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‫به انم آنکه جان را فکرت آموخت ‪...‬‬
Dr. khorram
Knowledge about Gastric Carcinoma in North of Iran, A High
Prevalent Region for GastricCarcinoma: A Population-Based
Telephone Survey.
Mansour-Ghanaei F, Joukar F, Soati F, Mansour-Ghanaei A, Naserani SB.
 Totally the mean knowledge level of the
respondents toward gastric carcinoma would be
17.1±3.97 from the maximum grade of 29.
 The age group of 45-55 y/o, bachelor degree and
higher, physicians and nurses
 There is a general lack of awareness of cancer risk
factors, symptoms and signs, methods of
prevention, and importance of early diagnosis
and treatment.
Esophagus cancer
Esophagus cancer
 Most esophageal tumors are malignant,
fewer than 1% are benign
Esophagus cancer
Squamous cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
 95% of esophageal cancer worldwide
 Commonly 7th decade of life, 1.5-3 times more common
in men
 Thought to occur from prolonged exposure of
esophageal mucosa to noxious stimuli in persons with
a genetic predisposition to the disease.
Squamous cell carcinoma
 The incidence of esophageal SCC varies
considerably among geographic regions.
 The highest rates are found in Asia, Africa, and
Iran
ETIOLOGIC FACTORS
Squamous cell carcinoma
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Demographic and socioeconomic factors
Smoking and alcohol
Dietary factors
Underlying esophageal disease
Prior gastrectomy
Atrophic gastritis
Human papilloma virus
Tylosis
Bisphosphonates
Upper aerodigestive tract cancer
Risk Factors
 CONSUMPTION OF:
Tobacco, Alcohol
Risk Factors
 smoking (5-fold) and alcohol (5-fold)abuse.
 Heavy smoking and heavy drinking combine to
increase the risk 25- to 100-fold.
Risk Factors
 UNDER-CONSUMPTION OF:
Fruits, Fresh meat, Riboflavin. Beta-carotene,
Vitamin C, Magnesium, Vegetables, Fresh fish,
Niacin, Vitamin A, Vitamin B complex, Zinc
Risk Factors
 PREDISPOSING CONDITIONS:
Caustic injury, Esophageal webs, Achalasia, Esophageal
diverticula
 OTHER EXPOSURE:
Asbestos, Ionizing radiation,
Exceptionally hot beverages (tea)
Location: Middle East, South Africa, northern China,
southern Russia, India
Adenocarcinoma
EPIDEMIOLOGY
 Incidence rates for adenocarcinoma of the esophagus
have been increasing in several Western countries, in
part due to increases in known risk factors such as
overweight and obesity.
Risk Factors
 Gastroesophageal reflux disease
 Smoking
 Alcohol
 Obesity
 Increased esophageal acid exposure
 Use of drugs that decrease lower esophageal
sphincter pressure
 Cholecystectomy
 Nitrosative stress
Risk Factors
 Possible protective effect of cereal fiber and other
nutrients
 Diets high in fiber, beta-carotene, folate, and vitamins
C and B6 were protective while diets high in dietary
cholesterol, animal protein and vitamin B12 were
associated with an increased risk .
Clinical Findings
 Both adenocarcinoma and SCC have similar clinical
presentations except that adenocarcinoma arises
much more commonly in the distal esophagus/GEJ.
Clinical Findings
Symptom
 Dysphagia
 Weight loss
 Vomiting or regurgitation
 Pain
 Cough or hoarseness
 Dyspnea
Percent
87-95
42-71
29-45
20-46
7-26
5
Clinical Findings
 Dysphagia is the most common presenting symptom.
Dysphagia is initially experienced for solids, but eventually
it progresses to include liquids.
 Weight loss is the second most common symptom and
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occurs in more than 50%
Pain can be felt in the epigastric or retrosternal area.
Hoarseness caused by invasion of the recurrent laryngeal
nerve is a sign of unresectability.
Patients may have a persisting cough.
Respiratory symptoms can be caused by aspiration of
undigested food or by direct invasion of the
tracheobronchial tree by the tumor.
Clinical finding
 The examination findings are often normal.
 Hepatomegaly may result from hepatic metastases.
 Lymphadenopathy in the laterocervical or
supraclavicular areas represents metastasis.
Differential Diagnoses
 Achalasia
 Esophageal Stricture
 Gastric Cancer
DIAGNOSTIC TESTING
 Barium studies may suggest the presence of
esophageal cancer
 It is now rarely used.
 It may be useful to study the distal anatomy in
obstructive tumors inaccessible by endoscopy.
screening
Barrett's esophagus
 People with Barrett's esophagus should be treated to
decrease reflux symptoms.
 The first follow-up endoscopy should be done one year
after Barrett's is diagnosed. Endoscopy may then be
done every 3 years
 People with low grade dysplasia generally are advised
to have repeat endoscopy at 6 and 12 months, followed
by annual endoscopy if the lesion does not appear to
progress.
Gastric neoplasms
Gastric neoplasms
 Polyps are common but usually not neoplastic
(hyperplastic polyps. Hamartomas, ectopic
pancreas)
 Adenomas occur but are rare
Carcinoma of the stomach
 The second most common fatal malignancy in the
world
 Commonest in Far East (Japan)
 High mortality unless disease detected early
Trend analysis of gastric cancer incidence in iran and its
six geographical areas during 2000-2005.
