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

Gastric Carcinoma
Vic Vernenkar, D.O.
St. Barnabas Hospital
Department of Surgery

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.

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.

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.

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.

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.

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

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.

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.

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.

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.