Dr. Saleh M.

Al Salamah

GASTRIC TUMOURS

Anatomy of the stomach Aetiology of Gastric cancer Types of Gastric cancer Pathology of Gastric Cancer Evaluation of Gastric Cancer Treatment of Gastric Cancer

ANATOMY:

The stomach J-shaped. The stomach has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.

BLOOD SUPPLY:
a. b. c. d. e.
The left gastric artery

Right gastric artery

Right gastro-epiploic artery Left gastro-epiploic artery Short gastric arteries The corresponding veins drain into portal system. The lymphatic drainage of the stomach corresponding its blood supply.

AETIOLOGY:

Gastric cancer is the second most common fatal cancer in the world with high frequency in Japan.
The disease presents most commonly in the 5th and 6th decades of life and affect males twice as often as females.
Contn

The cause of the disease multistep process but several predisposing factors attributed to cause the disease :
Environment Diet Heredity Achlorhydria

a. b. c. d.

e. Atrophic gastritis f. Chronic gastric ulcer g. Adenomatous polyps h. Blood group A i. H. Pyloric colonisation

TYPES OF GASTRIC CANCER:

A. Benign Tumours
B. Malignant Tumours

THE BENIGN TUMORS:

Although benign tumors can occur in the stomach most gastric tumours are malignant.

 The benign groups includes:-

1. Non-neoplastic gastric polyps 2. Adenomas 3. Neoplastic gastric polyps 4. Smooth muscles tumours benign
(Leiomyomas)

5. Polyposis Syndrome (eg:- Polyposis coli,

Juvenile polyps and P.J. Syndrome)

6. Other benign tumours are fibromas,

and angiomas.

neurofibromas, aberrat pancreas

PATHOLOGY OF GASTRIC (MALIGNANT) TUMOURS:

The gastric cancer may arise in the antrum (50%), the gastric body (30%), the fundus or oesophago-gastric juntion (20%).

 Types of Malignant Tumours:

a. Adenocarcinoma
b. Leiomyosarcoma c. Lymphomas d. Carcinoid Tumours

 The macroscopic forms of gastric cancers are classified by (Bormann classification) into:-

1. Polypoid or Proliferative
2. Ulcerating

3. Ulcerating/Infiltrating
4. Diffuse Infiltrating (LinnitusPlastica)

Microscopically the tumours commonly adenocarcinoma with range of differentiation. The most useful to clinician and epidemiologist is Lauren Histological Classification: a. Intestinal gastric cancer

b. Diffuse gastric cancer

Early Gastric Cancer: Defined as

cancer which is confined to the mucosa and submucosa regardless of lymph nodes status.

Advanced

Gastric

Cancer:

Defined as tumor that has involved the muscularis propria of the stomach wall.

STAGING OF GASTRIC CANCER: a. TNM System b. CT Staging c. PHNS Staging System (Japanese)
P-factor (Peritoneal dissemination)
H-factor (The presence of hepatic metastases) N-factor (Lymphnodes involvement) S-factor (Serosal invasion)

SPREAD OF GASTRIC CANCER:

The diffuse type spreads rapidly through the submucosal and serosal lymphatic and penetrates the gastric wall at early stage, the intestinal variety remains localized for a while and has less tendency to disseminate.
The spread by:
1. 2. 3. 4. Direct (loco regional) Lymphatic Blood (Haematogenous) Transcoelomic

EVALUATION OF GASTRIC CANCER:

History
Clinical Examination Investigations

The clinical features of gastric cancer may arise from local disease, its complications or its metastases.

SUMMARY:
Often asymptomatic until late stage.
Marked weight loss Anorexia Feeling of abdominal fullness or discomfort Epigastric mass

Iron Deficiency Anaemia

Left supraclavicular mass (Troisiers Sign) Obstructive Jaundice (Secondary in porta hepatitis) Pelvic mass (Krukenberg)

INVESTIGATIONS: A. Upper gastero intestinal endoscopy with multiple biopsy and brush cytology
B. Radiology:
CT Scan of the chest and abdomen
USS upper abdomen Barium meal

C. Diagnostic laparoscopy

TREATMENTS OF GASTRIC CANCER:

Surgery (Early or Advanced Cancer)

lower (sub-total or

Distal tumours which involve the partial gasterectomy). Proximal tumours which involve body (total gasterectomy).

the

fundus, cardia or

Inoperable tumours: Whenever possible it is advisable to do even a limited gastric resection. If resection is impossible an anterior gastrojejunostomy.

Chemotherapy for gastric cancer (Pre-operatve & post-operative) Radiotherapy (Pre-intra & post-operatively)

OTHER GASTRIC TUMOURS:

Gastric Lymphomas:
the non Hodgkins type

Primary lymphomas of the stomach of (NHL).

The symptoms are similar to those of gastric cancer (adenocarcinoma). The diagnosis is made principally from endoscopic examination with biopsy and cytology. CT Scanning is important in staging the disease.

Treatment:
with resection (surgery) followed by radiotherapy or chemotherapy.

- Well-localized disease should be treated - Extensive disease by adjuvant chemotherapy & radiotherapy than surgery.

Leiomyosarcoma:
Arise in the stomach representing 1% of gastric tumors.

They may be sessile or pedanculated projecting into the gastric lumen or extragastrical or both (dumb-bell tumour). Presentation due to blood loss anaemia dyspepsia.

or epigastric mass or vague more than 5cm and confirmed

Malignancy is suggested by the size by noting increased mitosis on histology.

Gastric Carcinoid Tumour:

Are very rare. There is established gastritis & carcinoid & pernicious association between atrophic anemia. local resection. If very small

Gastric carcinoids are best treated by by endoscopic resection.