1. Stomach cancer
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2. Сlinical anatomy
◼ distinguish cardiac part, bottom
part of the body and
привратниковую part - In
the stomach. In the clinical
literature is divided: on the top -
the cardiac department, middle -
and lower body of the stomach -
pyloric part.
◼ Stomach wall has an uneven
inner surface wrinkles due to a
large number consisting of the
mucosa and submucosa.
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3. Сlinical anatomy
◼ The mucosa is lined cylindrical glandular
epiteliem. Epitely forms glands. The
greatest number of glands (35 million)
and is located in the bottom of the
stomach. Forming cells produce their
pepsinogens (chief cells), hydrochloric
acid (parientalnye cells) and mucoid
(mucosal cells).
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4. Epidemiology
◼ stomach cancer ranks 2nd place in
the structure of morbidity
onkologichskoy despite a steady
decline in incidence.
◼ • Analysis of data on mortality in 24
developed countries showed that the
share of stomach cancer accounted
for 50% of tumors of the
gastrointestinal tract.
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5. Epidemiology
◼ • The maximum incidence observed
in men in Japan (114.7), and the
minimum - U.S. white women.
◼ • Men sick 2 times more often than
women.
◼ • Average age of onset - 65.8 years,
the peak incidence occurs in 75 - 79
years.
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6. ETIOLOGY & RISK FACTORS
◼ The nature of food (eating pickles, salted,
smoked)
◼ The presence in foods of carcinogenic substances
(aromatics, nitroso compounds, amines,
aromatic)
◼ Excessive intake of salt
◼ Helicobacter pylori. Risk of gastric cancer in
infected patients was 3.8 times higher compared
to uninfected. Helicobacter pylori belongs to the
group 1 (explicit carcinogens), according to WHO
classification
◼ Smoking
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7. Premalignant disease
◼ precancerous gastric are dysplasia
and intestinal metaplasia of the
epithelium, morphologically.
◼ The main precancerous gastric
diseases are chronic atrophic
gastritis, peptic ulcer and gastric
polyposis.
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8. Pathologic characteristics
◼ Early gastric cancer called tumor affects
only the mucosa and submucosa. Cancer
occurs in one or more regions of the
gastric mucosa. Plots of tumor growth
typically located close to each other.
Emerging tumor grows in thickness of the
wall, consistently capturing layers of the
stomach and extends to the surrounding
organs and tissues.
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9. Localization
◼ Swelling can occur in any part of the
stomach. Gradually increasing tumor
invades adjacent organs, and even the
entire stomach.
◼ Most often, the cancer is located in the
antrum, at least - in the middle third on
the lesser curvature and in the cardiac
department. Rarely observed in tumors of
large curvature, front and rear walls, and
diffuse organ damage.
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10. Forms of growth
◼ Cancer can grow Exophytic, appearing
into the gastric lumen, or endophyte,
spreading mainly along the wall body.
The central part of the tumor is often
subject to ulceration.
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11. Macroscopic form of
stomach cancer
◼ polypoid carcinoma gastric lumen serves
as a small dense formation, located on a
broad basis and resembling a polyp
◼ Бляшковидный (round) cancer, is a
flat plot with infiltrated mucosa and
smooth folds
◼ ulceration (advanced) cancer is a plane
surface ulcers with slightly protruding
above the surface of the mucosal edges.
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12. Large tumor appearance
divided into four forms:
◼ Mushroom or exophytic cancer protruding
into the gastric lumen formation, clearly
limited by the surrounding tissue. The
tumor has an irregular bumpy surface
view "cauliflower"
◼ saucer cancer looks extensive ulcers with
dense rough bottom, covered with
necrotic touch and edges
валикообразными (ring)
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13. Large tumor appearance
divided into four forms:
◼ hummocky formation is not seen in
infiltrative cancer, stomach wall is
thickened and infiltrated by cancer cells.
Infiltration may extend to the entire
stomach.
◼ Ulcer-infiltrative cancer is characterized by
the presence of flat ulcers, gradually
transforming into infiltrating the gastric
wall.
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14. Histology
◼ Stomach cancer usually has a
structure adenocarcinoma.
undifferentiated tumors are rare,
even rarer - squamous cell
carcinoma, adenokankroid.
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15. Growth and spread of
tumors
◼ Gastric cancer cells spread throughout the
body wall by sprouting beyond the
stomach, lymphatic, hematogenous
metastasis and implantation.
◼ Tumors of the small curvature can grow
into a small gland, the left lobe of the
liver, retroperitoneal fat and pancreatic
cancer that has spread beyond the
stomach.
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16. Growth and spread of
tumors
◼ Tumors were located on the front and rear
walls closer to greater curvature
germinate in the transverse colon,
mesentery its gastro ligament and
pancreas.
◼ Cancer and cardiac portion of the gastric
fundus be granted to the diaphragm.
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17. Lymphatic metastasis
◼ First, the lymph nodes are affected,
located near the stomach.
◼ • Metastases in supraclavicular lymph
nodes (Virchow) located in the left
supraclavicular region in neck
sternocleidomastoid muscle. Lymph nodes
are rounded, dense consistency, mobile,
painless. Sizes up to 2 cm in diameter.
◼ • Metastases in the navel are painless seal
of up to 1.5-2 cm in diameter. Rare.
