GASTRIC

CARCINOMA

Outline
1.
2.
3.
4.
5.
6.

Overview
Risk Factor
Clinical Feature
Investigation
Management
Conclusions

Overview
1. Worldwide, 4th most common cancer and 2nd most
common cause of death
2. More common in male, aged >50 years old
3. The etiology is multifactorial but H. pylori is an
important factor for distal not proximal gastric
cancer
4. Poor prognosis
early gastric cancer : 5 years survival rate >90%
advanced gastric cancer: 5 year survival rate
<20%.
5. The incidence in USA 10 cases per 100 000
population, In Japan the disease is much more
common 70 cases per 100 000 population.

Risk Factor
1. Diet - high nitrate, high salt, low fat & protein
2. Environmental - radiation exposure,
occupational( coal mining, rubber or asbestos
related), low socio-economic group, smoker,
nitrosamine exposure
3. Medical - H.pylori infection, prior gastric
surgery, gastritis, adenematous polyp,
pernicious anemia, hypogammaglobulinaemia
4. Family history of gastric cancer
5. Others

Clinical feature
Symptoms

Indigestion (Dyspepsia)
Nausea or vomiting
Dysphagia
Postprandial fullness
Loss of appetite
Melena or pallor from anemia
Hematemesis
Weight loss

Clinical feature
Signs
Palpable enlarged stomach
Enlarged lymph nodes such as Virchow
nodes (ie, left supraclavicular)(Troisier
sign) and Irish node (anterior axillary)
Thrombophlebitis (trousseaus sign)

Classification
1. The most useful classification is
the Lauren classification
2. Intestinal gastric cancer and
diffuse gastric cancer.

Early gastric carcinoma

Advanced gastric carcinoma

-When the cancer invasion is confined to

mucosa or submucosa. (T1, with or
without lymph node involvement)
- Is curable but if it is associated with
lymph node it have 90% survival rate
- Use the Japanese
classification(protruding, superficial,
or excavated)

-When there is invasion into muscularis

propria and beyond
- Macroscopic appearance have been
classified by Bormann into four
types.
- Type 3 and 4 are commonly
incurable.

Usually within the lower 2/3rd of

stomach

50% confined to the antrum

Have excellent prognosis-5year survival

rate of 90%
Recurrence rate is 2% due to:
- Residual or remnant tumor
- Hematogenous spread

5 year survival rate <20%.

Investiga
tion

1. Upper gastrointestinal
endoscopy (OGDS) with
biopsy
2. Double contrast barium meal
to find any irregular filling
defect, delayed emptying or
distorted outline of stomach.
3. Endoscopic ultrasound to help
in staging by identifying local
stomach invasion and nodal
status.
4. Other modalities such as CXR,
CT scan and laparascopy.

Staging & Evaluation

1. Ultrasound of abdomen- detect liver
metastases, ascites, pelvic deposition,
krukenberg tumour
2. Liver function test- detect liver
metastases
3. Chest x-ray- lung metastases
4. Laparoscopy- identify
macromatastases smaller than 5mm in
peritoneum and liver

International Union against

Cancer(UICC) staging of gastric cancer
tumor

node

metastasis

T1 : Tumour involves lamina

propria
T2 : Tumour invade muscularis
or subserosa
T3 : Tumour involves serosa
T4 : Tumour invades adjacent
organs

Nx : regional LN cannot be
assessed
N0 : no regional LN metastasis
N1 : metastasis in 1-6 regional
LN
N2 : metastasis in 7-15
regional LN
N3 : metastasis in 15 and
more regional LN

M0 : no distant metastasis
M1 : Distant metastases
present
(includes peritoneum and
distant lymph nodes)

Stage 0

Stage 1

Stage 2

Stage 3

Stage 4

Tis

A : T1
B : T1, N1
T2,N0,M0

A : T1,N2
T2, N1,M0
T3, N0,M0

A : T2.,N2,M0
T3, N1, M0
T4, N0,M0
B : T3, N2, M0

Any TN M1

Management
Surgery
Radical gastrectomy
Total gastrectomy
Subtotal gastrectomy
Palliative therapy

Conclusion
1. Gastric cancer is one of the most
common causes of cancer death in the
world.
2. The aetiology of gastric cancer is
multifactorial but H.pylori is an
important factor for distal gastric
Cancer.
3. Can be classified into intestinal and
diffuse types. (Lauren classification)
4. Early gastric cancer is associated with
high cure rates
5. The definitive treatment is gastrectomy.

Complications
(UpperGit Bleed)
COMPLICATIONS

ANAEMIA

HYPOVOLEMIC
SHOCK

ANEMIA
Blood cell
loses from
body

Body tissue lack

of oxygen and
nutrients supply

Hypovolemic shock
Decrease
volume of
blood
Severe
bleeding

Symptoms of
Shock:
1)Cool & clammy
skin
2)Loss of
conscious
3)Low BP
4)Increase heart
rate
5)Cyanosis

Heart need
to pump to
compensate

Hypotension

Hypoperfusio
n to organs

ACUTE MANAGEMENT OF COMPLICATIONS

Secure the
airway

Adequate
breathing
ventilation

Check for
circulation and
vital signs