Transcript CANCERUL GASTRIC

GASTRIC CANCER
GASTRIC CANCER
4% 5th position
 2nd cause of
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the world
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cancer related death in
5 y survival rate
B:F=2:1
More frequent in Japan, Latin America, Far East, North
Europe.
Incidence is droping
Pathology
 Adenocarcinoma
 Sarcoma
 Limfoma
90%
CAUSES
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66-75% can be prevented with diet using high
quantity of fruits and vegetables and low in salty
foods.
Integral cereals and green teea can reduce the
incidence
Vitamin C şi carotenoids probably decrease the
risk
Alcoholmay increase the risk of GC in cardia
region
Smoking increases the risk
ETHIOLOGY
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Atriphic gastritis
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9% will develop GC
Chronic inflammation – destruction of glands – lower capacity of acid secretion –
intestinal metaplasia
Causes
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Helicobacter pylori
Ac anti parietal cells – Biermer
Antral resection
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ETHIOLOGY
Helicobacter pylori
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Distal GC + association with atrophy
Appears to be protective against procimal GC
1/ 97 infectet patients develop CG
Inf:noninf=8:1, ONLY CERTAIN FENOTYPES
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Polyps
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Hiperplastic – 80%
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Very high risck
Familial risk
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High risk over 0,5 cm
Adenomatos
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ETHIOLOGY
2-3X higher
Mutation in gene CHD1 -Ecadherina role in
diferencietion and cel
arhitecture
Molecular fenotype
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c-met, K-sam involved in
cell groth
p53 suppressor gene– 64%
cyclin E
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PATHOLOGY
Intestinal
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Atrophy – metaplasia displasia – adenoma cancer
Difuz – linitis plastica
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Submucosal invasion
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Macroscopic – Borrmann
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Type I - polipoid well defined
Type II – polipoid with marked
infiltration
Type III – ulceratio with
infiltrated margins
Tip IV – linitis plastica
Microscopic – OMS
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Adenocarcinoma – intestinal,
difuse
Adenocarcinoma papilary
Adenocarcinoma tubular
Adenoacrcinom mucinos (>50%
mucinous cells)
Signet cells carcinoma (>50%
signet cells)
Adenosquamos carcinoma
Squamos cell carcinoma
Small cells carcinoma
Nondiferentiated
altele
Primary tumor (T):
Tis = carcinoma in situ: intraepithelial tumor without invasion of lamina propria
T1 = tumor invades lamina propria or submucosa
T2 = tumor invades muscularis propria or subserosa
T3* = tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures
T4**,*** = tumor invades adjacent structures
*A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments or
into the greater or lesser omentum without perforation of the visceral peritoneum.
**Structures adjacent to the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal
wall, adrenal gland, kidney, small intestine, and retroperitoneum.
***Intramural extension to the duodenum or esophagus is classified by the depth of greatest invasion in any of
these sites, including the stomach).
Regional lymph nodes (N):
Include the perigastric nodes along the lesser and greater curvatures, and the nodes along the left gastric, common
hepatic, splenic, and celiac arteries.
N0 = no regional lymph node metastasis
N1 = metastasis to 1–6 regional lymph nodes
N2 = metastasis in 7–15 regional lymph nodes
N3 = metastasis in more than 15 regional lymph nodes
Distant metastasis (M):
M0 = no distant metastasis
M1 = distant metastasis
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Grading
G1 - well diferentiated->95% glands
 G2 – moderat diferentiated – 50-95% glands
 G3 – poor diferentiated - <49% glands
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Adc tubular – G1
 Adc signet cells – G3
 Adc small celss and non diferetiated – G4
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CLINICA PRESENTATION
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Subjectiv
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Objectiv
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General neoplastic simptoms
Dispepsia
UGI bleeding
Tumor palpable
Hepatomegaly, ascites, jaundice,
splenomagaly
Sister Mary Joseph – sign
(umbilkical nodule)
Virchow sign – left supraclavicular
LN
Krukenberg –ovarian MTS
Blumer – rectal palpable mass
Trousseau – migrating flebitis
Leser-Trelat – seborheic keratitis
Lab
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Anemia
Ocult bleeding
ACE, CA 19.9
Rx barium
CT, MRI, echoendoscopy+biopsy
brush citology, laparoscopy, lapro echography
COMPLICATIONS
 Bleeding
 Perforation
 Obstruction
 Penetration
TREATMENT
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SURGICAL
Rezection
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Limfadenectomy
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R0 – complete, no
microscopic tumor left
R1 – microscopic tumor left
in situ
R2 – macrosocopic residual
tumor
D1 – stations 1-6
D2 – stations 7-11
D3 – stations 12-14
D4 – stations 15-16
Omentectomy
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Endoscopic treatment
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Mucosal resection in early
gastric cancer
Paliative
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Sclerotherapy
Laser destruction
Stent
TREATMENT
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Chemotherapy
Neoadjuvant / adjuvant
 5-FU, doxorubicin şi mitomycin C (FAM)
 Immunochemoterapy – CHT bound to specific
tumoral ATB. Ag
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Radioterapy
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neoadjuvant
Chemoradiation
Adjuvant
 Major discussions
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