Chapter 24.Stomach and Duodenum Diseases
Chapter 24. Stomach and Duodenum Diseases
Sections 4. Gastric Carcinoma ★★★★★·4.1 Epidemiology·4.2RiskFactors·4.3 Pathology·4.4Diagnosis· 4.5 Staging·4.6 Treatment·4.70utcomes
Sections 4. Gastric Carcinoma ★★★★★ • 4.1 Epidemiology • 4.2 Risk Factors • 4.3 Pathology • 4.4 Diagnosis • 4.5 Staging • 4.6 Treatment • 4.7 Outcomes
Epidemiology: Every year, around 99o,o00 people are diagnosed with Gc worldwide, ofwhomapproximately738,oo0die.GCisthe4thmostcommonincidentcancerandthe2ndmostcommoncauseofcancerdeath.GCincidence is different concerning sex andgeographicalvariability.Menaretwotothreetimesmoresusceptiblethanwomen.Theincidencedisplays huge geographical diversity.It is noted that more than 5o% of newincidentscomeupindevelopingcountries.Areaswiththehighestprobability for GC development encompass regions like Centraland SouthAmerica,EasternEuropeandEastAsia(ChinaandJapan)The5-yearsurvivalrateismildlygoodonlyinJapan.InEurope,theratiofluctuatesbetween10-30%.Theincreased5-yearsurvival rateisprobablydueto earlydiagnosis usingtheendoscopicexamination method, whichallowsfortheearlydetection and resectionof cancer
Epidemiology • Every year, around 990,000 people are diagnosed with GC worldwide, of whom approximately 738,000 die. GC is the 4th most common incident cancer and the 2nd most common cause of cancer death. • GC incidence is different concerning sex and geographical variability. Men are two to three times more susceptible than women. The incidence displays huge geographical diversity. It is noted that more than 50% of new incidents come up in developing countries. Areas with the highest probability for GC development encompass regions like Central and South America, Eastern Europe and East Asia (China and Japan). • The 5-year survival rate is mildly good only in Japan. In Europe, the ratio fluctuates between 10–30%. The increased 5-year survival rate is probably due to early diagnosis using the endoscopic examination method, which allows for the early detection and resection of cancer
EpidemiologyMaleFemaleEastemAsiaCentralandEasternEuropeLessdevelopedregionsWorldSouthAmericaIncidenceMoredeveloped regionsCentralAmericaMortality75%WestemAfrica65-74%SouthemAfricaNorthemAfricaM55-64%6040200204060<55%
Epidemiology
RiskFactorsSmokingDietNutritionalLowfatorproteinconsumptionFamilyAlcoholSaltedmeatorfishHistoryHighnitrateconsumptionHighcomplexcarbohydrateconsumptionEpstein-EnvironmentalBarrH.pyloriPoorfoodpreparation(smoked,salted)virusLack ofrefrigerationPoordrinkingwater(e.g,contaminatedwellwater)SmokingSocialLowsocial classMedicalPrior gastric surgeryH.pylori infectionGastricatrophyandgastritisToto.ito-5Adenomatouspolyps5to-12eeOtherNoditaNAMalegenderHelicobacterpylori infectionassociated WithIncreasedRiskforDevelopingintheworldwide
Risk Factors Helicobacter pylori infection associated With Increased Risk for Developing in the worldwide
PathologyProtrudedtypeTheBorrmannclassificationType1systemdevelopedin1926;itremainsusefultodayforthedescriptionofendoscopicfindingsType2Thissystemdividesgastriccarcinomaintofivetypes,dependingonthelesion'smacroscopicappearanceType 3DepressedtypeOnetype,linitisplastica,describesadiffuselyinfiltratinglesioninvolvingtheentirestomach.Type4
Pathology The Borrmann classification system developed in 1926; it remains useful today for the description of endoscopic findings. This system divides gastric carcinoma into five types, depending on the lesion’s macroscopic appearance. One type, linitisplastica, describes a diffusely infiltrating lesion involving the entire stomach
PathologyDIFFUSEINTESTINALLaurenClassificationsystemseparatesgastricadenocarcinomaFamilialEnvironmentalintointestinalordiffusetypesGastric atrophy,intestinal metaplasiaBlood typeAbasedonhistology,withbothtypes havingdistinctpathology,Men>womenWomen>menepidemiology,andprognosis.Increasing incidence with ageYounger age groupGland formationPoorly differentiated, signetring cellsHematogenous spreadTransmural,lymphaticspreadMicrosatellite instabilityDecreased E-cadherinAPCgenemutationsp53,p16inactivationp53,p16inactivation
Pathology Lauren Classification system separates gastric adenocarcinoma into intestinal or diffuse types based on histology, with both types having distinct pathology, epidemiology, and prognosis
PathologyTypical adenocarcinoma with signet ringWell-circumscribedlesioninthecellsshownonclose-up.posteriorgastricbody
Pathology Typical adenocarcinoma with signet ring cells shown on close-up. Well-circumscribed lesion in the posterior gastric body
Diagnosis_ Signs and Symptoms.The symptoms of gastric cancer are generally nonspecific andcontribute toits frequently advanced stage atthe time of diagnosisThey include epigastric pain, early satiety, and weight loss.·These symptoms are frequently mistakenfor more common benigncauses of dyspepsia including PuD and gastritis.Thepainassociatedwith gastric cancer tends to be constant, nonradiating, and isgenerally not relieved by eating.More advanced lesions may presentwith either obstruction or dysphagia depending on the location of thetumor. Some degree of Gl bleeding is common, with up to 40% ofpatientshaving someformof anemiaand upto15%havingfrankhematemesis
Diagnosis _ Signs and Symptoms • The symptoms of gastric cancer are generally nonspecific and contribute to its frequently advanced stage at the time of diagnosis. They include epigastric pain, early satiety, and weight loss. • These symptoms are frequently mistaken for more common benign causes of dyspepsia including PUD and gastritis. The pain associated with gastric cancer tends to be constant, nonradiating, and is generally not relieved by eating. More advanced lesions may present with either obstruction or dysphagia depending on the location of the tumor. Some degree of GI bleeding is common, with up to 40% of patients having some form of anemia and up to 15% having frank hematemesis
Diagnosis_ Signs and Symptoms: A complete history and physical examination should be performedwith special attentionto anyevidence ofadvanced disease.Thisincludes metastatic nodal disease, supraclavicular (Virchow's)orperiumbilical (Sister Mary Joseph's node), and evidence of intra-abdominal metastases suchas hepatomegaly,jaundice, orascites.Dropmetastasestothe ovaries (Krukenberg'stumor)maybedetectableonpelvicexaminationandperitoneal metastasescanbefeltasafirm(Blummer's)shelf onrectalexamination.·Acomplete blood count, chemistrypanel,including liverfunctiontests, and coagulation studies should be carried out
Diagnosis _ Signs and Symptoms • A complete history and physical examination should be performed, with special attention to any evidence of advanced disease. This includes metastatic nodal disease, supraclavicular (Virchow’s) or periumbilical (Sister Mary Joseph’s node), and evidence of intraabdominal metastases such as hepatomegaly, jaundice, or ascites. Drop metastases to the ovaries (Krukenberg’s tumor) may be detectable on pelvic examination and peritoneal metastases can be felt as a firm (Blummer’s) shelf on rectal examination. • A complete blood count, chemistry panel, including liver function tests, and coagulation studies should be carried out