Slides and presentations for stomach cancer. Presentation on the topic "stomach cancer"

Stomach cancer. Gastric cancer ranks first in the structure of the overall incidence of malignant neoplasms. Gastric cancer ranks first in the structure of the overall incidence of malignant neoplasms. Men aged 40 to 60 years are most often affected. Men aged 40 to 60 years are most often affected.

Etiology Etiology and pathogenesis have not been fully elucidated. The etiology and pathogenesis have not been fully elucidated. As predisposing factors, the adverse effects of excessively hot, rough food, as well as alcohol and smoking are indicated. As predisposing factors, the adverse effects of excessively hot, rough food, as well as alcohol and smoking are indicated. In the pathogenesis of stomach cancer, precancerous diseases are important. In the pathogenesis of stomach cancer, precancerous diseases are important: chronic atrophic gastritis with restructuring of the gastric mucosa. chronic atrophic gastritis with restructuring of the gastric mucosa. long-term non-scarring stomach ulcers. long-term non-scarring stomach ulcers. polyps and polyposis of the stomach. polyps and polyposis of the stomach.

Pathological anatomy Localization (most often) Localization (most often) in the pyloric region in the pyloric region in the prepyloric region of the stomach. prepyloric section of the stomach. According to the nature of growth, they distinguish according to the nature of growth: exophytic (polypoid, saucer-shaped) exophytic (polypoid, saucer-shaped) endophytic (ulcerative-infiltrative, diffuse-infiltrative) forms. endophytic (ulcerative-infiltrative, diffuse-infiltrative) forms. According to histological structure, cancer is divided into. According to histological structure, cancer is divided into glandular (adenocarcinoma). glandular (adenocarcinoma). solid. solid. colloidal (mucous). colloidal (mucous).

Pathological anatomy Depending on the predominance of cancerous parenchyma or stroma in the tumor, medullary (brain) medullary (brain) fibrous (scirrhus) cancer is classified. fibrous (scirrh) carcinoma. Gastric cancer metastases spread through the lymphatic and circulatory routes. Most often, metastases are observed in regional lymph nodes. Gastric cancer metastases spread through the lymphatic and circulatory routes. Most often, metastases are observed in regional lymph nodes. lymph nodes on the left in the supraclavicular fossa (Virchow gland). lymph nodes on the left in the supraclavicular fossa (Virchow gland). liver. liver. ovary (Krukenberg tumor). ovary (Krukenberg tumor). rectum. rectum.

Clinical picture: In the early stage of the disease, a “minor sign syndrome” is distinguished, consisting of the following symptoms: In the early stage of the disease, a “minor sign syndrome” is distinguished, consisting of the following symptoms: unmotivated general weakness. unmotivated general weakness. decreased ability to work. decreased ability to work. mental depression. mental depression. decreased appetite. decreased appetite. the appearance of gastric discomfort (feeling of heaviness, fullness, fullness of the stomach). the appearance of gastric discomfort (feeling of heaviness, fullness, fullness of the stomach). causeless progressive weight loss. causeless progressive weight loss.

Clinical picture: The pronounced clinical picture of gastric cancer is heterogeneous; it depends on the location and anatomical nature of the tumor. The pronounced clinical picture of gastric cancer is heterogeneous; it depends on the location and anatomical nature of the tumor. Local symptoms are: Local symptoms are: pain (pain in stomach cancer, unlike ulcers, is constant). pain (pain with stomach cancer, unlike ulcers, is constant). dyspepsia (impaired appetite up to a complete aversion to food, perversion of appetite, a feeling of heaviness and pressure in the epigastric region, accompanied by nausea, vomiting. dyspepsia (impaired appetite up to a complete aversion to food, perversion of appetite, a feeling of heaviness and pressure in the epigastric region, accompanied by nausea, vomiting. presence of a palpable tumor. presence of a palpable tumor.

Clinical picture: Depending on the location: Depending on the location: When cancer is localized in the cardiac part of the stomach, dysphagic complaints predominate. When cancer is localized in the cardiac part of the stomach, dysphagic complaints predominate. When localized in the pyloric region, they are stenotic. When localized in the pyloric region, they are stenotic. Cancer that has developed on the greater curvature remains silent for a long time. Cancer that has developed on the greater curvature remains silent for a long time. In the presence of scirrhus, patients complain of a decrease in the ability to eat food in the usual amount (microgastria). In the presence of scirrhus, patients complain of a decrease in the ability to eat food in the usual amount (microgastria).

Clinical picture: General symptoms General symptoms Increased body temperature to subfebrile levels. (in rare cases, the temperature rises to C Increase in body temperature to subfebrile numbers. (in rare cases, the temperature rises to C Anemia (hypochromic) Anemia (hypochromic) Initial stomach cancer can manifest itself with bleeding, usually small, in rare cases massive. Bleeding occurs as usually as a result of ulceration of the mucous membrane. Clinical symptoms appear associated with anemia of the patient, occult blood is detected in stool tests. Edema is associated with a pronounced disturbance of protein balance.

Inspection When examining the patient, weight loss is noted. When examining the patient, weight loss is noted. weight loss. pale skin with an earthy tint. pale skin with an earthy tint. drop in skin turgor. drop in skin turgor. reduction of shine and liveliness of the eyes. reduction of shine and liveliness of the eyes. The tongue is coated, sometimes reminiscent of Hunter's. The tongue is coated, sometimes reminiscent of Hunter's. in the presence of significant anemia and cachexia, the patient may experience swelling of the face, trunk, and limbs. in the presence of significant anemia and cachexia, the patient may experience swelling of the face, trunk, and limbs.

Palpation of the abdomen. The study must be carried out with the patient lying down and standing, since cancer of the lesser curvature is accessible to palpation only when the patient is in an upright position. The study must be carried out with the patient lying down and standing, since cancer of the lesser curvature is accessible to palpation only when the patient is in an upright position. You can palpate a cancerous tumor only if it reaches a certain size (with “drain” according to V. Kh. Vasilenko). You can palpate a cancerous tumor only if it reaches a certain size (with “drain” according to V. Kh. Vasilenko). The palpable tumor has different consistencies depending on its anatomical structure. The palpable tumor has different consistencies depending on its anatomical structure. There is no pain. There is no pain.

Palpation of the abdomen. Since in the epigastric region you can palpate a tumor coming from another organ (left lobe of the liver, omentum, spleen, pancreas), you should remember the characteristic signs of a stomach tumor: Since in the epigastric region you can palpate a tumor coming from another organ (left lobe of the liver , omentum, spleen, pancreas), you should remember the characteristic signs of a stomach tumor: it is in the zone of the tympanic sound of the stomach, it is in the zone of the tympanic sound of the stomach, it is mobile during breathing and palpation, and when the tumor is localized on the posterior wall, a splashing noise appears above it ; mobile during breathing and palpation, and when the tumor is localized on the posterior wall above it, a splashing noise appears; When the stomach is full, the tumor is difficult to palpate. When the stomach is full, the tumor is difficult to palpate.