Haidari M, Nikbakht MR, Pasdar Y, Najaf F.
 The overall incidence rate increased from 2.8 in 2000 to 9.1
per 100,000 persons per year in 2005.
 The average six-year incidence of gastric cancer in the
central and northwestern border of Caspian Sea was 7.8 per
100,000 persons per year, while it was 0.9 per 100,000
persons per year in the border of the Persian Gulf.
 Generally the incidence rate in men was higher than in
women.
 Iran is one of the high-risk areas for gastric cancer. Increase
in incidence might continue in the future.
CLINICAL FEATURES
 Abdominal pain
 A feeling of fullness in the stomach area
 Dark stools
 Nausea
 Vomiting
 Loss of appetite
 Excessive belching
 Feeling bloated after eating
 Indigestion
 Unintentional weight loss
 Fatigue
 Weakness
CLINICAL FEATURES
 Weight loss and persistent abdominal pain are the most common
symptoms at initial diagnosis
 Dysphagia is a common presenting symptom in patients with
cancers arising in the proximal stomach or at the
esophagogastric junction.
 They may also present with a GOO from an advanced distal
tumor.
 pseudoachalasia syndrome
 Approximately 25 percent of patients have a history of gastric
ulcer.
 All gastric ulcers should be followed to complete healing, and those that do
not heal should undergo resection
Paraneoplastic manifestations
 Dermatologic findings
 The sudden appearance of diffuse seborrheic keratoses
 Acanthosis nigricans
 Microangiopathic hemolytic anemia
 Membranous nephropathy
 Hypercoagulable states (Trousseau's syndrome)
 Polyarteritis nodosa
Risk factors
 Some of the risk factors for stomach cancer are related
to lifestyle choices, such as:
 Eating a diet high in salty or smoked foods
 Eating a diet low in fruits and vegetables
 Eating foods contaminated with aflatoxin fungus
 Smoking
Risk factors
 family history of stomach cancer
 Stomach polyps
 Infection with Helicobacter pylori
 long-term stomach inflammation
 pernicious anemia
DIAGNOSIS
 Barium studies — Barium studies can identify both malignant
gastric ulcers and infiltrating lesions and some early gastric
cancers
 false-negative barium studies can occur in as many as 50 percent
of cases.
 In early gastric cancer where the sensitivity of barium meals may
be as low as 14 percent .
 Upper endoscopy is the preferred initial diagnostic test for
patients in whom gastric cancer is suspected.
 The barium study may be superior to upper endoscopy is in
patients with linitis plastica.
Screening
 Consensus has not been achieved on screening
recommendations for many conditions that predispose
to gastric cancer.
 Optimal methods and intervals for screening and the
risks and benefits of screening in these populations
have not been clearly established.
Screening
 Screening recommendations for specific groups
of patients
Screening
 Elderly patients with atrophic gastritis or pernicious
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anemia
Partial gastrectomy
Sporadic gastric adenoma
Immigrant ethnic populations from countries with
high rates of gastric cancer
Familial adenomatous polyposis or hereditary
nonpolyposis colorectal cancer (particularly if gastric
cancer has occurred in the kindred)
Colorectal cancer
Colorectal cancer
 CRC is the third most commonly diagnosed cancer in
males and the second in females
 Rates are substantially higher in males than in females
Colorectal cancer
 Trends in incidence of gastrointestinal tract
cancers in Western iran, 1993-2007.
 Najafi F, Mozaffari HR, Karami M, Izadi B, Tavvafzadeh R, Pasdar Y.
 An increase in the incidence of colorectal cancer are in
line with reports from other developing countries in
epidemiologic transition
Risk factors
Gender
 Overall age-standardized incidence rates were 65.1 per
100,000 for men and 47.6 per 100,000 for women
 Male-female ratio=1.37
 Mortality rates were also higher in men than women
 25.4 versus 18.0 per 100,000
Screening
 One in four patients with colorectal cancer has a
family history of colorectal cancer.
 3 to 4 percent of patients with CRC have one of two
genetic syndromes (HNPCC) and (FAP).
Screening
 Clinicians can screen for a family history of colorectal
cancer by asking a simple set of three questions:
 Have any blood relatives had colorectal cancer or a
precancerous polyp?
 How many, and were these first-degree relatives (parent,
sibling, or child) or second-degree relatives)?
 At what age were the cancers or polyps diagnosed?
Screening
 If the patient is at risk for earlier onset CRC (eg, first-
degree relative with onset of CRC before age 50), screening
should begin earlier.
 If the patient is at risk for more rapid progression of disease
(eg, HNPCC or FAP), screening should be performed more
frequently.
 If the patient is at substantially increased risk (eg, HNPCC
or FAP), screening should be with the best available test,
colonoscopy.
Screening
 Screen with colonoscopy.
 If a single first-degree relative was diagnosed at age 60
years or older with CRC or an advanced adenoma (≥1 cm, or
high-grade dysplasia, or villous elements), screening with
colonoscopy is recommended every 10 years beginning at
age 50
 If a single first-degree relative was diagnosed before 60
years with CRC or an advanced adenoma, or two or more
first-degree relatives had colorectal cancer or advanced
adenomas at any age, screening with colonoscopy is
recommended at age 40 or 10 years before the youngest
relative's diagnosis, to be repeated every five years.
Screening
 Individuals at highest risk with familial syndromes
(HNPCC, FAP) should be screened for CRC with
colonoscopy at frequent specified intervals.