Stomach cancer ☼ An Overview Distributed under Creative Commons license ☼ Introduction • leading cause of cancer related morbidity • Second most common cause of cancer related deaths after Lung cancer (10.4% of all cancer related deaths). • 60% cases occur in the developing world • linked to dietary habits and unhealthy food preservation practices ☼Causes• A/S/LElderly Male Asians and East Europeans. • Diet- Food preserved by drying, smoking, salting and pickling Dietary nitrites converted to carcinogenic N-nitroso compounds by bacteria in the stomach. • Helicobacter Pylori infection-People with H. Pylori bacteria infection of the stomach have greater risk. Causes- contd • Prior stomach surgery-People with a history of stomach surgery face a greater risk due to alteration in normal ph of the stomach. • Stomach Disorders- Pernicious anemia, achlorhydria and atrophic gastritis 6 times more prone. • Smoking • Hereditary- underlying genetic factors are poorly understood (KRAS mutation, c-met amplification) Rarely, some gastric ulcers may turn into cancer. ☼ Types • 90% arise from the glandular cells of the stomach wall and are called Adenocarcinomas. • Others – Gastric Lymphomas (cancer of gastric lymphatic tissue) Soft tissue sarcomas (e.g. Leiomyosarcomas) Carcinoids ☼Clinical features • Early stages asymptomatic. • non-specific symptoms like indigestion, nausea, vomiting and sometimes Pain. • bloated feeling after eating, loss of appetite, dark colored stools (due to presence of blood) and feeling of tiredness (due to anemia). • Late features- peritoneal and pleural effusions, Jaundice and cachexia. • Hepatomegaly usually occurs and presence of an enlarged left supraclavicular lymphnode (Virchow's sign) is a typical finding. ☼Treatment • Surgical intervention Partial/subtotal gastrectomy , Total gastrectomy + making of a new stomach from S.I • Radiation therapyexternal beam radiation (5 days/week*6 to 8 weeks). Tomotherapy HI-ART (Tomotherapy highly integrated adaptive radiotherapy) for specific reduced doses. • Chemotherapy – 5 fluorouracil, Cisplatin, Doxorubicin. • Immunotherapy ☼ Prognosis • Indicators - Stage - Tumor Size - Histological Type - Degree of cytological atypia - Lymphatic/vascular invasion • Generally, five year survival is a poor 30%. • Younger patients have more aggressive disease. Dr. Neelesh Bhandari MBBS(A.F.M.C), MD (Path.) PGP Human Rights.