Palpation. The issue of tumor localization is finally resolved through the use of additional research methods. The issue of tumor localization is finally resolved through the use of additional research methods. Metastases from stomach cancer can be detected in the form of dense lymph nodes on the left in the supraclavicular fossa (Virchow's gland). Sometimes a dense lymph node may be found in the left axillary region. Metastases from stomach cancer can be detected in the form of dense lymph nodes on the left in the supraclavicular fossa (Virchow's gland). Sometimes a dense lymph node may be found in the left axillary region.

Instrumental methods X-ray examination. X-ray examination. with stomach cancer, a characteristic radiological sign is a filling defect; with stomach cancer, a characteristic radiological sign is a filling defect, the absence of peristaltic movements in the affected area. lack of peristaltic movements in the affected area. the contours of the stomach are eroded. the contours of the stomach are eroded. Gastroscopy. The value of this method has increased recently due to the emerging opportunity to simultaneously perform a targeted biopsy with subsequent morphological examination while examining the mucous membrane. Gastroscopy. The value of this method has increased recently due to the emerging opportunity to simultaneously perform a targeted biopsy with subsequent morphological examination while examining the mucous membrane. Gastric probing: anacid state, lactic acid, atypical cells. Gastric probing: anacid state, lactic acid, atypical cells.

Complications. profuse stomach bleeding. profuse stomach bleeding. perforation of the stomach wall. perforation of the stomach wall. formation of a fistula between the stomach and large intestine. formation of a fistula between the stomach and large intestine. ulceration of a cancerous tumor can contribute to the occurrence of subphrenic and intrahepatic abscesses. ulceration of a cancerous tumor can contribute to the occurrence of subphrenic and intrahepatic abscesses. Treatment is surgical. If surgery is not possible, X-ray and chemotherapy are used.

Celiac disease. Celiac disease is a chronic and progressive disease characterized by diffuse atrophy of the mucous membrane of the small intestine, which develops as a result of intolerance to the protein (gluten) of cereal gluten. Celiac disease is a chronic and progressive disease characterized by diffuse atrophy of the mucous membrane of the small intestine, which develops as a result of intolerance to the protein (gluten) of cereal gluten.

Etiology and pathogenesis The gliadin fraction of gluten has a damaging effect. The gliadin fraction of gluten has a damaging effect. The leading role in pathogenesis is played by enzyme deficiency, namely the deficiency of specific enzymes from the group of peptidases in the intestinal wall, which break down gliadin. The leading role in pathogenesis is played by enzyme deficiency, namely the deficiency of specific enzymes from the group of peptidases in the intestinal wall, which break down gliadin. As a result of a deficiency of these enzymes, products of incomplete breakdown of gluten are absorbed, which has a toxic effect. As a result of a deficiency of these enzymes, products of incomplete breakdown of gluten are absorbed, which has a toxic effect.

Etiology and pathogenesis The state of hypersensitization in response to the introduction of gluten into the body is of great importance in pathogenesis. The extreme degree of allergic reaction is “gliadin shock”. The state of hypersensitization in response to the introduction of gluten into the body is of great importance in pathogenesis. The extreme degree of allergic reaction is “gliadin shock”. The proximal part of the small intestine is more intensively involved in the pathological process, where digestion and absorption of gluten mainly occurs. The proximal part of the small intestine is more intensively involved in the pathological process, where digestion and absorption of gluten mainly occurs. Gluten enimopathy can be primary (congenital) and secondary, occurring in a number of diseases of the small intestine (nontropical sprue, enteritis, etc.). Gluten enimopathy can be primary (congenital) and secondary, occurring in a number of diseases of the small intestine (nontropical sprue, enteritis, etc.).

Clinical picture. chronic diarrhea, polyfecal (fecal weight exceeds 300 g/day) chronic diarrhea, polyfecal (fecal weight exceeds 300 g/day) steatorrhea, steatorrhea, abdominal pain, sometimes cramping. abdominal pain, sometimes cramping. weight loss weight loss vitamin and mineral deficiency (deficiency of vitamins B1, B6, PP, iron, etc.) vitamin and mineral deficiency (deficiency of vitamins B1, B6, PP, iron, etc.) apathy, muscle weakness, hypotension, paresthesia , convulsions, myalgia, ossalgia, arthralgia. apathy, muscle weakness, hypotension, paresthesia, convulsions, myalgia, ossalgia, arthralgia. the severity of the disease is assessed depending on the severity of the malabsorption syndrome and the duration of the disease. the severity of the disease is assessed depending on the severity of the malabsorption syndrome and the duration of the disease.

Physical status: deficiency in body weight and height with signs of “intestinal infantilism.” (delay not only in physical, but also in intellectual and sexual development) deficiency of body weight and height with signs of “intestinal infantilism.” (delay not only in physical, but also in intellectual and sexual development) bloating (enlargement) of the abdomen. bloating (enlargement) of the abdomen. diffuse abdominal palpation tenderness. diffuse abdominal palpation tenderness. pelagroid pigmentation of the skin pelagroid pigmentation of the skin trophic changes in the skin and mucous membranes. trophic changes in the skin and mucous membranes.

Diagnostics. Due to the various variants of the course of the disease (from extremely severe to latent), the diagnosis should always be based on the results of an endoscopic examination with biopsy samples taken from the jejunum or from the distal parts of the duodenum. Due to the various variants of the course of the disease (from extremely severe to latent), the diagnosis should always be based on the results of an endoscopic examination with biopsy samples taken from the jejunum or from the distal parts of the duodenum. In this case, an increase in the number of interepithelial lymphocytes is detected, the presence of SO atrophy with a sharp shortening of the villi or their complete atrophy with elongation of the crypts (SO atrophy of the hyperregenerative type). In this case, an increase in the number of interepithelial lymphocytes is detected, the presence of SO atrophy with a sharp shortening of the villi or their complete atrophy with elongation of the crypts (SO atrophy of the hyperregenerative type).

Diagnostics. Laboratory tests reveal a significant increase in the concentration of antibodies to the gliadin fraction (an increase in the titer of antigliadin antibodies in untreated patients is the most sensitive diagnostic test). Laboratory tests reveal a significant increase in the concentration of antibodies to the gliadin fraction (an increase in the titer of antigliadin antibodies in untreated patients is the most sensitive diagnostic test). the presence of iron deficiency anemia (decrease in the concentration of serum iron, ferritin, hemoglobin, hematocrit). the presence of iron deficiency anemia (decrease in the concentration of serum iron, ferritin, hemoglobin, hematocrit). steatorrhea (fat loss in feces can reach g/day. steatorrhea (fat loss in feces can reach g/day.

Diagnostics An indirect method for diagnosing celiac disease is the gliadin tolerance test (gliadin load test). Oral administration of gliadin causes an increase in glutamine in the blood, which is not observed in healthy people. The most convincing diagnostic sign is the beneficial effect of a gluten-free diet and the occurrence of relapse with the introduction of foods containing gluten. An indirect method for diagnosing celiac disease is the gliadin tolerance test (gliadin load test). Oral administration of gliadin causes an increase in glutamine in the blood, which is not observed in healthy people. The most convincing diagnostic sign is the beneficial effect of a gluten-free diet and the occurrence of relapse with the introduction of foods containing gluten.

