STOMACH CANCER BY DR: ALI ALWAILY/MD

objects Definition precursor or risk factors Sign and symptoms stages Diagnosis Treatment Complication References

Definition stomach cancer or gastric cancer :-It’s a malignant tumor mostly ( adenocarcinoma) with poor prognosis starting from inner layer of stomach and grow slowly over many years

precursor or risk factors Diet high in nitrate + salt Diet low in fresh vegetables ( antioxidant ) H.Pylori Chronic gastritis Previous gastric operation Hereditary by (CDH1) gene Asbestosis Smoking Type A blood Obesity

symptoms Early stage always asymptomatic or sometimes with indigestion and loss of appetite Late stage (alarm symptoms ) Abdominal pain Weight lose Upper GI bleeding Nausea Vomiting GERD Anemia Fatigue

Signs Palpable abdominal mass: most common physical finding If cancer spreads via lymphatics… Left supraclavicular node (Virchow’s) Periumbilical node (Sister Mary Joseph) Left axillary node (Irish) Enlarged ovary (Krukenberg's tumor) Ascites

Left supraclavicular node (Virchow’s)

Periumbilical node (Sister Mary Joseph)

Left axillary node (Irish)

Enlarged ovary (Krukenberg tumor)

stages Two systems: Japanese classification (more elaborate and anatomic based) Western: developed by American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) -- more widely used Tumors at GE junction of in cardia of stomach within 5cm of GE junction Classified using esophageal staging Depth of invasion EARLY GASTRIC CA - mucosa & submucosa ADVANCED GASTRIC CA - into or through muscularis propria Macroscopic growth pattern – Ming classification Expanding Infiltrative - "linitis plastica" Histologic subtype Intestinal Diffuse (gastric); poorly differentiated; "signet r

CLASSIFICATION according TNM T Stage for Gastric Cancer - Tis (Carcinoma in situ), T1, T2, T3, T4 N Stage of Gastric Cancer - N0, N1, N2, N3 M Stage for Gastric Cancer - M0, M1

Diagnosis upper GI endoscopy + biopsy( definitive test ) Barium swallow X-ray Ct scan

EGD

Treatment Early stage with surgical resection 0 stage remove unhealthy cells in stomach which may turn into cancer and lymph node nearby 1st stage surgical remove of part of all stomach with lymph node beside it + chemotherapy before it to shrink the cells 2nd stage same to 1st 3rd stage Chemotherapy and surgical and maybe metastasis into colon and spleen (may cure may not ) 4th stage the tumor has metastasis to far organ and hard to cure and we shpuld handle the symptoms

Treatment We can use stent which is metal between esophagus and stomach and small intestine Gastric bypass around the tumor

Complication Malnutrition Partial carcinomatous Total or partial intestinal obstruction Etc..

References Usmle step 2 https://www.webmd.com/cancer/stomach-gastric-cancer https://en.wikipedia.org/wiki/Stomach_cancerY YouTube MD VIDEOS Some ppt

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