1. Gastric tumours Angl speak IV year 2012-2013 DEGHAS

2. Gastric tumours Epidemiology and incidence Pathology Histology Symtpoms Diagnosis Therapy Prognosis Prevention

3. Incidence Rapid decrease mortality in 80 years USA men 28/5 women 2.8/100 tis High incidence Japan,Chile,China,Ireland Dietary factors – poor people Study of migrants – eniviromental factors (infection,freezing boxes)

4. Incidence stomach carcinoma

5. Stomach tumours patology/histology Adenocarcinoma 85% – advanced – early Lymphoma 15% Leiomyosarkoma and + GIST= (Gastro Intestinal Stromal Tumour) celkem 1-3%

6. Patology/course of disease Difuse type – less common (cca 10%) – Malignant cells infiltrates the whole stomach– linitis plastica – Younger patients – Diagnosis dificult by endoscopy – X-ray barium meal not extendable stomach Intestinal type – Polypoid-ulcerative changes antral and small curve – Long-term praekancerous proces – High risk areas

7. Aetiology Nitrátes + bakteries = nitrites = cancerogeny – Smoked,tinned,salted preserved food Helicobacter pylori Reduction of gastric acidity – Gastric surgery – Medication - PPI,H2, Blood group A- low mucus secretion Adenomatous polyps

9. Symptoms and course Asymptomatic anemie Epigastric pain,anorexy,loww of weight – Palpable mass –inoperable tumour Complications – Pylorus – vomiting – Cardia - dysfagia Metastasis – Per continuitatem – pancreas – Lymfonodes (Wirchov, umbilicus,,Douglas,ovarium,ascites) – Hematogenic – liver,pulmo

10. Borrmannś makroscopic clasification of advanced gastric cancer I Polypoid II Ulcerative limited III Ulcerative with uneven margins IV Infiltrative- only biopsy or X-ray or CT,mostly non visible during endoscoopy

11. Early gastric carcinoma Limited to mucosa and/or submucosa(infiltrated lymphonodes may or not may be present Difficult diagnosis – small lesions Histology the basis Mostly in Japan Definitive diagnosis only after pathological assesment of surgery tissue Early lesion (whioch can follow into advanced) or another type of carcinoma?

12. Klasifikace karcinomu

13. Diagnosis Endoscopy + biopsy Ulcus benign – malignant- biopsy in all ulcers X-ray of the stomach double contrast (leatherbottle) or CT Lymphoma and carcinoma loooks similarly in endoscopy

14. Normal barium meal and rumorous infiltration of the stomach

15. Gastric cancer : polypoid

16. Benign and malignant ulcer Biopsy in every gastric ulcer necessary – tumour ?

17. Malignant ulcer

18. Proximál gastric tumor

19. Gastric adenokarcinoma

20. Gastric lymphoma

21. Gastric leiomyosarcoma

22. Surgery gastric carcinoma Resection Billroth I a II + lymphonodes!! Total gastrektomy rarely Gastroenteroanastomosis Laparotomy without resection (not common now)

23. Surgery for gastric carcinoma

24. Surgery other types

25. Lymphonodes extirpation

26. Prognosis - 5 years survival Depends on deep of wall infiltration, lymphonodes, histology and genetic abnormalities Operable radically 20-30% – Distal tumor – 20% – Proximal tumor – 10% Chemotherapy – cisplatina, epirubicin,5-Fluorouracil – Before and after surgery - different protocols

27. Prognosis of lymphoma MALT H.pylori – antibiotics Surgery and chemotherapy – 5 years 40-60% survival

28. Prevention of gastric cancer Follow-up of precancerous states – Pernicious anemia – Previous gastrectomy Eradikation of H.Pylori Fruit and vegetable