Definition: Crohn's disease (regional ileitis, enteritis) is a nonspecific inflammatory granulomatous process localized in any part of the small intestine (but more often in the terminal segment of the ileum), leading to the formation of necrotic areas, ulcers, granulomas, followed by narrowing of the intestinal lumen and scarring. Crohn's disease (regional ileitis, enteritis) is a nonspecific inflammatory granulomatous process localized in any part of the small intestine (but more often in the terminal segment of the ileum), leading to the formation of necrotic areas, ulcers, granulomas, followed by narrowing of the intestinal lumen and scarring.

Clinical symptoms Acute form. Acute form. increasing pain in the right lower quadrant of the abdomen. increasing pain in the right lower quadrant of the abdomen. nausea. nausea. vomit. vomit. increased body temperature with chills. increased body temperature with chills. flatulence. flatulence. diarrhea, sometimes mixed with blood. diarrhea, sometimes mixed with blood. a thickened, painful terminal segment of the small intestine is palpated. a thickened, painful terminal segment of the small intestine is palpated.

Clinical symptoms Chronic form. Chronic form. Periodic, and later constant dull pain (with damage to the duodenum in the right epigastric region, jejunum in the left upper and middle abdomen, ileum in the right lower quadrant of the abdomen). Periodic, and later constant dull pain (with damage to the duodenum in the right epigastric region, jejunum in the left upper and middle abdomen, ileum in the right lower quadrant of the abdomen). The stool is semi-liquid, liquid, foamy, sometimes mixed with mucus and blood. The stool is semi-liquid, liquid, foamy, sometimes mixed with mucus and blood. With intestinal stenosis, signs of partial intestinal obstruction (cramping pain, nausea, vomiting, gas and stool retention). With intestinal stenosis, signs of partial intestinal obstruction (cramping pain, nausea, vomiting, gas and stool retention).

Clinical symptoms On palpation, abdominal tenderness and “tumor” in the terminal ileum; when other parts are affected, pain in the peri-umbilical region. On palpation of the abdomen, there is pain and “tumor” in the terminal ileum, and if other parts are affected, there is pain in the umbilical region. Formation of internal fistulas, opening into the abdominal cavity (rectal, perirectal, interloop, between the ileum and the cecum, sigmoid, gall and bladder), and external, opening into the lumbar and groin areas. Formation of internal fistulas, opening into the abdominal cavity (rectal, perirectal, interloop, between the ileum and the cecum, sigmoid, gall and bladder), and external, opening into the lumbar and groin areas. Intestinal bleeding (melena) is possible. Intestinal bleeding (melena) is possible.

Clinical symptoms General symptoms: General symptoms: weakness, malaise, decreased performance, increased body temperature to subfebrile, weight loss, weakness, malaise, decreased performance, increased body temperature to subfebrile, weight loss,

Clinical symptoms Extraintestinal manifestations: Extraintestinal manifestations: hypovitaminosis (bleeding gums, decreased twilight vision, cracks in the corners of the mouth). hypovitaminosis (bleeding gums, decreased twilight vision, cracks in the corners of the mouth). swelling (due to loss of protein), edema (due to loss of protein), pain in bones and joints (depletion of calcium salts). pain in bones and joints (depletion of calcium salts). trophic disorders (dry skin, hair loss, brittle nails). trophic disorders (dry skin, hair loss, brittle nails). Uveitis Uveitis

Clinical symptoms of adrenal insufficiency (skin pigmentation, hypotension). adrenal insufficiency (skin pigmentation, hypotension). thyroid insufficiency (lethargy, puffiness of the face). thyroid insufficiency (lethargy, puffiness of the face). insufficiency of the gonads (menstruation disorders, impotence). insufficiency of the gonads (menstruation disorders, impotence). insufficiency of the parathyroid glands (tetany, osteomalacia, bone fractures). insufficiency of the parathyroid glands (tetany, osteomalacia, bone fractures). pituitary insufficiency (polyuria with pituitary insufficiency (polyuria with low specific gravity of urine, thirst). low specific gravity of urine, thirst).

Laboratory data: CBC: signs of anemia, neutrophilic leukocytosis, increased ESR. CBC: signs of anemia, neutrophilic leukocytosis, increased ESR. LHC: hypoalbuminemia, increased levels of α2- and γ-globulins, hypocalcemia, hypokalemia, hypoprothrombinemia, hypochloremia. LHC: hypoalbuminemia, increased levels of α2- and γ-globulins, hypocalcemia, hypokalemia, hypoprothrombinemia, hypochloremia. Coprocytogram: steatorrhea, red blood cells, mucus. Coprocytogram: steatorrhea, red blood cells, mucus.

Instrumental studies: X-ray of the intestine: rigidity of the affected intestinal loops, narrowing of the lumen, a mosaic pattern with small filling defects due to edema and linear ulcers, “string symptom” (sharp narrowing of the lumen of the terminal ileum). X-ray of the intestine: rigidity of the affected intestinal loops, narrowing of the lumen, a mosaic picture with small filling defects due to edema and linear ulcers, “string symptom” (sharp narrowing of the lumen of the final section of the ileum). Colonoscopy, sigmoidoscopy, examination of biopsy samples of the small intestine: granulomatous inflammation of all layers, necrotization, ulceration. Colonoscopy, sigmoidoscopy, examination of biopsy samples of the small intestine: granulomatous inflammation of all layers, necrotization, ulceration. CLASSIFICATION OF CHRONIC NON-SPECIFIC ULCERATIVE COLITIS I. According to clinical course: Acute form. Chronic relapsing form: a) exacerbation phase; b) phase of fading exacerbation; c) remission phase. 3.Chronic continuously relapsing form. II. According to the prevalence of the process: Total defeat. Segmental lesion: a) right-sided; b) transverse colon; c) left-handed.

CLASSIFICATION OF CHRONIC NON-SPECIFIC ULCERATIVE COLITIS III. According to the severity of the process: a) mild degree; b) average degree; c) severe degree. IV.By the nature of the damage to the colon: Superficial. Superficial. Deep (ulcer, pseudopolyposis, sclerosis of the walls of the colon). Deep (ulcer, pseudopolyposis, sclerosis of the walls of the colon).

CLASSIFICATION OF CHRONIC NON-SPECIFIC ULCERATIVE COLITIS Complications; 1) Local: a) perforation; b) toxic dilatation; c) bleeding; d) cancer; e) strictures. 2) General: a) hepatitis, cholangitis; b) arthritis (synovitis); c) stomatitis, glossitis; d) skin changes; d) conjunctivitis, iritis.

