Gastric Carcinoma

Gastric Tumours

 Tumours from mucosa predominates than

mesenchymal.  Benign and malignant  90% of the polyps are hyperplastic polyps  Carcinoma is the most important and most common malignant tumours of stomach.

 Second most common carcinoma in world.  Incidence varies with the country.  High in Japan and China and relatively low

in USA.  Common in males above 50 yrs

Risk factors        

H. pylori – 60 – 70 % smoking alcohol pernicious anaemia adenomatous gastric polyps familial adenomatous polyposis Blood group A 1st degree relatives of patients

Pathology 

Adenocarcinoma arising from mucus secreting cells from base of glands

Histologically arising from - intestinal : intestinal metaplasia - diffuse : normal gastric mucosa

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site of tumour : 50 % - antrum : 20 – 30% - gastric body : 20 % - cardia  Macroscopically - polypoid, ulcerative, fungating, diffuse 

Clinical Features  Most of the patients are in advanced stage

while presentation.  Epigastric pain  Dysphagia , nausea, anorexia, vomiting  weight loss  Anaemia  Malena

Metastasis - Virchow’s node ( Troisier’s sign ) - umbilicus (Sister Mary Joseph nodule) - ascites, jaundice - ovaries ( krukenberg’s tumour ) - pelvic mass

Diagnosis Ba study  Endoscopy  CT scan  Laparoscopy for peritoneal mets 

Adenocarcinoma stomach

Adenocarcinoma

Carcinoma of Stomach 

Surgical options  Proximal tumours  Total or proximal subtotal gastrectomy with Roux –Nreconstruction  

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Mid-body tumours Total gastrectomy Distal tumours Distal subtotal gastrectomy with or without regional lymphadenectomy

Carcinoma of Stomach Surgical treatment - cardia : gastrectomy with distal esophagectomy

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Chemotherapy - 5 FU , Doxorubicin , Mitomycin – C ( FAM ) - Epirubicin, Cisplatin , 5 FU ( ECF )

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Palliative therapy in inoperable tumours - endoscopic laser therapy - endoscopic dilation for cardia tumours - metallic stenting

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Gastric Lymphoma 5% of all GI malignancies  60% of all extranodal non-hodgkins  polypoid or ulcerative lesion  Therapy - surgery - chemotherapy - radiotherapy 

Zollinger Ellison syndrome Triad of - peptic ulcer - gastric acid hypersecretion - non-beta islet cell tumour of pancreas ( Gastrinoma )

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Common in both sexes & between 30 - 50 yrs of age

 Pathophysiology

- gastrin stimulates excess secretion of acid - inactivation of pancreatic lipase - diarrhoea & steatorrhoea

Pathology - 90% : head of pancreas - multiple , size 1mm to 20 cm - associated parathyroid & pituitary adenomas in 20 – 60 %

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Clinical features - multiple ulcers in duodenum, jejunum - bleeding & perforation common - unresponsive to standard therapy for PUD - Diarrhoea

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Investigations serum gastrin levels increased 1000 times normal Endoscopic USG

Treatment - single lesion : Resection - multiple lesion : control of complication : PPI – Omeprazole : Somatostatin analogue for decreasing gastrin secretion

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