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Gastric cancer: Difference between revisions
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<section begin="oncology" />'''Gastric adenocarcinoma''' accounts for 95% of '''gastric cancers'''. It’s a cancer of elderly, mostly men, and it’s the fifth most common cancer worldwide. It is more common in Asian countries like Japan and Korea, as well as certain regions in Africa and South America. | <section begin="surgery" /><section begin="oncology" />'''Gastric adenocarcinoma''' accounts for 95% of '''gastric cancers'''. It’s a cancer of elderly, mostly men, and it’s the fifth most common cancer worldwide. It is more common in Asian countries like Japan and Korea, as well as certain regions in Africa and South America. | ||
It causes no or only nonspecific symptoms in the early stages. If diagnosed early, the prognosis is excellent, but at the time of diagnosis, 50-75% of cancers have already spread and are incurable, which leads to a poor prognosis overall. | It causes no or only nonspecific symptoms in the early stages. If diagnosed early, the prognosis is excellent, but at the time of diagnosis, 50-75% of cancers have already spread and are incurable, which leads to a poor prognosis overall. | ||
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We distinguish “early” and “advanced” gastric cancer. Per definition, “early” gastric cancer infiltrates no deeper than the submucosa but even early cancer can give metastasis to the lymph nodes, while “advanced” cancers infiltrate the muscularis propria and deeper. | We distinguish “early” and “advanced” gastric cancer. Per definition, “early” gastric cancer infiltrates no deeper than the submucosa but even early cancer can give metastasis to the lymph nodes, while “advanced” cancers infiltrate the muscularis propria and deeper. | ||
<section end="oncology" /> | <section end="surgery" /><section end="oncology" /> | ||
=== Lauren classification === | === Lauren classification === | ||
We can use the ''Lauren classification'' which separates the gastric cancers into ''intestinal'' and ''diffuse'' types according to their location in the stomach and their gross and histological morphology. | We can use the ''Lauren classification'' which separates the gastric cancers into ''intestinal'' and ''diffuse'' types according to their location in the stomach and their gross and histological morphology. | ||
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Linitis plastica is the end-stage of diffuse type gastric cancer, where the entire stomach is affected by the cancer. This leads to a rigid, non-distensible, “leather bottle-like” stomach. | Linitis plastica is the end-stage of diffuse type gastric cancer, where the entire stomach is affected by the cancer. This leads to a rigid, non-distensible, “leather bottle-like” stomach. | ||
<section begin="oncology" /> | <section begin="oncology" /><section begin="surgery" /> | ||
=== Metastatic spread === | === Metastatic spread === | ||
Gastric adenocarcinoma often spreads to skeleton, liver, lung, brain, and the peritoneum. The Virchow lymph node, the left supraclavicular lymph node, is the most common site of gastric cancer metastasis. | Gastric adenocarcinoma often spreads to skeleton, liver, lung, brain, and the peritoneum. The Virchow lymph node, the left supraclavicular lymph node, is the most common site of gastric cancer metastasis. | ||
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The standard curative surgical treatment for “advanced” gastric cancer patients is radical [[gastric resection]] with lymphadenectomy. For intestinal type gastric cancer, distal or subtotal gastric resection is performed. For diffuse type gastric cancer, total gastrectomy is necessary. Afterwards, the <abbr>GI</abbr> system must be reconstructed by Roux-en-Y, Billroth I, or Billroth II. | The standard curative surgical treatment for “advanced” gastric cancer patients is radical [[gastric resection]] with lymphadenectomy. For intestinal type gastric cancer, distal or subtotal gastric resection is performed. For diffuse type gastric cancer, total gastrectomy is necessary. Afterwards, the <abbr>GI</abbr> system must be reconstructed by Roux-en-Y, Billroth I, or Billroth II. | ||
Surgery may be used [[Palliative surgery|palliatively]] as well, in cases where the tumour obstructs passage of foodstuffs, for example. A stent may be placed, the stomach may be resected, or bypass surgery may be employed. | Surgery may be used [[Palliative surgery|palliatively]] as well, in cases where the tumour obstructs passage of foodstuffs, for example. A stent may be placed, the stomach may be resected, or bypass surgery may be employed.<section end="surgery" /> | ||
=== Chemotherapy === | === Chemotherapy === | ||