Macroscopic signs of nonspecific ulcerative and granulomatous colitis Signs Nonspecific ulcerative colitis Granulomatous colitis Crohn's 1. Distribution of the lesion a) Continuous b) Diffuse c) The entire circumference is affected a) Alternation of affected and unaffected areas b) Segmental c) Uneven damage to the walls 2. Involvement of the direct line in the process intestines More than 90% Less than 40% 3. Lesion of the ileum Less than 10% More than 50% 4. Shortening of the colon Pronounced, diffuse Minor, limited (segmental) 5. Serosa Tender (except for toxic megacolon) Fibrous thickened

Macroscopic signs of nonspecific ulcerative and granulomatous colitis Signs Nonspecific ulcerative colitis Granulomatous colitis Crohn's 6. Transition of the process to the serous membrane of the mesentery Absent Clearly expressed 7. Strictures Rarely Often 8. Mucous membrane a) Ulcers, pseudopolyps b) Absence of fissures (cracks) a) Longitudinal ulcers b ) Transverse fissures 9. Wall thickness Moderately thickened Severely thickened 10. Spontaneous fistulas Rarely Very often 1 1. Anal fissures and fistulas Less than 10% More than 80% 12. Toxic megacolon 1-2% Very rarely 13. Malignant degeneration 3-4% Very rarely

Histological picture of nonspecific ulcerative and granulomatous colitis Sign Nonspecific ulcerative colitis Granulomatous colitis Crohn's Prevalence of inflammation Mucosa and submucosal layer All layers of the intestinal wall Submucosal layer Superficial fibrosis, pronounced vascularization Deep fibrosis, slight vascularization Focal lymphoid hyperplasia Mucosa, sometimes submucosa 1st layer All layers intestinal wall Epithelioid cell granulomas Absent Found in 70-75% of cases

Fissures Rarely observed, extending only to the submucosal layer Often observed, transmural Cryptogenic abscesses Always Rarely Mucus formation Clearly reduced Slightly reduced Inflammatory pseudopolyps Often Less common Obliterating endangitis Relatively common Rare Changes in the anal area Nonspecific Granulomas Regional lymph nodes Nonspecific reactive hyperplasia Granulomas (about 50% of cases)

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Epidemiology

Gastric cancer is the second most common cause of death from malignant neoplasms. The highest incidence is recorded in Japan, China, Korea, countries of South and Central America, as well as in Eastern Europe, including the former Soviet republics. In the Russian Federation, about 40 thousand primary patients with stomach cancer are registered annually, 35 thousand die. The incidence is 28.4 per 100 thousand population. Since the mid-20th century, there has been a worldwide decline in the incidence of stomach cancer due to patients with intestinal-type cancer of the distal parts of the stomach, while the proportion of cardia cancer is growing, most rapidly among people under 40 years of age.

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Epidemiological classification according to Lauren's

Intestinal type: The tumor has a structure similar to colorectal cancer and is characterized by distinct glandular structures consisting of well-differentiated columnar epithelium with a developed brush border. Diffuse type: the tumor is represented by loosely organized groups or single cells with a high content of mucin (signet ring-shaped) and is characterized by diffuse infiltrative growth.

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Epidemiology of stomach cancer

Peak incidence 50-60 years Men are 2-12 times more likely to get sick Localization: more often distal sections. However, there is a tendency towards an increase in proximal and cardio-esophageal cancer, especially in the countries of Europe and America Asia - distal cancer is much more common (better treatment results and prognosis!)

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Epidemiology of gastric cancer in Europe

2006 - 159,900 new cases and 118,200 deaths, which ranks fourth and fifth in the structure of morbidity and mortality, respectively. Men get sick 1.5 times more often than women; the peak incidence occurs at the age of 60-70 years.

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Biography

Genus. April 23, 1867 in Silkeborg, Denmark. He studied bacteriology under the guidance of R. Koch and E. von Behring, worked together with Karl Salomonsen at the University of Copenhagen. His doctoral dissertation on the bacteriology of diphtheria was completed in 1895, and in 1900 he became professor of pathological anatomy at the university. Introduced Behring's serum to treat diphtheria in Denmark and investigated the relationship between outbreaks of tuberculosis in cows and the spread of this disease in humans. Rat tuberculosis and gastric cancer with Spiroptera neoplastica (Gongylonema neoplasticum). In the 1920s, he conducted a comparative experimental study of cancer caused by coal tar, Spiroptera neoplastica and clinical manifestations. A combination of external influences with a genetic, not general, but organ predisposition to cancer. Nobel Prize in Medicine or Physiology for 1926. “For the first time, it has become possible to experimentally transform normal cells into malignant cancer cells. Thus, it was convincingly shown not that cancer is always caused by worms, but that it can be provoked by external influences” (W. Wernstedt). He died in Copenhagen on January 30, 1928 from rectal cancer.

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Etiology

A. Nutritional risk factors Excessive consumption of table salt and nitrates Lack of vitamins A and C Consumption of smoked, pickled and dried foods Preserving food without using a refrigerator Quality of drinking water B. Environmental and lifestyle factors Occupational hazards (rubber, coal production) Tobacco smoking Ionizing radiation History of gastric resection Obesity B. Infectious factors Helicobacter pylori Epstein-Barr virus

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D. Genetic factors Blood type A (II) Pernicious anemia Familial gastric cancer Syndrome of hereditary diffuse gastric cancer (HDGC). Hereditary non-polyposis colorectal cancer Li Fraumeni syndrome (hereditary cancer syndrome) Hereditary syndromes accompanied by polyposis of the gastrointestinal tract: familial adenomatous polyposis of the colon, Gardner syndrome, Peutz-Jeghers syndrome, familial juvenile polyposis E. Precancerous diseases and changes in the gastric mucosa Adenomatous polyps of the stomach Chronic atrophic gastritis Menetrier's disease (hyperplastic gastritis) Barrett's esophagus, gastroesophageal reflux Dysplasia of the gastric epithelium Intestinal metaplasia

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Etiological factors of stomach cancer

Nutrition Bile reflux Helicobacter pylori Genetic disorders Risk factors - exogenous sources of nitrates and nitrites, endogenous formation of nitrates, increased salt intake, food storage, alcohol. Protective factors are antioxidants and beta-carotene.

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Helicobacter pylori

Etiological factor of some forms of gastritis (hyperacid and hypoacid) Pathogenetic connection with duodenal ulcer, adenocarcinoma and MALT lymphoma of the stomach CagA gene Vacuolating toxin (vac-A) - 50-60% (switching off ion transporting ATPases) Activation of EGF, HB-EGF, VEGF Alcohol dehydrogenase – acetaldelhyde – lipid peroxidation – DNA damage Mucolytic enzymes

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First line therapy - for 7-14 days: PPI: Omeprazole (Ultop, Rabeprazole, Esomeprazole) 20 mg x 2 times a day; or Lansoprazole 30 mg x 2 times a day; or Esomeprazole 40 mg x 2 times per day Clarithromycin (Fromilid) 500 mg x 2 times per day Amoxicillin (Hiconcil) 1000 mg x 2 times per day N.B.: In case of hypersensitivity to penicillin antibiotics, you can replace metronidazole or immediately prescribe quadruple therapy Efficacy of treatment regimens I line exceeds 80%. The effectiveness of treatment is checked by a 13CO(NH)2 breath test 4 weeks after antibiotic treatment or two weeks after PPI.

