Gastric cancer

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

Avoidable Risk Factors

Nutrition

• Smoked, smoked foods

• Vitamin A and C deficiency, inadequate intake with food

• Foods that are stored or prepared by excessive salting

professional

• Plastic

• Pitch

• exposure to radiation

Habits

• Cigaret

infection

• Helicobacter pylori

• Epstein Barr virus

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

Resume

• Having had previous stomach surgery

Pathology

intestinal type

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

Diffuse type

It is mostly seen in Europe and America. It is more macularly differentiated (less similar to the cell it originates from), horny (malignant) character. It mostly covers the stomach entrance part. (Proximal stomach)

Symptoms

• Stomach ache

• Anorexia

• weight loss

• Weakness

• Nausea

• Anemia

• Difficulty in swallowing (especially in the types that hold the stomach entrance)

• It may give signs of gastric outlet obstruction (vomiting without bile in the gushing style, abdominal bloating and tension)

Results

• Supraclavicular lymph node (Wirchow): Long, left-sided swelling above the collarbone

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

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

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

Diagnosis

Upper gastrointestinal endoscopy is diagnostic.

Preoperative Evaluation

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

For this:

• 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 liver).

• Endoscopic ultrasound allows us to understand the depth of the disease in the stomach wall, this is necessary for staging.

• 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 laparoscopy performed for staging before surgery if it cannot be detected by radiological systems, but there is clinical suspicion. It is mostly done to detect small metastases on the peritoneal surface. If it is detected, the treatment formula changes.

Staging

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

• This staging is based on the depth of the tumor, lymph node metastases, and distant metastases.

• Treatment varies according to each stage.

Treatment

• It should be multidisciplinary. This group may include surgeon, oncologist, pathologist, radiologist, radiation oncologist, gastroentereologist, dietitian, internist, cardiologist, chest diseases specialist depending on 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 metastasis): It should be approached multidisciplinary, preoperative (neoadjuvant) chemoradiation can be considered.

• Metastatic disease: Palliative chemotherapy is performed.

Operation

• 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 clear surgical margin can be achieved.

• Wide surgical margin (approximately 5 cm): It is valuable to be able to provide a clean surgical margin, since the tumor has the potential to spread submucosally. 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

Palliative Resection (For patients with advanced stage, no survival expectation)

• occlusive

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

• With simple resection or sometimes without resection, the obstruction is opened by by-pass. Treatment is then continued with adjuvant chemotherapy.

Adjuvant Chemotherapy

• It is done after resection for potentially curative treatment.

Prognosis (process)

Depends on three factors

• The depth of the tumor in the stomach wall

• To the involved lymph nodes

• To distant metastases

Protection

I suggest you reread the preventable risk factors. 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 event 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.