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Back to Topics<<<< Defintions: Cancer: is the malignant tumor of the epithelial cells Sarcoma: is the malignant tumor of the connective tissue The most and severe type is adenoma, which is derived from the glandular cells. They are divided into two categories on the basis of their morphology: Intestinal and diffused. Intestinal is thought to arise from gastric mucous cells that have undergone intestinal metaplasia. Intestinal metaplasia is the setting of chronic gastritis. This pattern of cancer leads to be well differentiated and is more common type in high risk population. It occurs primarily after the age of 50 years with 2:1 of male predominance. Diffused type is thought to arise from native gastric mucosal cells and is not associated with chronic gastritis. It tends to be poorly differentiated and can occur at any stage of life. Risk Factors:
Early gastric carcinoma is defined as the location confined to mucosa and submucosa regardless of the presence and/or the absence of perigastric lymph node metastasis. Advanced gastric carcinoma is a neoplasm that has extended below the submucosa into the muscular wall or perhaps has spread more widely. There are three macroscopic patterns of gastric carcinoma, which may be evident at both early and advanced stages. Exophytic: with protrusion of tumour mass into the lumen Flattened or depressed: in which there is no obvious tumour mass Excavated: Deeply erosive crater is present in the wall of stomach. Whatever the histological form it has, all gastric carcinomas eventually penetrate the wall to involve the serosa, spread to adjacent region and distant lymph nodes and matastize widely. Clinical Features: Early carcinoma is generally asymptomatic and can be discovered by repeated endoscopic, CT and Ultrasound examinations. When symptomatic, there is abdominal discomfort, anorexia, weight loss with common signs of gastric cancer (95%). Nausea and vomiting may occur when distal lesion in pylorus is present. Dysphagia is a dominant symptom when cancer arises within the cardia of the stomach. A palpable abdominal mass is common (50%). Peritoneal seeding may cause massive ascites. A palpable lymph node in supraclavicular space (Virchows node) is also a sign of advanced malignancy. TNM Classification: T0 No Cancer T1 Cancer occupies only mucous layer and little part of submucosa T2 Cancer occupies submucosa and partially muscular layer T3 Cancer occupies muscular layer completely and serosal layer partially T4 Serosal layer and adjacent organs are involved N0 No regional lymph nodes involved N1 Regional lymph nodes are involved and contain 1st and 2nd basis (i.e. we can remove and basis are the portions of lymph nodes). N2 3rd and 4th basis are present M0 No distant metastasis present M1 Distant metastasis present Treatment: Treatment can be:
Palliative Surgery: in which we perform partial gastrectomy and later on Billroth II is performed. If it is obvious that gastric cancer is not removable and other complications occur such as outlet obstruction of stomach, perforation or bleeding due to cancer then it is necessary to have palliative surgery such as gastrojejunal anastomosis (in case of gastric obstruction). Suturing of perforated cancer or legation of bleeding vessels is done in case of perforation or bleeding. Also palliative gastric resection maybe performed. Radical Surgery: It is done in the following process:
the techniques depend upon the growth of cancer. There are two types of growing cancers:
If the intraluminal gastric cancer is located in the outlet of stomach then distal partial gastrectomy may be performed, which involves the removal of greater omentum and lesser omentum (hepatoduodenal ligaments). If the intraluminal cancer is located in the fundus or the cardia of the stomach then proximal partial gastrectomy is indicated with the removal of spleen, greater omentum and lesser omentum. Chemotherapy: if the therapy is combined then we add so called cytostatic drugs e.g. 5-Fu or Flurasole to the surgical intervention. Radiotherapy: is not indicated only pre-operative but also post-operative when various degrees of radiations are applied (alpha, beta or sometimes gamma) This article has been written by Dr. M. Javed Abbas. If you have any comments please do not hesitate to sign my Guest Book. 21:01 21/12/2002 |