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Second line therapy - quadruple therapy: Bismuth subsalicylate or subcitrate 1 table. x 4 times / day PPI: Omeprazole (Ultop, Rabeprazole, Esomeprazole) 20 mg x 2 times per day; or Lansoprazole 30 mg x 2 times a day; or Esomeprazole 40 mg x 2 times a day Metronidazole 500 mg x 3 times a day Tetracycline hydrochloride 500 mg x 4 times a day

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Hereditary stomach cancer

A study of families with hereditary forms of gastric cancer showed that inheritance corresponds to a monogenic autosomal dominant type with high penetrance (75-95%) of the gene Morphological form - diffuse adenocarcinoma Hereditary syndromes in which gastric cancer develops with increased frequency - familial hereditary colon polyposis, Gardner and Peutz-Jeghers syndromes Lynch syndrome CDH1 is a gene associated with gastric carcinoma. It is located on chromosome 16 and encodes the E-cadherin protein, which is an adhesive protein involved in the formation of intercellular contacts. It also plays a role in transmitting signals from the membrane to the nucleus

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Molecular pathogenesis

p53 suppressors - inactivation by micromutations or deletions of the corresponding chromosomal locus Methylation of the promoter regions of suppressor genes leads to a phenotype of microsatellite instability, inhibition of the expression of the retinoic acid receptor gene (RAR-beta), cell cycle regulators, RUNX family genes

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Paraneoplastic syndromes

Acantosis nigricans Polymyositis with dermatomyositis Ring-shaped erythema, bullous pemphigoid Dementia, cerebellar ataxia Venous thrombosis of the extremities Multiple senile keratomas (Leser-Trélat sign)

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Ring-shaped erythema

Ring-shaped erythema is based on cutaneous vasculitis or a vasomotor reaction

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Bullous pemphigoid

A benign chronic skin disease, the primary element of which is a bubble that forms subepidermally without signs of acantholysis and with a negative Nikolsky sign in all modifications. The autoallergic nature of the disease is most substantiated: autoantibodies to the basement membrane of the epidermis (usually IgG, less often IgA and other classes) were detected.

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Cerebellar ataxia-telangiectasia

Hereditary zinc-dependent immunodeficiency

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Venous thrombosis of the extremities

There are thrombophlebitis of superficial (mainly varicose) veins and thrombophlebitis of deep veins of the lower extremities. Rarer forms of thrombophlebitis include Paget-Schretter disease (thrombosis of the axillary and subclavian veins), Mondor disease (thrombophlebitis of the saphenous veins of the anterior chest wall), thromboangiitis obliterans (buerger's migrating thrombophlebitis), Budd-Chiari disease (thrombosis of the hepatic veins), etc.

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Eruptive seborrheic keratosis (Leser-Trélat syndrome)

Characterized by the sudden appearance of multiple seborrheic keratosis in combination with malignant neoplasms of internal organs

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Diagnostics

Clinical picture Laboratory research data X-ray examination EGD with biopsy Ultrasound of peripheral and retroperitoneal lymph nodes, liver, pelvic organs, anterior abdominal wall of the umbilical region Laparoscopy Results of morphological studies

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Classification of stomach cancer

By localization. Anatomical areas: Cardiac region; Fundus of the stomach; Body of stomach; Antral and Pyloric department. +total defeat

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Stomach Cancer Clinic

Often asymptomatic Abdominal pain (60%) Weight loss (50%) Nausea and vomiting (40%) Anemia (40%) Palpation of a stomach tumor (30%) Hematemesis and melena (25%)

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Syndrome of “small signs” A.I. Savitsky

Changes in the patient’s well-being General weakness Persistent loss of appetite “Stomach discomfort” Weight loss Anemia Loss of interest in others Mental depression

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Primary diagnosis of stomach cancer

Clinical examination of endoscopy with multiple biopsies Histological / cytological examination of biopsy samples

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Clarifying diagnostics A. Basic complex

Polypositional X-ray examination under double contrast conditions (barium suspension and air) EGD with biopsy from unchanged areas of the gastric mucosa outside the area of ​​intended resection Transabdominal ultrasound examination of the abdominal organs, retroperitoneum, pelvis and cervical-supraclavicular areas. Chest X-ray in 2 projections

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Clarifying diagnostics B. Additional methods

Computer or magnetic resonance imaging Diagnostic laparoscopy Endosonography Fluorescent diagnostics Tumor markers (REA, CA-72-4, CA-125)

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Endosonography allows

visualize 5 layers of the unchanged stomach wall; determine the extent of the lesion, infiltration of individual layers; distinguish between a submucosal tumor of the stomach or esophagus and external pressure; assess the condition of the perigastric lymph nodes; identify invasion into neighboring organs and large vessels; in early gastric cancer, it allows, with a probability of up to 80%, to establish the depth of invasion within the mucous-submucosal layer.

Fig. 1 Normal appearance of the stomach

Fig. 2 Submucosal cancer growth

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Indications for diagnostic laparoscopy:

Clarifying diagnostics

subtotal / total lesion appearance of serosa according to ultrasound/CT data presence of multiple enlarged regional lymph nodes according to ultrasound/CT data initial manifestations of ascites changes in the peritoneum visualized by ultrasound/CT

Contraindications:

complicated gastric cancer requiring urgent intervention (stenosis, bleeding, perforation); pronounced adhesions in the abdominal cavity after previous operations

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Laparoscopic fluorescence diagnostics

L Dissemination along the peritoneum is detected in 63.3%. In 16.7% of patients, dissemination was determined only in fluorescence mode. The sensitivity of the method for gastric cancer is 72.3%, the specificity is 64%, and the overall accuracy of the method is 69%.

MNIOI named after. P.A. Herzen

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Indications for CT/MRI:

significant discrepancy between the results of various examination methods in assessing the extent of the tumor process. Impossibility of assessing resectability according to other research methods; invasion of the pancreas; involvement of large vessels; liver metastases; suspicion of intrathoracic metastasis; planning of combined treatment

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Research of sentinel L/U

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Terminology

JGCA version Early cancer – T1 N any Locally advanced cancer – T2-4 N any Russian version Early cancer – T1 N0 Locally advanced cancer – T1-4, N+ – T4 N0

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Endoscopic classification of early gastric cancer (T1, N any, M0)

Type I – elevated (the height of the tumor is greater than the thickness of the mucous membrane) Type II – superficial IIa – elevated type IIb – flat type IIc – deep Type III – ulcerated (ulcerative defect of the mucous membrane)

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Differential diagnosis

Polyps and other benign tumors, incl. and leiomyomas Ulcers Lymphomas Other sarcomas, including leiomyosarcomas, GISTs Metastatic stomach tumors (melanoma, breast cancer, kidney cancer)

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N – Regional lymph nodes

M – Distant metastases

Distant (M) Regional (N)

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Tumor germination: into the lesser and greater omentum; into the liver and diaphragm; into the pancreas; to the spleen; into the biliary tract; into the transverse colon; into the anterior abdominal wall. Lymphogenic metastasis: to regional lymph nodes; to distant lymph nodes (Virchow’s metastasis, metastasis in the left axillary region), Hematogenous metastasis: to the liver; into the lungs; in the bones; into the brain. Implantation metastases: dissemination, local or total; in the pelvis (metastasis of Krukenberg, Schnitzler).

WAYS OF SPREAD OF STOMACH CANCER

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pTNM Pathological classification

pN0 During histological analysis of regional lymphadenectomy material, at least 15 lymph nodes should be examined

G Histopathological differentiation

Gx The degree of differentiation cannot be established G1 High degree of differentiation G2 Moderate degree of differentiation G3 Low degree of differentiation G4 Undifferentiated tumor

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Treatment of stomach cancer

Surgical interventions Chemotherapy Radiation therapy Combination treatment

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Surgery is the only potentially curable treatment for stages I-IV M0; The optimal extent of regional lymphadenectomy has not yet been established. To date, randomized trials have not demonstrated superiority of D2 over D1 resection, which is likely due to the higher complication rate after splenectomy and pancreatic tail resection (ESMO). D2 resection without spleen removal and pancreatic resection is currently recommended glands. At least 14 (optimally 25) LNs must be removed (ESMO)

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Types of surgical interventions

Radical operations: surgical endoscopic Palliative operations

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Endoscopic resection (ER) of the mucosa for early gastric cancer

Indications: stomach cancer of the structure of papillary or tubular adenocarcinoma; I-IIa-b types of tumor up to 2 cm in size IIc type without ulceration up to 1 cm in size.

