Gastric_Carcinoma-1 - Gastric Carcinoma Vic Vernenkar D.O...

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Gastric Carcinoma Vic Vernenkar, D.O. St. Barnabas Hospital Department of Surgery
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Background Second most common cancer-related death. Korea, Japan, China, Taiwan high rates. 22,000 diagnosed annually in US. 14 th most common cancer. Difficult to cure, as advanced disease. Most die of recurrent disease even after resection for cure.
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Anatomy Stomach begins at GE junction, ends at duodenum. 3 parts- uppermost is cardia, largest part in middle is body, the last part is pylorus. Cardia contains mucin producing cells. Fundus or body mucoid cells, chief cells, parietal cells. Pylorus has mucin producing cells.
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Anatomy Five layers: Mucosa, submucosa, muscular layer, subserosal layer, serosal layer. Peritoneum of greater sac covers anterior surface A portion of lesser sac drapes posteriorly over stomach. The GE junction has limited serosal covering.
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Anatomy The site of the lesion is classified on basis of relationship to long axis of stomach. 40% lower part 40% middle part 15% upper part 10% more than one part Recently the # of lesions proximally has increased.
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Pathophysiology Understand vascular supply, allows for understanding of routes of spread. Derived from celiac artery. Left gastric supplies upper right stomach. Right gastric off common hepatic- lower portion. Right gastroepiploic -lower portion of greater curve.
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Pathophysiology Understanding lymphatic drainage can clarify nodal involvement. Complex drainage Primarily along celiac axis. Minor drainage along splenic hilum, suprapancreatic nodal groups, porta hepatis, and gastroduodenal areas
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Frequency US: seventh leading cause of cancer deaths, with 22,000 diagnosed yearly, and 14,000 deaths. Internationally: second most common cancer. Tremendous geographic variation, with highest death rates in Chile, Japan, and former USSR.
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Mortality and Morbidity 5-year survival for curative resections ranges from 30-50% for stage II disease and 10-25% in stage III. High likelihood of systemic and local relapse. Adjuvant therapy is offered . Operative mortality is less than 3% for curative resections.
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Race Higher in Asian countries. Japanese detect patients at very early stage, patients appear to do quite well. In Asian studies, patients with resected stage II and III disease have better outcomes than similar stages in the west. Some believe this reflects a biologic difference between diseases in Asia and west. Black race, low socioeconomic class.
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Sex, Age Men>women Most are elderly at diagnosis. Median age 65 years. The ones that present in younger patients may represent a more aggressive variant.
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  • Fall '11
  • Dr.Aslam
  • Adjuvant Therapy, GE junction, advanced disease, Previous stomach surgery

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