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1、,Gastric Cancer,Epidemiology,Forth common types of cancer,Second most common cancer related death,Geographic variations (ten times),Continuing decline,Primarily a decline of distal GC,(2000),(2000),Geographic variations, 起重机 立体停车设备 电动葫芦 ,Geographic distribution of mortality rates for gastric cancer
2、in males in China,Gastric Cancer,Environmental factors,H. pylori,Genetic factors,Etiological Factors of Gastric Cancer,Precancerous changes,Environmental factors,Environmental factors are involved,Japanese immigrants in US: 25%,Second generation: 50%,Subsequent generations: comparable to General US
3、population,Environmental factors,Lower socioeconomic status,Tobacco/alcohol,Fresh vegetable/fruits /Micronutrition,Poor food storage,Eating salted/ Smoked food,Mucosal damage,Pro-carcinogen/ Carcinogen,Lack of antioxidant,GC,Genetic factors,The majority of gastric tumor are sporadic in nature There
4、are rare inherited gastric cancer predisposition traits such as germline p53 (Li-Fraumeni syndrome) E-cadherin (CDH1) alterations in diffuse gastric cancers,Precancerous changes,Precancerous lesions,Precancerous conditions,Precancerous lesions,Defined as those pathological changes predisposed to gas
5、tric cancer dysplasia 10% of patients may progress in severity majority of patients either regress or remain stable High-grade dysplasia may be only a transient phase in the progression to gastric cancer occurs in atrophic gastritis or intestinal metaplasia,Nature history of gastric dysplasia,No Dys
6、plasia,Mild Dysplasia,Moderate Dysplasia,High-grade Dysplasia,Gastric adenocarcinoma,5 years,5 years,5 years,3 months-2 years,10%,10%,50%-90%,60%,60%,10%,Precancerous condition,Defined as those clinical setting with higher risk of developing gastric cancer Chronic atrophic gastritis Gastrectomy Pern
7、icious anemia Menetriers disease Chronic gastric ulcer Gastric polyps,Postulated sequence of histologic events in the progression to gastric adenocarcinoma and potential contributory factors,H. Pylori,Other factors,Chronic Superficial Gastritis,Intestinal Metaplasia,Atrophic Gastritis,Dysplasia,FAP
8、or Adenomas,Gastric Adenocarcinoma,Other factors,Association,Strong Association,Correa hypothesis,Pathology,Stages,Morphology,Pathohistologic classification,Metastasis,Stages,Early stage limited in the mucosa and submucosa layers, no matter with or without lymph node metastasis Classified by the Jap
9、anese Society for Gastric Cancer 1cm 0.5cm Advanced stage invaded over submucosa According to Bormann classification,TNM classification (UICC),0 Tis N0 M0 III A T2 N2 M0 I A T1 N0 M0 T3 N1 M0 I B T1 N1 M0 T4 N0 M0 T2 N0 M0 III B T3 N2 M0 II T1 N2 M0 IV T4 N2 M0 T2 N1 M0 T13 N3 M0 T3 N0 M0 any T any
10、N M1,Morphology-early stage,Morphology-early stage,Morphology-early stage,Morphology -advanced stage,Pathohistologic classification,Histology Adenocarcinoma 90% Lymphoma 5% Stromal 2% Carcinoid 1% Metastasis 1% Adenosquamous/squamous 1% Miscellaneous 1%,Origin (Lauren),Intestinal type associated wit
11、h most environmental risk factors carries a better prognosis shows no familial history Diffuse type consists of scattered cell clusters with poor prognosis,Growth pattern (Ming),Expanding type grew en mass and by expansion resulting in the formation of discrete tumor nodules with relatively good pro
12、gnosis Infiltrative type invaded individually with poor prognosis,Metastasis,Direct invasion,Lymph node dissemination,Blood spread,Intraperitoneal colonization,Special term,Blumer shelf A shelf palpable by reactal examination, due to metastatic tumor cells gravitating from an abdominal cancer and gr
13、owing in the rectovesical or rectouterine pouch Krukenberg tumor A tumor in the ovary by the spread of stomach cancer,Clinical manifestation,Signs and Symptoms Early Gastric Cancer Asymptomatic or silent 80% Peptic ulcer symptoms 10% Nausea or vomiting 8% Anorexia 8% Early satiety 5% Abdominal pain
14、2% Gastrointestinal blood loss 2% Weight loss 2% Dysphagia 1%,Signs and Symptoms,Advanced Gastric Cancer Weight loss 60% Abdominal pain 50% Nausea or vomiting 30% Anorexia 30% Dysphagia 25% Gastrointestinal blood loss 20% Early satiety 20% Peptic ulcer symptoms 20% Abdominal mass or fullness 5% Asym
15、ptomatic or silent 5%,Duration of symptoms Less than 3 month 40% 3-12 months 40% Longer than 12 month 20%,Special signs & terms,Linitis plastica: diffusely infiltrating with a rigid stomach Virchows node: supraclavicular lymphadenopathy (left) Irishs node: axillary lymphadenopathy Sister Mary Josephs node: umbilical lymphadenopathy,Sister Mary Josephs node,Laboratory tests,Iron deficiency anemia,Fecal occult