Frequency of lymphogenous metastases - 0% Local recurrences - 5% 5-year survival rate -95%

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Surgical treatment of resectable gastric cancer stages I-IV Scope of surgery

Gastrectomy Subtotal distal gastrectomy Subtotal proximal gastrectomy Extirpation of the operated stomach

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Selecting the scope of the operation

Distal subtotal gastrectomy is indicated for tumors of exophytic or mixed growth, located below a conventional line connecting a point located 5 cm below the cardia along the lesser curvature, and the gap between the right and left gastroepiploic arteries along the greater curvature. Proximal subtotal gastrectomy is performed for cancer of the cardia and cardioesophageal junction. For cancer of the upper third of the stomach, it is possible to perform both proximal subtotal resection and gastrectomy. In all other cases, gastrectomy is indicated

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When tumors of exophytic and mixed growth forms spread to the esophagus, a deviation of 5 cm from the palpable edge of the tumor in the proximal direction is acceptable. For tumors of endophytic growth form, the spread of cancer cells in the proximal direction can reach 10-12 cm from the visible edge of the tumor. When the retropericardial segment of the esophagus is involved, it is advisable to perform a subtotal resection of the esophagus. Morphological control of resection edges is mandatory

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Selecting online access

For stomach cancer without involvement of the cardia rosette, a superomedian laparotomy to the body of the sternum and a wide diaphragmotomy according to Savinykh are performed. For tumors affecting the rosette of the cardia or spreading to the esophagus to the level of the diaphragm, the operation is performed through a thoracolaparotomy access in the VI-VII intercostal space on the left. If the tumor spreads above the diaphragm, it is necessary to perform a separate laparotomy and thoracotomy in the V-VI intercostal space on the right.

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Regional lymph nodes of the stomach N1

No. 1 right paracardial No. 2 left paracardial No. 3 along the lesser curvature No. 4 greater curvature No. 5 suprapyloric No. 6 infrapyloric

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Regional lymph nodes of the stomach N2

No. 7 left gastric artery No. 8 common hepatic artery No. 9 celiac trunk No. 10 hilum of the spleen No. 11 splenic artery

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Regional lymph nodes of the stomach N3

No. 12 hepatoduodenal ligament No. 13 behind the head of the pancreas No. 14 superior mesenteric vessels No. 15 - middle colic vessels No. 16 - para-aortic lymph nodes No. 17 anterior surface of the head of the pancreas No. 18 along the lower edge of the pancreas No. 19 subdiaphragmatic lymph nodes No. 20 of the esophageal opening aperture

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Regional lymph nodes of the stomach (para-aortic lymph nodes)

No. 110 lower paraesophageal No. 111 supradiaphragmatic No. 112 posterior mediastinum

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Volumes of lymphadenectomy

No. 1 right paracardial No. 2 left paracardial No. 3 along the lesser curvature No. 4 greater curvature No. 5 suprapyloric No. 6 infrapyloric No. 7 along the left gastric artery No. 8 along the common hepatic artery No. 9 around the celiac trunk No. 10 hilum of the spleen No. 11 along the splenic artery No. 12 hepatoduodenal ligament No. 19 subdiaphragmatic No. 20 esophageal opening of the diaphragm No. 110 lower paraesophageal No. 111 supradiaphragmatic No. 112 lymph nodes of the posterior mediastinum No. 13 behind the head of the pancreas No. 14 along the superior mesenteric vessels No. 15 along the middle colic vessels No. 16 paraaortic No. 17 on anterior surface of the head of the pancreas No. 18 along the lower edge of the pancreas

when moving to the esophagus

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Splenectomy for stomach cancer

Increased number of purulent-septic and infectious complications (subphrenic abscesses, pancreatitis, pleurisy, pneumonia) Immunological disorders Negative impact of splenectomy on long-term results

Consequences:

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Absolute indications for splenectomy

tumor ingrowth into the spleen, tumor ingrowth into the distal pancreas, tumor ingrowth into the splenic artery, metastases into the splenic parenchyma, tumor infiltration of the gastrosplenic ligament in the area of ​​the splenic hilum, inability to control hemostasis if the integrity of the splenic capsule is violated (technical splenectomy)

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Splenectomy is not indicated

localization of the tumor in the lower third of the stomach; localization of the tumor along the anterior wall and lesser curvature of the stomach; depth of invasion T1 – T2

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10-year results of D2 lymph node dissection compared with D1 (Hartgrink et al., 2004)

Parameters* D1 D2 Locoregional relapse 21% 19% Locoregional recurrence 37% 26% + distant metastases Distant metastases 11% 15% *All differences are not statistically significant

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Results of D2/D3 lymph node dissection compared with D1 (D'Angelica et al., 2004)

Parameters* D1 D2/D3 Locoregional relapse 53% 56% Peritoneal metastases 30% 27% 3. Hematogenous metastases 49% 53% *All differences are not statistically significant

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Results of D2/D3 lymph node dissection compared with D1 (Roviello et al., 2003)

Parameters* D1 D2/D3 Locoregional relapse 39% 27% Peritoneal metastases 16% 18% Cumulative risk of development 65% 70% relapse *All differences are not statistically significant

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The presentation on the topic “Stomach cancer - diagnosis and treatment” can be downloaded absolutely free on our website. Project subject: Various. Colorful slides and illustrations will help you engage your classmates or audience. To view the content, use the player, or if you want to download the report, click on the corresponding text under the player. The presentation contains 24 slide(s).

Presentation slides

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STOMACH CANCER

A malignant tumor developing from the gastric mucosa. In economically developed countries, the incidence (prevalence) of stomach cancer has decreased markedly, mainly due to changes in the quality of nutrition.

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Epidemiology

In the structure of cancer morbidity and mortality of the Russian population, stomach cancer ranks second after lung cancer. Every year in our country, 48.8 thousand new cases of this disease are recorded, which is slightly more than 11% of all malignant tumors. About 45 thousand Russians die from stomach cancer every year. In the vast majority of countries in the world, the incidence of the disease in men is 2 times higher than in women. The maximum incidence rate of stomach cancer (114.7 per 100 thousand population) was observed in Japanese men, and the minimum (3.1 per 100 thousand population) was observed in white women in the USA.

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Precancerous diseases of the stomach

These are conditions that can develop into cancer over time or that cause cancer to develop more often. is intestinal metaplasia of the gastric epithelium, from which highly differentiated and sometimes polypoid tumors subsequently develop. It is also interesting that polyps and ulcers themselves are usually not considered obligatory precancerous diseases, because very rarely lead to cancer.

