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Gastric tumours
Angl speak IV year
2012-2013 DEGHAS
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Gastric tumours
Epidemiology and incidence Pathology Histology Symtpoms Diagnosis Therapy Prognosis Prevention
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Incidence
Rapid decrease mortality in 80 years USA men 28/5 women 2.8/100 tis High incidence Japan,Chile,China,Ireland Dietary factors – poor people Study of migrants – eniviromental factors
(infection,freezing boxes)
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Incidence stomach carcinoma
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Stomach tumours patology/histology
Adenocarcinoma 85%– advanced– early
Lymphoma 15% Leiomyosarkoma and + GIST= (Gastro Intestinal Stromal Tumour)
celkem 1-3%
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Patology/course of disease
Difuse type – less common (cca 10%)– Malignant cells infiltrates the whole stomach– linitis plastica– Younger patients– Diagnosis dificult by endoscopy – X-ray barium meal not
extendable stomach
Intestinal type– Polypoid-ulcerative changes antral and small curve– Long-term praekancerous proces– High risk areas
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Aetiology
Nitrátes + bakteries = nitrites = cancerogeny– Smoked,tinned,salted preserved food
Helicobacter pylori Reduction of gastric acidity
– Gastric surgery– Medication - PPI,H2,
Blood group A- low mucus secretion Adenomatous polyps
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Symptoms and course
Asymptomatic anemie Epigastric pain,anorexy,loww of weight
– Palpable mass –inoperable tumour Complications
– Pylorus – vomiting– Cardia - dysfagia
Metastasis – Per continuitatem – pancreas– Lymfonodes (Wirchov, umbilicus,,Douglas,ovarium,ascites)– Hematogenic – liver,pulmo
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Borrmannś makroscopic clasification of advanced gastric cancer
I Polypoid II Ulcerative limited III Ulcerative with uneven margins IV Infiltrative- only biopsy or X-ray or
CT,mostly non visible during endoscoopy
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Early gastric carcinoma
Limited to mucosa and/or submucosa(infiltrated lymphonodes may or not may be present
Difficult diagnosis – small lesions Histology the basis Mostly in Japan Definitive diagnosis only after pathological
assesment of surgery tissue Early lesion (whioch can follow into advanced) or
another type of carcinoma?
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Klasifikace karcinomu
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Diagnosis
Endoscopy + biopsy Ulcus benign – malignant- biopsy in all
ulcers X-ray of the stomach double contrast
(leatherbottle) or CT Lymphoma and carcinoma loooks similarly in
endoscopy
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Normal barium meal and rumorous infiltration of the stomach
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Gastric cancer : polypoid
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Benign and malignant ulcer
Biopsy in every gastric ulcer necessary – tumour ?
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Malignant ulcer
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Proximál gastric tumor
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Gastric adenokarcinoma
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Gastric lymphoma
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Gastric leiomyosarcoma
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Surgery gastric carcinoma
Resection Billroth I a II + lymphonodes!! Total gastrektomy rarely Gastroenteroanastomosis Laparotomy without resection (not common
now)
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Surgery for gastric carcinoma
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Surgery other types
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Lymphonodes extirpation
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Prognosis - 5 years survival
Depends on deep of wall infiltration, lymphonodes, histology and genetic abnormalities
Operable radically 20-30%– Distal tumor – 20%– Proximal tumor – 10%
Chemotherapy – cisplatina, epirubicin,5-Fluorouracil– Before and after surgery - different protocols
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Prognosis of lymphoma
MALT H.pylori – antibiotics Surgery and chemotherapy – 5 years 40-60% survival
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Prevention of gastric cancer
Follow-up of precancerous states– Pernicious anemia– Previous gastrectomy
Eradikation of H.Pylori Fruit and vegetable