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18. Lymphatic metastasis
◼ Kryukenberg metastases ( ovaries ) .
Have lymphogenous origin. Defeat often
bilateral . affected ovaries palpated as
painless rounded formations with a
smooth surface Vaginal study.
◼ Hematogenous metastases often affect
the liver , at least - the lungs, pleura ,
pancreas, and kidneys.
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19. Lymphatic metastasis
◼ Implantation metastases - small seal
scattered over the parietal and visceral
peritoneum . They are often accompanied
by ascites.
◼ Implatatsionnye metastases about proctal
fiber ( shnitsler metastases) . They
palpated by digital rectal examination in
the form of dense formations painless .
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20. Stage gastric cancer
◼ Stage I - tumor size up to 3 cm, localized in the
mucosa and submucosa without regional
metastases.
◼ Stage II - The tumor size greater than 3 cm
without sprouting muscle layer. Or tumor of any
size, germinating in the muscle layer, but
without serous injury.
◼ IIA - no metastases to regional lymph nodes
◼ IIB - there are single (no more than 2 cm)
metastases to regional lymph nodes
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21. Stage gastric cancer
◼ Stage III - tumor of any size germinating entire wall of
the stomach or esophagus, or turning on the duodenum.
Perhaps spayanie with neighboring authorities and (or)
the germination of the ligamentous apparatus of the
stomach or the top sheet of the mesentery.
◼ IIIA - metastases in regional lymph nodes are missing
◼ IIIB - there are multiple metastases to regional lymph
nodes
◼ Stage IV - the tumor grows into the surrounding organs
and tissues, or tumor with distant metastases.
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22. Symptoms
◼ Clinic gastric cancer varied and similar to other
gastric diseases.
◼ Pain - is a common symptom. With advanced
forms of cancer occurs in 85 - 90% of patients.
Pain occurs for no reason, or worse after eating,
constant, dull, persistent, not associated with
eating,. Felt in the epigastric region, more often
than not radiating, but can give back, scapula,
sternum, left hand. Characterized by constant
pain, but the intensity may vary during the day.
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23. Symptoms
◼ Loss of appetite. Aversion to food -
meat, fat.
◼ Belching, heartburn. Nausea.
◼ Weight loss - weight loss for 2 - 3
months. Or more than a few pounds.
◼ Weakness, fatigue.
◼ Mental depression.
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24. Syndrome of small signs"
L.I. Sawicki
◼ General weakness, fatigue, decreased
ability to work
◼ Decrease or loss of appetite, aversion to
meat food
◼ Gastric discomfort
◼ Progressive weight loss
◼ Persistent or increasing anemia
◼ Apathy.
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25. Diagnostics
◼ Inspection - color, condition of the
subcutaneous tissue, the configuration of
the stomach, the presence of abdominal
bulging stneki and supraclavicular regions.
◼ • Palpation of the abdominal cavity is
performed with the patient on the back,
on the left and right side. Palpable tumor
has a dense texture, rough, usually
painless, shifted together in the stomach.
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26. Diagnostics
◼ X-ray diagnostics. Chest x-ray (for
exclusion of metastases in the lungs),
and gastric and gastric radiography.
◼ Endoscopic examinations.
Esophagogastroduodenoscopy. Biopsy
of any suspicious areas in cases of
endoscopic detection of changes of
gastric mucosa
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27. Diagnostics
◼ Ultrasonography
◼ Laparoscopy
◼ A digital rectal examination
◼ bimanual pelvic examination (for
women)
◼ Laboratory tests (complete blood
count, fecal occult blood).
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28. Radiographic signs of
stomach cancer:
◼ Filling defect
◼ Deformation of the contour of the
stomach
◼ Pathological changes in mucosal relief
◼ Lack of peristalsis in the area of
tumor lesions.
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29. Differential diagnosis:
◼ Peptic ulcer
◼ Gastritis stomach
◼ Gastric Polyposis
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30. Treatment
◼ Stomach cancer can be cured only by surgery. It is
impossible to achieve cure with radiation and
chemotherapy.
◼ Radical treatment:
◼ subtotal gastrectomy - with early cancer and exophytic
tumors. Regional lymph nodes should be removed along
with part of the stomach rezertsiruemoy. Large and
small glands removed in one block with the stomach,
with the prisoners in their lymph nodes.
◼ • Gastrectomy shown at the infiltrative forms of cancer,
as well as large exophytic tumors. The entire stomach
with both seals and prisoners they lymph nodes - is
removed during surgery.
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31. Treatment
◼ Palliative operations:
◼ Palliative Gastrectomy - glands with lymph
nodes removed with the stomach. Operation
eliminates the painful symptoms and prolongs
the life of the patient for several months.
◼ Bypass gastroenteroanastomosis - shown in
inoperable cancer, complicated by pyloric
stenosis. Evacuation operation restores the
contents of the stomach, eliminates painful
vomiting and improves patients.
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32. Treatment
◼ Recanalization cardia and gastroesophageal
eyunostomiyu performed with inoperable
cancer with the aim of eliminating dysphagia.
◼ Radiation therapy as an independent method is
not applicable due to severe complications in the
appointment of the dose required for tumor
destruction.
◼ Chemotherapy is used in advanced forms of
gastric cancer (methotrexate, doxirubicin,
etoposide, cisplatin).
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