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However, about 40% of special, villous polyps can become malignant, in about 3% of cases, stomach ulcers actually turn out to be cancer, and chronic atrophic gastritis is one of the most dangerous precursors of cancer. The main macroscopic types of early gastric cancer: Type I - elevated, or polypoid; Type II – flat; Type III - in-depth, or ulcerative (a defect in the mucous membrane is detected as an ulcer).

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Pernicious (B12 - deficiency) anemia. A number of studies have shown that 1–10% of patients with pernicious anemia develop stomach cancer. The risk of cancer depends on the severity of concomitant atrophic gastritis, in which the acidity of gastric juice decreases, microbial growth occurs, and the formation of nitrogenous compounds increases. Stomach ulcer. Until relatively recently, it was believed that in approximately 10% of cases, a stomach ulcer turns into cancer. More recent studies have shown that most cases of so-called ulcer-to-cancer progression are early gastric cancer with ulceration. Most scientists believe that true malignancy of a gastric ulcer is possible in no more than 1% of cases.

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Cancer of the operated stomach. The risk of stomach cancer after gastric resection usually increases by 3–4 times. In this case, the tumor, as a rule, is located in the gastric stump and almost never spreads to the anastomosed (sewn to the gastric stump) loop of the small intestine. Gastric stump cancer accounts for about 5% of all cancers in this location. The risk of gastric stump cancer during the first 20 years after organ resection for duodenal ulcer remains low. After 20 years, it increases significantly and indicates the importance of the time factor for the transformation of a precancerous condition into a malignant tumor. Menetrier's disease (hypertrophic gastropathy). Ménétrier's disease is a rare disease characterized by the formation of additional large folds, decreased production of hydrochloric acid, and loss of protein due to disruption of the normal functioning of the cells of the gastric mucosa. There is an opinion that in 15% of cases Ménétrier's disease transforms into stomach cancer.

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Factors contributing to the development of gastric cancer.

The main group of reasons consists of nutritional and environmental characteristics: Nutritional characteristics: predominance of flour foods; reducing vitamin C intake; lack of fruits and vegetables; increased consumption of smoked and heavily fried foods, high consumption of animal fats, canned food. Increased alcohol consumption, as well as alcohol consumption on an empty stomach. Smoking also contributes to the development of stomach cancer. Excessive intake of nitrates, nitrites and especially nitrosamines from food. Infectious factor (H. Pylori - Helicobacter or Campylobacter, whose favorite habitat is the stomach).

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Helicobacter pylori (H. pylori) infection of the stomach. H. pylori is a bacterium that infects the lining of the stomach and causes chronic inflammation and ulcers. Advanced age (an average age of 70 for men and 74 for women). Male gender (men have more than double the risk of getting stomach cancer over women.) A diet low in fruits and vegetables. A diet high in salted, smoked, or preserved foods. Chronic gastritis. Pernicious anemia. Some gastric polyps. Family history of gastric cancer (which can double or triple the risk). Smoking.

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Nitrates and nitrites are carcinogenic metabolites, which, with prolonged exposure to the gastric epithelium, can potentiate its malignancy. The main source of nitrates and nitrites (89%) in human food are vegetables. These include cabbage, including cauliflower, carrots, lettuce, celery, beets and spinach. The concentration of nitrates and nitrites in vegetables varies greatly depending on the methods of their cultivation, storage conditions, the type of fertilizers used and water for irrigation. Additional, but less significant sources of nitrates and nitrites are dried and smoked foods. A significant amount of these substances is also found in cheeses, beer and some other alcoholic beverages, mushrooms, and spices.

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Non-food sources of nitrates and nitrites entering the human body are smoking and cosmetics. The widespread decline in the incidence of stomach cancer in many countries around the world is partly associated with improved quality of food storage, in particular with the widespread use of refrigerators. This has led to a decrease in the ability of bacteria and fungi to produce nitrosamine and other carcinogenic metabolites in stored food. In addition, thanks to the use of refrigerators, the ability to consume fresh fruits and vegetables has significantly increased and the need for smoking and drying food has decreased. Beer, whiskey and many other alcoholic drinks contain gastric carcinogens - nitrosamines. According to some researchers, alcohol itself can increase the risk of stomach cancer.

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Stomach Cancer Clinic

usually manifests itself quite late, which once again emphasizes the need for preventive examinations. Characteristic: General weakness, fatigue. Unpleasant sensations and/or pain in the epigastrium (above the navel). Decreased appetite. Feeling of heaviness after eating. Nausea, vomiting. Changing the stool. Bleeding, which may appear as melena (black stool).

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Signs and symptoms of stomach cancer may include: Fatigue Feeling bloated after eating Feeling full after eating little Heartburn Indigestion Nausea Stomach pain Vomiting Weight loss

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Types of stomach cancer include:

Cancer that begins in the glandular cells (adenocarcinoma). Adenocarcinoma accounts for more than 90 percent of all stomach cancers. Cancer that begins in immune system cells (lymphoma). Cancer that begins in hormone-producing cells (carcinoid cancer). Cancer that begins in nervous system tissues.

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Stages of stomach cancer

Stage I. At this stage, the tumor is limited to the layer of tissue that lines the inside of the stomach. Cancer cells may also have spread to nearby lymph nodes. Stage II. The cancer at this stage has spread deeper, growing into the muscle layer of the stomach wall. Cancer may also have spread to the lymph nodes. Stage III. At this stage, the cancer may have grown through all the layers of the stomach. Or it may be a smaller cancer that has spread more extensively to the lymph nodes. Stage IV. This stage of cancer extends beyond the stomach, growing into nearby structures. Or it is a smaller cancer that has spread to distant areas of the body

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Clinical classification

Stage I. The tumor is small, clearly limited, localized in the thickness of the mucous membrane and submucosal layer of the stomach. There are no regional metastases. Stage IIa. A tumor of any size that grows into the muscular layer of the wall, but does not grow into the serous layer. The tumor does not invade neighboring organs and there are no regional metastases. Stage IIb. A tumor of any size that grows into the muscular layer of the wall, but does not grow into the serous layer. The tumor does not invade neighboring organs; single metastases are present.

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Stage IIIa. A tumor of considerable size, extending beyond the wall of the stomach, moves to the abdominal segment of the esophagus, grows into neighboring organs and tissues with a sharp limitation of the mobility of the stomach. There are no regional metastases. Stage IIIb. The same. Multiple regional metastases. Stage IVa. A tumor of any size that grows into neighboring organs. There are no regional metastases. Stage IVb. Tumor of any size with distant metastases.

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Diagnosis of stomach cancer

For early diagnosis of stomach cancer, the following are used: Specific markers (carbohydrate antigen CA 19-19, CA 72-4 and some others). Endoscopy with visual inspection, the use of specific dyes, biopsy and cytological examination of the contents and/or suspicious areas. These methods make it possible to almost accurately detect precancerous conditions, as well as

Stomach cancer, what is it?

Structure of the stomach

Histological structure of the stomach

Precancerous conditions

Precancers

The first signs of stomach cancer

Minor signs of stomach cancer

The symptoms of stomach cancer largely depend on the location of the tumor.

Histogenesis of stomach cancer

Nature of metastasis

Metastasis of stomach cancer is carried out by lymphogenous, hematogenous and implantation (contact) routes.

Localization

The degree of spread of the cardia tumor.

Stages of stomach cancer

Zero stage.

