1. Stomach Cancer

2. Anatomy of Stomach

3. Physiology of Stomach Motility 1. Muscles 2. The pacemaker 3. The pylorus

4. Physiology of Stomach Functions 1. Storage 2. Mixing food and the formation of chime 3. Controlled emptying

5. Controlled emptying of stomach 1. Peristalsis 2. Volume of chyme and liquids 3. Hormone modulators 4. Physicochemical modulators a) nature of food; b) caloric density; c) osmolarity; d) pH

6. Controlled emptying of stomach MMC - Migrating Myoelectric Complex a cycle of gastrointestinal motor activity, initiated in the stomach and propagated through the small intestine

7. Physiology of stomach Stomach secretion: a)Vagus phase b)Stomach phase c)Intestinal phase

8. Physiology of stomach Zones of secretion a)Cardiac zone b)Fundic zone c)Antral zone

9. Physiology of stomach Stomach secretion 1.Mucus Mucous cells 2.Intrinsic factor Parietal cells 3.H+ Parietal cells 4.Pepsinogen Chief cells 5.Gastrin G cells

10. Physiology of stomach Defensive barrier a) mucus b) 1 st level – cells’ apical membranes c) 2 nd level – basal membrane of mucous layer

11. Tumors of stomach Benign tumors: 1. Leiomyoma 2. Fibroma 3. Lipoma 4. Hemangioma 5. Lymphoma

12. Tumors of stomach Gastric polyps a) hyperplastic polyps b) adenomatous polyps

13. Gastric carcinoma Risk factors a)Genetic predisposition; b)Diet; c)Alcohol and smoking d)Atrophic gastritis; e)Adenomatous polyps;

14. Gastric carcinoma Risk factors f) Nitrosamines g) Pernicious anemia h)Hypochlorhydria i)H. pylori colonization

15. Gastric carcinoma Two morphologic types: a)Intestinal type b)Diffuse type

16. Classification of gastric cancer Stages Stage 1 - lesion up to submucous layer Stage 2 – lesion up to serous layer Stage 3 – lesion through all layers Stage 4 – metastases to another organ

17. Classification of gastric cancer TNM system p1 – lesion through mucous layer p2 – lesion up to muscular layer p3 – lesion up to serous layer p4 – lesion of all layers

18. Clinical features of gastric cancer 1.Pain 2.Cycle-type running features 3.General symptoms 4.Complications

19. Treatment of gastric cancer 1.Distal subtotal resection 2.Proximal subtotal resection 3.Gastrectomy

20. Statistics of stomach cancer 5-year survival rate: I stage 95% II stage 86% III stage 10-28% IV stage