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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%