A 58 years old man presents with melena.

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A 58 years old man presents with melena.
What would you ask him?
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What are the common complaints of patients with
gastric cancer?

• Nonspecific gastrointestinal symptoms, eg
• Indigestion
• Belching
• Early satiety
• Acute intraabdominal condition
• Signs/symptoms indicative of
• Chronic disease anemia, weight loss, fatigue
• Advanced disease palpable mass, ascites,
  jaundice, cachexia

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Symptoms
Hematemesis Melena Fullness Nausea Loss of
appetite Weight loss Abdominal pain
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GASTRIC CANCERRisk factors

• Genetic, eg
• Type A blood
• Pernicious anemia
• Family history of gastric cancer
• Hereditary nonpolyposis colon cancer
• Li-Fraumeni syndrome
• Precursor lesions, eg
• Chronic atrophic gastritis
• Adenomatous gastric polyps

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• Nutritional factors, eg
• High salt and nitrate consumption
• Poor intake of vitamins A and C
• Cigarette smoking
• Viral infections
• Helicobacter pylori
• Epstein-Barr
• Prior surgery for gastric ulcer
• Radiation exposure

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GASTRIC CANCERDiagnosis

• Physical examination
• Of limited utility in detecting early disease
• Radiographic evaluation
• Double-contrast barium radiographic examination
• Upper gastrointestinal endoscopy
• Biopsy

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GASTRIC CANCERHistology

• 95 of gastric neoplasms are adenocarcinomas
• Other subtypes include
• Squamous cell carcinoma
• Adenoacanthoma
• Carcinoid tumors
• Gastric stromal tumor (leiomyosarcoma)
• Primary lymphoma

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What is the staging?
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GASTRIC CANCERTNM staging for gastric cancer
Classification Definition Primary tumor (T)
TX Primary tumor
cannot be assessed T0
No evidence of primary tumor Tis
Carcinoma in situ
intraepithelial tumor without invasion of lamina
propia T1
Tumor invades lamina propia or submucosa T2
Tumor invades the
muscularis propia or the subserosa T3
Tumor penetrates the serosa
without invasion of adjacent structures T4
Tumor invades adjacent
structures
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GASTRIC CANCERTNM staging for gastric cancer
(contd)
Classification Definition Regional lymph nodes
NX Regional lymph
node(s) cannot be assessed N0
No regional lymph node metastasis
N1 Metastasis in
1-6 regional nodes N2
Metastasis in 7-15 regional nodes N3
Metastasis in more than 15
regional lymph nodes Distant metastasis MX
Presence of distant
metastasis cannot be assessed M0
No distant metastasis M1
Distant metastasis
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Our patient had penetration of tumor
to muscularis and 5 out of 20 lymph nodes
involved.
What is his staging?
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What is the expected 5 years survival of this
patient?
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What is the prognosis of gastric cancer?
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Can we improve his chances of survival after the
operation?
Is there any value for adjuvant therapy?
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4 years later a CT examination detects liver
metastases.
What are the most common sites of metastases in
gastric cancer patients?
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GASTRIC CANCERSites of metastasis
Liver 38-54 Peritoneum
17-24 Omentum 13-21 Lungs
12-22 Mesentery 9 Pancreas
7-29 Adrenals 5-15
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Is there any value for chemotherapy in metastatic
patients?
What is the median survival of metastatic
patients without chemotherapy ? with
chemotherapy?
3 mo
9 mo
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Which chemotherapy?
5-FU Cisplatin
Taxol
CPT 11 Irinotecan
Adriamycin
Methotrexate