Welcome All to

Weakly Clinical Meeting

on

Ca. Stomach

Objectives:Anatomy & PhysiologyEpidemiologyAetiologic factorsPathologyClinical featuresInvestigationsTreatment

Carcinoma of the stomach is the major cause of cancer mortality worldwide.

Anatomy of the Stomach

Lymphatic Drainage

Incidence & Epidemiology

•Distal carcinoma

is common in low

socio-economic

society &

developing

countries

•Proximal

carcinoma is

common in high

society &

developed

countries

H. pylori infectionSmoking Pernicious anaemiaGastric atrophyGastric polypPost gastric

surgeryDietFamilial & genetic

factor

Aetiology

Common sites of carcinoma

Lauren classification:

1. Intestinal 2. Diffuse

Classification

Other classification:1.Early gastric cancer2.Advanced gastric

cancer

TNM Staging

M 0: No metastesisM 1 : Distant metastesis

G1: Well differentiatedG2: Moderately

differentiatedG3: Poorly differentiatedG4: Undifferentiated

Histopathological Grade

Spread1. Direct2. Lymphatic3. Blood born4. Trans

peritonial

Early gastric cancer: Dyspepsia

Advanced gastric cancer: Dyspepsia after 40 yrs Blotting Early satiety Distention Features of inlet obstruction Features of outlet

obstruction Metastatic features Non Metastatic features

Clinical feature

Trousseau’s syndrome(thrombophlebitis)

Syster Joseph nodule

krukenberg tumour

o Endoscopy of upper GIT

o Contrast Radiologyo Ultra sonographyo CT Scanningo Laparoscopyo PET Scan

Investigations:

Surgery Total gastrectomy Subtotal gastrectomy Palliative surgery

Chemo therapyRadiotherapy

Treatment

Haematogenous metastasisInvolvement of distant peritoneumN4 nodal disease and disease beyond N4 node

Fixation to the surrounding structures

Inoperability

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