +owel
leeding
Intrahepatc )aundice +y hepatomegaly
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)i+erential )ia(nosis)i+erential )ia(nosis
1.2astric ulcer
3.0ther gastric neoplasms
4.2astritis
.2astric olyp
5.6rohns disease.
Fro "istor&,
Caner is not relieved & antaids
Not 'eriodi
Not releived & eating or voiting*
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IN=ESTIGATIONS
>ull -lood count ?I)A@
L>T4R>T
Amylase 0 li!ase.Serum tumor marers 3CA B#@;4CEA4CA18@85 not s!eci*c
Stool e2amination &or occult -lood
CR 4
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S!eci*c$DGI endosco!y ,it" -io!sy
)ou-le contrast study
CT4 MRI 0 DS
La!arosco!ry
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EG$ eso'"agogastrod!odenoso'&
$iagnosti a!ra& is =9 if !'to 0 io'sies is taen*
$o!le Contrast ari! !''er GI /ra&
$iagnosti a!ra& =.9
D:H>
$iagnosti st!d& of C"oie
3*Earl& s!'erfiial gastri !osal lesion
an e issed*
7* ant differentiate4# enign !ler +
6lerating adenoarinoa*
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/ra& s"o#ing Gastri !ler
Dit" s&etrial radiating
M!osal folds*
%& "istolog&, no evidene of
Malignanies #as oserved*
/ra& s"o#ing Etensive
arinoa involvingt"e ardia + F!nd!s
P&lori stenosis
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CT,MRI + 6S2
Ba'aroso'&2
%elp in assessment of wall thickness$
metastases peritoneum $liver & /7s"
8etection of peritonealmetastases
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T:E GOB$ STAN$AR$
It allows taking +iopsies
(afe in e!perienced hands"
UGI ENDOSCOPY
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UGI ENDOSCOPY,contd.
Ho! a& see an !ler (7-9),'ol&'oid ass (7-9), s!'erfiials'reading (3.9),or infiltrative(linnitis 'lastia)/diffi!lt to edeteted/
A!ra& -./=-9 it de'ends on
gross a''earane,siJe,loation +no* of io'sies
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IF YOU SEE ULCER ASK UR SELFBENIGN OR MALIGNANT?
BENIGN MALIGNANT Ro!nd to oval '!n"ed o!tlesion #it" straig"t #alls +
flat soot" ase
Irreg!lar o!tline #it"neroti or "eorr"agi
ase
Soot" argins #it"noral s!rro!nding
!osa
Irreg!lar + raised argins
Mostl& on lesser !rvat!re An"ere
Maorit&7 An& siJe
Noral adoining r!galfolds t"at etend to t"e
argins of t"e ase
Proinent + edeato!sr!gal folds t"at !s!all& do
not etend to t"e argins
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Mana(ement
, S!rger&
, C"eot"era'& NO PROVEN BENEFIT
, Radiot"era'&
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TreatentTreatent
Initial treatent2
3*I'rove n!tritionif
needed & 'arentral
or enteral feeding*7*Corret fl!id
+eletrol&te
+ aneia if t"e& are'resent*
Preo'erative Care
Preo'erative Staging is
i'ortant ea!se #edont #ant to s!et
t"e 'atient to radial
s!rger& t"at ant "el'
"i*
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PRE-OPERATIVE CARECaref!l 'reo'erative staging
Sreen for an& n!tritional defiienies +onsider n!tritional s!''ort
S&'toati ontrol
%lood transf!sion in s&'toati aneia
:&dration
Pro'"&lati antiiotis
A%O + rossat"
As ao!t !rrent ediations + allergiesCessation of soing
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BASIC SURGICAL PRINCIPLES
8 THPES2
TOTAB,S6%TOTAB,PABBIATIE
ANTRAB $ISEASES6%TOTAB
GASTRECTOMH
MI$%O$H + PROIMAB TOTAB
GASTRECTOMH
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TOTAL RADICAL! GASTRECTOMY
o Reove t"e stoa" ;distal 'artof eso'"ag!s; 'roial 'art of
d!den! ; greater + lesseroenta ; BNs
o Oeso'"agoe!nosto& #it" ro!/
en/& *
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SUBTOTAL GASTRECTOMY
Siilar to total one ee't t"at t"e
PROIMAB PART of t"e stoa"
is 'reserved
Follo#ed & reonstr!tion +
reating anastoosis
( & gastroe!nosto&,illrot" II )
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PALLIATIVE SURGERY
, For 'ts #it" advaned (ino'erale)disease + s!ffering signifiants&'tos e*g* ostr!tion,
leeding*, Palliative gastreto& not
neessaril& to e radial, reove
resetale asses + reonstr!t(anastoosis4int!ation4stenting4
reanalisation)
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POSTOPERATIVE ORDERS
, Adit to PAC6
, $etailed n!tritional advise (sall
fre?!ent eals)
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Post/O'erative Co'liations
3*3*Beaage fro
d!odenal st!'*
7*7*Seondar&
"eorr"age*
8*8*N!tritional
defiien& in long
ter*
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2.Chemotherapy:
Res!onds ,ell4 -ut t"ere is no e+ect onser%i%al.
Marsden Re(imen
E!iru-icin4 cis!latin 07@urouracil 3 ,s5
F cyclesRes!onse rate $ ;9: .
3. Radiotherapy:ostperative-radiotherpy9may decrease the
recurrence.
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reventive measuresreventive measures
%& diet%& dietConvining2Convining2
vegetale + fr!its*
Proale2Proale2
it*C +E
PossilePossile
Carotenoids,#"ole grean ereals and green tea*Soing essation
Cessation of alo"ol intae
Earl& diagnosis reains t"e Ke&
Prole
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PROGNOSTIC FEATURES
7 i'ortant fators infl!ening s!rvival inresetale gastri aner2
de't" of aner invasion
'resene or asene of regional BNinvolveent
, -&rs s!rvival rate23.9 in 6SA
-.9 in 1a'an
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Gastrointestinal Stromal TumorGIST
Pre%iously leiomyoma ! leomyosarcoma.
1 :
Rarly cause -leedin( or o-struction.
T"e ori(ion$ Intestinal Cells o& Ca'al ICCHs
autonomic ner%ous system.T"e distinction -, -eni(n 0 mali(nant is
unclear. In (eneral terms4 t"e lar(er t"etumor 0 (reater mitotic acti%ity4 t"e moreliely to metastases.
T"e stomac" is t"e most common site o&GIST.
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Dsually are disco%ered incidentallyon endosco!y or -arium meal
T"e endosco!ic -io!sies may -eunin&ormati%e -cJ t"e o%erlyin(mucosa is usually normal
Small tumors,ed(e resection
Lar(er ones(astrectomy
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Gastric Lymphoma
Most common !rimary GILym!"oma .
Its increasin( in &reKuency.
"resentation:
Similar to (astric carcinoma.
May re%eal !eri!"eral adeno!at"y4a-dominal mass or s!leenome(aly.
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$iagnosis2
1.EG) #.contrast GI 2@ray.
.CT (uided *ne needle -io!sy.Treatment $
1.sur(ery$total or su-total (astrectomy,it" s!leenectomy or !alliati%e resection.
#.Ad'unct radiot"era!y$ may im!ro%e 7year sur%i%al
.Ad'unct C"emot"era!y$may !re%ent
recurrance.
Bailey & Loves short
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E-medicine web siteThe Washington ManualSurgery
yractice of surgery!linical surgery" #$cuschieri%$
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