1. STOMACH CANCER
BY DR: ALI ALWAILY/MD

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

3. 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

4. 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

5. 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

6. 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

7. Left supraclavicular node (Virchow’s)

8. Periumbilical node (Sister Mary Joseph)

9. Left axillary node (Irish)

10. Enlarged ovary (Krukenberg tumor)

11. 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

13. 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

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

16. EGD

17. 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

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

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

20. References
Usmle step 2
YouTube MD VIDEOS
Some ppt

21. Thank you
Thank you