Stage 1.

Stage 2.

Stage 3.

Stage 4.

Stomach cancer has a classification

For the polypous form of the disease, stomach cancer is characterized by:

Ulcerative (saucer-shaped) stomach cancer

Infiltrative ulcerative gastric cancer

Scirrhous gastric cancer with a diffuse-infiltrative type of growth

Stomach cancer and diagnosis

Stomach cancer and diagnosis

Treatment of stomach cancer

Treatment methods

Surgical treatment of stomach cancer

Other treatments

Relapse

Rules for preventing stomach cancer:

Department of Oncology and Radiation Therapy with a PO course Topic: Stomach cancer Lecture 4 for non-oncology residents studying in the specialty - Oncology for students in the specialty - Oncology Lecturer: Doctor of Medical Sciences, Professor Dykhno Yuri Aleksandrovich Krasnoyarsk, 2012

Lecture outline: Lecture outline: 1. Relevance of the topic 2. Epidemiology of stomach cancer 3. Risk factors for stomach cancer 4. Precancerous diseases of the stomach 5. Classification and clinical picture of stomach cancer 6. Basic methods for diagnosing stomach cancer 7. Treatment methods for stomach cancer 8. Long-term results treatment of stomach cancer 9. Medical and social examination 10. Conclusions

Risk factors for stomach cancer Long-term infection Long-term infection with H. pylori Abuse of alcohol and table salt Reflux of duodenal contents into the stomach (secondary bile acids) Reflux of duodenal contents into the stomach (secondary bile acids) Carcinogens coming from water and food (nitrosamines, polycyclic Carcinogens coming from with water and food (nitrosamines, polycyclic hydrocarbons) hydrocarbons)

Environmental factors Condition of the gastric mucosa Dietary factors H. pylori (+) Smoking (+) Alcohol (+) Impaired absorption of vitamins (+) Table salt (+) Nitrates (+) -carotenes (-) Vitamin C (-) Vitamin E ( -) Se, Zn (-) Table salt (+) Nitrates (+) Vitamin C (-) Table salt (+) -carotenes (-) Normal mucosa Superficial gastritis Atrophic gastritis Metaplasia Dysplasia Cancer Scheme of the pathogenesis of gastric cancer T. Wadstorm, 1995

Classification of gastric polyps and the frequency of their transformation into cancer Group Localization Polyp size % malignancy I Antrum Up to 1 cm 2.9 II Antrum 1-2 cm 9.1 III Antrum More than 2 cm 18 Body of the stomach Regardless of size 40.5 IV Multiple

Syndrome of minor signs of stomach cancer (A.I. Savitsky, 1947) Decreased ability to work, rapid fatigue, weakness Decreased ability to work, rapid fatigue, weakness Mental depression, loss of interest in work and others, apathy, alienation Mental depression, loss of interest in work and others , apathy, alienation Unmotivated decrease in appetite, aversion to food Unmotivated decrease in appetite, aversion to food “Gastric discomfort” - a feeling of fullness, bloating, heaviness, pain “Gastric discomfort” - a feeling of fullness, bloating, heaviness, pain Unreasonable weight loss, pallor Unreasonable weight loss , pallor In patients with peptic ulcer and gastritis - modification and appearance of new symptoms In patients with peptic ulcer and gastritis - modification and appearance of new symptoms - pronounced 70% - insufficient 18% - none 12%

Clinical forms of stomach cancer 1. Gastralgic (painful) 2. Dyspeptic 3. Stenotic 4. Anemic 5. Cardiac 6. Bulemic 7. Enterocolitic 8. Ascitic 9. Hepatic 10. Pulmonary 11. Metastatic 12. Febrile 13. Asymptomatic

Spread of stomach cancer Contact path (tumor cells spread in infiltrative tumors by 6-8 cm, and in exophytic tumors - by 2-3 cm from the visible borders of the tumor) (tumor cells spread in infiltrative tumors by 6-8 cm, and in exophytic tumors - by 2-3 cm from the visible borders of the tumor) Implantation (Schnitzler metastases) Lymphogenous (metastases to the navel, Virchow, Krukenberg, etc.) Hematogenous (more often the liver is affected, less often the lungs, pleura, pancreas, kidneys)

Treatment methods for stomach cancer Surgical - Subtotal gastrectomy - Radical gastrectomy - Gastro-, enterostomy Radiation - Preoperative (40-45 Gy) - Intraoperative (15 Gy) - Postoperative (45-60 Gy, radioactive gold) Chemotherapy - 5-fluorouracil - Ftorafur - Mimomycin C - Adriamycin - UFT, S-1 - Polychemotherapy: FAP, FAM, EAP, EFL, etc. proximal distal

Reasons for late diagnosis of stomach cancer Lack of oncological alertness of general practitioners Lack of oncological alertness of general practitioners The practice of diagnosing chronic gastritis without X-ray and endoscopic examination remains The practice of diagnosing chronic gastritis without X-ray and endoscopic examination remains Low capacity of X-ray rooms Low capacity of X-ray rooms Lack of an extensive network gastric centers Lack of an extensive network of gastric centers

Labor prognosis for stomach cancer Heavy physical labor is contraindicated Heavy physical labor is contraindicated Light work, including administrative and economic Light work, including administrative and economic Dietary meals every 2 - 3 hours Dietary meals every 2 - 3 hours Compliance with sanitary and hygienic regime, additional breaks Compliance with the sanitary and hygienic regime, additional breaks Exemption from business trips, travel around the city Exemption from business trips, travel around the city

MSEC for stomach cancer I disability group: I disability group: - patients with stage IV, - with relapse and distant metastases, - with severe agastric asthenia. - patients with stage IV, - with relapse and distant metastases, - with severe agastric asthenia. Disability group II: Disability group II: - after gastric extirpation and combined operations (upon re-examination after a year, it is possible to assign Group III for life based on an anatomical defect). - after gastric extirpation and combined operations (if re-examined after a year, it is possible to assign group III for life according to the anatomical defect).

MSEC after gastrectomy at stages I – II Sick leave for months Sick leave for months III disability group - for those performing light physical labor III disability group - for those performing light physical labor II disability group - for those performing heavy physical labor II disability group - for those performing heavy physical labor

Literature: Basic 1) Davydov, M. I. Oncology: textbook / M. I. Davydov, Sh. Kh. Gantsev, -M. GEOTAR-Media, Additional 1) Oncology: national guide / ch. ed. V. I. Chissov [etc.]; scientific ed. G. A. Frank [and others]. - M.: GEOTAR-Media,) Oncology / trans. from English A. A. Moiseev; ed. D. Casciato [et al.]. - M.: Praktika,) Oncology: modular workshop: textbook / M. I. Davydov, L. Z. Welscher, B. I. Polyakov [and others]. - M.: GEOTAR-Media,) Cherenkov, V. G. Clinical oncology: textbook / V. G. Cherenkov. - 3rd ed., rev. and additional - M.: Medical book, Electronic resources: 1) IHD KrasSMU 2) MedArt DB 3) Medicine DB 4) Ebsco DB 5) Physician consultant. Oncology [Electronic resource]. - M.: GEOTAR-Media, (CD-ROM) Oncology Oncology: modular workshop Clinical oncology Physician consultant. Oncology