Stomach Cancer

Question 1

Definition

Answer 1

Stomach cancer is a malignant tumor of the stomach developing out of the glandular epithelium

Question 2

Risk factors

Answer 2

Chronic diseases of the stomach with mucosal hyper trophy
Adenomatous gastric polyps
Hyperplastic gastritis
Chronic callous gastric ulcer
Chronic atrophy gastnhis with intestinal metaplasia
Diets { high salt intake, spices, non refined fats,
Smoking, alcohol abuse
Hereditary

Question 3

Classification

Answer 3

According to the localisation
A. The body of the stomach
B.antral position and pyloric channel
C. Cardiac portion
D. Cardiac position with transition onto the esophagus

According to the form of growth
A. Fungiform
B. Exophytie ulcerated
C. Ulcerous- infiltrative
D. Diffuse infiltrative

According to spread oftheprocess
A. Lymphogenic- lymphatic nodes
B. Hematogenic - liver, lungs, bones, brain
C. Peritoneal- into umbilicus
D germination on into adjacent organs

According to the complication
A. Non-complicated
B. Stenosis of the cardiac portion of stomach
C. Perforation
D, bleeding

According to the international TNM system
A. To → no tumour detected
B. T1→ tumour germinates into the mucous and submucosal layer
c. T2 → tumour germinates into the muscular layer
D. T3 → tumour germinates into the serous layer
E .T4→ tumour germinates into the adjacent organs

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Question 4

Clinical picture

Answer 4

Early fatigue
Reduced working ability
Apathy
Decrease of appetite
Loss of weight
Anemia

So for the antral position
Sensation of overfilled stomach vomitting
Cachexia

For body of stomach
Worsening of general symptoms

Cardiac position
Dysphagia
Sensation of heaviness and pain behind breastbone
Salivation
Regurgitation
Hiccup
progressing cachexia

Question 5

Diagnostic workout

Answer 5

FDGS with biopsy -cancer of antral
USI
CT
NMRT
Laparoscopy-germination of the serous membrane of the stomach by the tumour

Question 6

Treatment main surgery

Answer 6

Radical methods performed with tumours without multiple hematogenic metases
A.Gastrectomy with lymphodissection (when there’s one or more portion of the stomach cancer or total cancer )
Lymphadissection is to remove impaired lymphatic nodes lymphatic vessels and fatty tissue

B.Subtotal resection of stomach (can be proximal or distal)
Distal {cancer of the antral portion }
Proximal { cancer of the cardiac portion }

Palliative methods done in case it’s impossible to remove tumors due to germination of large blood vessels or due to multiple hematogenic metases into lungs liver brain bones
Aimed to make patients condition better
A.anastomosis
B.Gastrostomy
C. Enterostomy
Palliative resection of stomach ~ aimed to remove the max mass of the tumour