1. Screening &early detection of gastric cancers Rasha Mahmoud Screening &early detection of gastric cancers Prepared by Rasha Mahmoud Faculty of medicine –Benha university

2. Epidemiology &incidence

3. Gastric cancer remains the second leading cause of cancer death worldwide. Japan, China, and South and Central America. It is more common in Japan, China, and South and Central America. It is adisease of elderly and more in male(2:1)

4. In Egypt In Egypt: Gastric tumors formed 2.12% of the total malignancy and 14.72 of all digestive system tumors Adenocarcinoma was the most common type (Mokhtar,etal,2007 )

5. What are the risk factors for stomach cancer?

6. 1-Helicobacter pylori infection. 2- Age&Sex. 3- Diet. 4- Tobacco use. 5-Obesity. 6- Previous stomach surgery. 7- Menetrier disease (hypertrophic gastropathy 8-Hereditary gastric cancer. 8- Pernicious anemia. 9- Some types of stomach polyps. 10- Epstein-Barr virus infection. 11-Occuptional exposure.

7. Helicobacter pylori infection&Gastric cancers Helicobacter pylori infection&Gastric cancers: Long-term infection of the stomach chronic atrophic gastritis pre-cancerous lesions(Intestinal metaplasia& dysplasia) Gastric carcinoma H pylori infection is also linked to MALT lymphoma of the stomach.

8. Diet &gastric cancers Smoked foods, salted fish and meat. Nitrates and nitrites are substances commonly found in cured meats. On the other hand, eating fresh fruits and vegetables that contain antioxidants appears to lower the risk of stomach cancer.

9. Tobacco use: Smoking increases stomach cancer risk, particularly for cancers of the upper portion of the stomach. Obesity: Being very overweight or obese is a possible cause of cancers of the cardia.

10. Previous stomach surgery: As partial gastrectomy; more nitrite-producing bacteria to be present & Less acid production & may be reflux (backup) of bile from the small intestine into the stomach.

11. Inherited cancer syndromes: 1- Familial adenomatous polyposis (FAP):. People with this syndrome are at greatly increased risk of getting colorectal cancer and have a slightly increased risk of getting stomach cancer. It is caused by mutations in the gene APC. 2-Hereditary non-polyposis colorectal cancer:. In most cases, this disorder is caused by a defect in either the gene MLH1 or the gene MSH2, but at least 5 other genes can cause HNPCC: MLH3, MSH6, TGBR2, PMS1, and PMS2. 3-Hereditary diffuse gastric cancer: This condition is quite rare, but the lifetime stomach cancer risk among affected people is about 70% to 80%. 4-BRCA1 and BRCA2 mutations.

12. Stomach polyps and gastric cancers Most types of polyps (such as hyperplastic polyps or inflammatory polyps) do not seem to increase a person's risk of stomach cancer, but adenomatous polyps( adenomas) can sometimes develop into cancer..

13. Occupational exposure and gastric cancer: Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer.

14. Signs and symptoms of stomach cancers :

15. 1-Poor appetite 2-Weight loss 3-Abdominal (belly) pain 4-Vague discomfort in the abdomen 5-A sense of fullness in the upper abdomen after eating a small meal 6-Heartburn, indigestion, or ulcer-type symptoms 7-Nausea 8-Vomiting, with or without blood 9-Swelling or fluid build-up in the abdomen

16. Early detection &Screening

17. Indications: 1- In patients suffering from dyspepsia not responding to antacid drugs. 2-In patients with any of the risk factors e.g. Helicobacter infection. 3- In countries with increased incidence e.g. Japan

18. Methods systematic mass screening by endoscopy Only systematic mass screening by endoscopy as practiced in Japan and Korea has been shown to improve early detection.

19. Advantages of early detection Gastric cancers are tumors of bad prognosis,if diagnosed at an early stage,they can be cured In the absence of screening, patients present with advanced disease, and prognosis is poor

20. But it can be cured if diagnosed at an early stage.

21. In the absence of screening, patients present with advanced disease, and prognosis is poor.

23. Screening &early detection Early diagnosis Good eradication & treatment Good prognosis and survival

25. PU.1 is a member of the Ets (E-twenty six) family of transcription factors and plays critical roles in the development of hemaopoietic cells such as macrophages and B cells

26. . Some studies revealed that in contrast to nodular lymphovyte predominant Hodgkin"lymphoma, Pu1 is consistently absent in all cases of classic Hodgkin" lymphoma

27. Lymphomas (Hodgkin and non-Hodgkin) are common malignancies seen in our practice. So we wanted to test the utility of Fascin and PU.1 in distinguishing between Hodgkin lymphomas and morphologically closely related forms of non-Hodgkin lymphomas such as diffuse large B cell lymphoma and anaplastic large cell lymphoma in difficult cases. If found useful, these antibodies could help in reaching a correct diagnosis in difficult cases and allow appropriate patient management.

28. Aim of the Work

29. 1-Histopatholgical study of Hodgkin, anaplastic large, and diffuse large B- cell lymphomas. 2-Immunohistochemical study of Fascin expression in Hodgkin, anaplastic large, and diffuse large B-cell lymphomas. 3-Immunohistochemical study of PU.1 expression in Hodgkin, anaplastic large, and diffuse large B-cell lymphomas 4-Showing to what extent Fascin and PU.1 can be used in the differential diagnosis between Hodgkin lymphomas and non Hodgkin lymphomas.

30. Materials and Methods

31. This retrospective study is carried upon different types of lymphoid neoplastic lesions.The material include consecutive archival formalin-fixed paraffin-embedded blocks of lymph nodes and available decalcified bone marrow biopsies processed during the years 2007 to 2010. These blocks were obtained from the departments of Pathology of faculty of medicine,Banha university and International Medical Center. From each block several adjacent sections were prepared and stained by:

32. 1- The Hematoxylin and Eosin for histopathological study. 2-Routinly used Immunohistochemical staining panel using antibodies against CD45, kappa & lamda light chains, CD30, CD15, CD20, CD79a and CD3 to establish clonality, differerentiate Hodgkin from non Hodgkin lymphomas and for subtyping. 3- Fascin using Immunohistochemical staining. 4-PU.1 using Immunohistochemical staining.