Download Stomach Cancer

Stomach Cancer
Anatomy of Stomach
Physiology of Stomach
Motility
1. Muscles
2. The pacemaker
3. The pylorus
Physiology of Stomach
Functions
1. Storage
2. Mixing food and the formation of
chime
3. Controlled emptying
Controlled emptying
of stomach
1.
2.
3.
4.
Peristalsis
Volume of chyme and liquids
Hormone modulators
Physicochemical modulators
a) nature of food;
b) caloric density;
c) osmolarity;
d) pH
Controlled emptying
of stomach
MMC - Migrating Myoelectric Complex
a cycle of gastrointestinal motor
activity, initiated in the stomach and
propagated through the small
intestine
Physiology of stomach
Stomach secretion:
a) Vagus phase
b) Stomach phase
c) Intestinal phase
Physiology of stomach
Zones of secretion
a) Cardiac zone
b) Fundic zone
c) Antral zone
Physiology of stomach
Stomach secretion
1. Mucus
2. Intrinsic factor
3. H+
4. Pepsinogen
5. Gastrin
Mucous cells
Parietal cells
Parietal cells
Chief cells
G cells
Physiology of stomach
Defensive barrier
a) mucus
b) 1st level – cells’ apical membranes
c) 2nd level – basal membrane of
mucous layer
Tumors of stomach
Benign tumors:
1.
2.
3.
4.
5.
Leiomyoma
Fibroma
Lipoma
Hemangioma
Lymphoma
Tumors of stomach
Gastric polyps
a) hyperplastic polyps
b) adenomatous polyps
Gastric carcinoma
Risk factors
a) Genetic predisposition;
b) Diet;
c) Alcohol and smoking
d) Atrophic gastritis;
e) Adenomatous polyps;
Gastric carcinoma
Risk factors
f) Nitrosamines
g) Pernicious anemia
h) Hypochlorhydria
i) H. pylori colonization
Gastric carcinoma
Two morphologic types:
a) Intestinal type
b) Diffuse type
Classification of gastric cancer
Stages
Stage 1
Stage 2
Stage 3
Stage 4
- lesion up to submucous layer
– lesion up to serous layer
– lesion through all layers
– metastases to another organ
Classification of gastric cancer
TNM
p1 –
p2 –
p3 –
p4 –
system
lesion through mucous layer
lesion up to muscular layer
lesion up to serous layer
lesion of all layers
Clinical features of gastric cancer
1.
2.
3.
4.
Pain
Cycle-type running features
General symptoms
Complications
Treatment of gastric cancer
1. Distal subtotal resection
2. Proximal subtotal resection
3. Gastrectomy
Statistics of stomach cancer
5-year survival rate:
I stage
II stage
III stage
IV stage
95%
86%
10-28%