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Gastric Cancer
Jun 19, 2024
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Gastric Cancer Lecture Notes
Overview
Definition:
Malignant or cancerous cells in the stomach.
Types:
Classified based on originating cells:
Adenocarcinoma: Columnar glandular epithelium
Lymphoma: Lymphocytes
Carcinoid tumor: G cells
Lyomyosarcoma: Smooth muscle cells
Stomach Anatomy
Regions:
Cardia, Fundus, Body, Pyloric Antrum
Layers:
Four layers of gastric wall:
Adventitia (serosa)
Muscular layer
Submucosa
Mucosa
Mucosa:
Three layers
Epithelial layer: Secretes mucus and digestive enzymes
Lamina propria: Contains blood, lymph vessels, and MALT
Muscularis mucosa: Smooth muscle aiding food breakdown
Gastric Pits and Glands:
Different epithelial cells secrete various substances (e.g., surface mucus cells, parietal cells, chief cells, G cells)
Types of Gastric Cancer
Adenocarcinoma:
Most common; 2 subtypes:
Intestinal (well-differentiated):
Often related to H. pylori
H. pylori causes chronic gastritis, metaplasia, and mutagenesis
Tumor appears on lesser curvature of the antrum
Diffuse (undifferentiated):
Related to CDH1 gene mutations
E-cadherin malfunction leads to cell detachment and uncontrolled division
More aggressive, can cause linitis plastica
Other Types:
Lymphoma:
Excessive B-cell proliferation due to chronic H. pylori infection
Carcinoid Tumor:
From G cells, appears as a polyp
Lyomyosarcoma:
From smooth muscle cells, very rare
Complications
Metastasis:
Spread to peritoneum, lymph nodes, liver; specific metastases:
Kruckenberg Tumor:
Bilateral ovarian metastases
Perineoplastic Syndromes:
Leser-Trelat sign:
Seborrheic keratosis spots
Polyarteritis Nodosa:
Inflammation and necrosis of arteries
Trousseau Syndrome:
Migratory thrombosis in veins
Risk Factors
General:
Family history, smoking, alcohol, obesity, increasing age
Specific (intestinal adenocarcinoma):
Male, H. pylori, blood type A, diet high in nitrates and nitrosamines, autoimmune conditions
Protective:
High intake of fruits, vegetables, fiber, and folate
Symptoms
Early:
Asymptomatic or vague symptoms like malaise, loss of appetite, dyspepsia
Advanced:
Epigastric pain, nausea, vomiting, weight loss, possible anemia, hematemesis, melena
Perineoplastic Signs:
Leser-Trelat sign, polyarteritis nodosa, Trousseau syndrome, acanthosis nigricans, Sister Mary Joseph sign
Diagnosis
Endoscopy:
Direct tumor visualization and biopsy
X-rays with Barium:
To identify complications
Abdominopelvic CT:
To assess spread to other organs/lymph nodes
Treatment
Early Stage:
Surgery
Advanced Stage:
Palliative surgery, chemo, radiotherapy
Recap
Gastric Cancer:
Malignant cells in stomach, most commonly adenocarcinoma
Complications:
Metastasis, perineoplastic syndromes
Risk Factors:
Family history, smoking, alcohol, obesity, H. pylori
Protective Factors:
Fruits, vegetables, fiber, folate
Symptoms:
Early asymptomatic, advanced include pain and weight loss
Diagnosis:
Endoscopy and biopsy, X-rays, CT
Treatment:
Surgery, with chemo and radiotherapy for advanced cases
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