Gastric cancer

It is one of the most dangerous cancer types after lung cancer.

Preventable Risk Factors

Nutrition

• Smoked, smoked foods p>

• Vitamin A and C deficiency, insufficient intake with food

• Foods stored or prepared by excessive salting

Professional

• Plastic

• Pitch

• Radiation Exposure

Habits

• Smoking

Infection

• Helicobacter pylori

• Epstein Barr virus

p>

Precancerous lesions

• Adenomatous polyps

• Chronic atrophic gastritis

• Dysplasia

• Intestinal metaplasia

• Menetrier's disease

Other Risk Factors

Genetic Factors

• A blood group

• Pernicious anemia

• Family history

• HNPCC and Lynch syndrome

• Li-Fraumeni syndrome

Curriculum vitae

• Previously having had stomach surgery

Pathology

Intestinal type

It is mostly seen in the Far East, Japan region. It is better differentiated. (more similar to the cell type it originates from, more benign) Distal (stomach outlet part) often involves the stomach.

Diffuse type

More common in Europe and America. It is poorly differentiated (less similar to the cell it originates from), and has a horny (malignant) character. It mostly holds the stomach entrance. (Proximal stomach)

Symptoms

• Abdominal pain

• Anorexia

• Weight loss

• Weakness

• Nausea

• Anemia

• Difficulty in swallowing (especially in types that involve the gastric entrance)

• Can give signs of gastric outlet obstruction (vomiting without bile, bloating and tension in the abdomen)

Results

• Supraclavicular lymph node (Wirchow): Swelling on the left side of the neck above the collarbone

• Periumblical lymph node (Sister Mary Joseph nodule): Lymph node around the navel

• Left axillary lymph node ( Irish nodule): Lymph node in the left armpit

• Extraluminal mass on rectal examination (Blummer's shelf): It is a finding of peritoneal metastasis.

Diagnosis

Upper gastrointestinal endoscopy is diagnostic.

Preoperative Evaluation

The patient should be evaluated for the extent of disease before surgery.

This for:

• Computed tomography

• i. Local spread of the disease,

• ii. Ascites (malignant fluid in the abdomen),

• iii. It allows us to understand whether there is distant metastasis (especially the liver).

• Whole body positron emission tomography (PET CT) is performed after surgery to find out if there is any other metastasis in the body in recurrent disease or advanced stage tumors.

• Staging laparoscopy (Staging laparoscopy) is a laparoscopy that cannot be detected by radiological methods, but is performed for staging before surgery if there is clinical suspicion. It is mostly done to detect small metastases on the peritoneal surface. If it is detected, the treatment method changes.

Staging

• American Joint Committee on Cancer (AJCC) ) staging is used.

• This staging is based on tumor depth, lymph node metastasis, and distant metastases�

• The treatment varies according to each stage.

Treatment

• Multidisciplinary should be done. This team may include surgeon, oncologist, pathologist, radiologist, radiation oncologist, gastroentereologist, dietician, internist, cardiologist, pulmonologist according to co-morbidities.

• Stage of the disease

• Co-morbidity of the patient

General Approach

• Early disease (Tis, T1a): endoscopic mucosal resection, endoscopic close follow-up is recommended.

• Local disease (T1b No): Surgical resection, regional lymph node dissection is recommended.

• Locally advanced disease (T2 regional lymph node dissection) node metastasis): It should be approached multidisciplinary, preoperative (neoadjuvant) chemoradiation may be considered.

• Metastatic disease: Palliative chemotherapy is performed.

Surgery

• Subtotal or total gastrectomy : It is preferred according to the location of the tumor. In tumors close to the exit site, subtotal gastrectomy can be performed if a clean surgical margin can be achieved.

• Wide surgical margin (approximately 5 cm): Potential for tumor to spread submucosal It is important to be able to provide a clean surgical margin. It is necessary to try to create a 5 cm border from the visible macroscopic tumor. If there is tumor infiltration in fundus and cardia tumors, the tail of the pancreas and spleen can be removed together.

• Lymphadenectomy

Paliative Resection (For advanced stage patients with no survival expectation)

• Occlusive

• It is performed in bleeding tumors, together with distant metastases

• The obstruction is opened by simple resection or sometimes by-pass without resection. Then the treatment is continued with adjuvant chemotherapy

Adju van Chemotherapy

• Performed after resection for potentially curative treatment.

Prognosis (process)

Depends on three factors

• Deep of tumor in the wall of stomach

• To involved lymph nodes

• To distant metastases

Prevention

I suggest you read the preventable risk factors again. In addition, it would be very appropriate for people with genetic risk factors to have an annual endoscopy 5 years before the age of the youngest gastric cancer case in the family. Apart from this, it would be appropriate for people with symptoms of stomach cancer to apply to a general surgeon or gastroenterologist for endoscopy.

_{Read: 0}