This presentation tackles the topic of gastric cancer. Presentation provides critical information but should be combined with knowledge of the presenter since it's meant for proper presentating and not read-only. Use freely to study or present.

1. Gastric Cancer
Jan Stanislav Dorosz
M1770

2. Epidemiology
1. Gastric cancer is the 7th most prevalent and 5th most deadly cancer in the world.
2. Males are more prevalent than women
3. The ratio between men and women stands around 2,5:1
4. More prevalent in developed countries (East Asia, Western Europe)
5. Over 1 million people around the world are diagnosed with stomach cancer every year
6. Over 783,000 people die due to gastric cancer annually
7. Big distinction in prevalence between developed and developing countries
8. Strongly related to food preservation and H. Pylori infections

3. Risk factors
1. Gender (Affects males more than females ~2,5:1 ratio)
2. Age (Mostly affects people of older age)
3. Ethnicity (Most commonly affects people of Hispanic, African, Native American and Asian
heritage)
4. Geography (Most common in Western World: Japan, China, Central and Eastern Europe, South
and Central America etc.)
5. H. Pylori (H. Pylori infection is a major cause of developing gastric cancer)
6. Stomach lymphoma (People who have had a certain type of lymphoma of the stomach known as
mucosa-associated lymphoid tissue - MALT - lymphoma have an increased risk of getting
adenocarcinoma of the stomach)
7. Diet (Smoked foods, salted fish and meat, pickled vegetables - Foods rich in nitrates, nitrites)
8. Tobacco use (Smoking severely increases risk of gastric cancer)
9. Overweight and obesity
10. Hereditary and genetic (especially among Eastern Asian populations - most common in Japanese
population by ratio and Chinese population by raw numbers)

4. Other risk factors
1. Occupational hazard (Exposure to asbestos, nickel, nitrates, nitrites)
2. Alcohol abuse
3. Syndromes of chromosomal fragility

5. Premalignant lesions
1. Chronic and atrophic gastritis (80-90% of people affected with gastric cancer have some degree
of atrophic gastritis, atrophic gastritis itself can also be a precursor of cancer, 5-10%)
2. Gastric ulcer (In 2-2,5% of cases gastric ulcer is thought to be a precursor of cancer, if gastric
ulcers along certain clinical signs are present they should be always suspected malignant)
a. Stomachache is not periodic as in the past
b. Pain is permanent, dull and not intense
c. Stomach pain does not react to changes in alimentation
Radiological changes:
d. There is no peristaltism
e. Unfolding and changes in gastric folds 2-3 cm from ulcer
3. Gastric polyps
a. Hyperplastic (no malignancy potential)
b. Hemartomatous adenomatous (no or weak malignancy potential)
c. Villous adenomas (premalignant condition)
4. Menetrier disease (rare disorder that is characterised by massive hypertrophy of gastric folds,
nearly no acid production and pain in the upper abdomen) - premalignant
5. Pernicious anemia (gastric cancer is 20 times more common in patients with pernicious anemia
and therefore gives big indication for regular monitoring)

6. Clinical signs and symptoms:
Signs:
- Nausea
- Pain (after ingesting food or permanent in gastric region of the abdomen)
- Dysphagia
- Blood containing vomit
- Melaena (dark black coloured feces indicating semi-digested blood)
- Anemia (due to either bleeding with simultaneous vomiting or fecal presence of semi-digested
blood or due to malnutrition due to malnutrition - resulted from pain after ingesting food etc.)
- Palpable masses (in late stage of the disease)
- Resulting from previous: Weight loss
Symptoms:
- Pain (after ingesting food or permanent in gastric region of the abdomen)
- Nausea
- General discomfort
Diagnosis

7. Physical examination:
- Searching for palpable masses or changes (tumour - late stage)
- Hepatomegaly
Radiological:
- Barium sulfate meal/bolus followed by X-Ray/CT
- CT Scan, Simple radiography
- MRI
- PET
Biopsy
Diagnosis

8. 1. Tumour markers checkup in (serum level)
a. CEA (>5 ng/ml)
b. CA 19-9 (>37 U/ml)
c. CA 72-4 (>4 U/ml)
Diagnosis

9. Diagnosis
1. Upper gastrointestinal endoscopy
a. Very accurate and reliable
b. Gives possibility to diagnose gastric cancer (and other) in early stage
c. Is relatively non-invasive (in comparison to exploratory laparotomy etc.)
d. Relatively cheap and easy in use
e. Magnification allows to observe microvascular architecture of mucosa and microsurface
pattern of the lesion
f. Endocytoscopic visualisation of nuclei (allows to give correct diagnosis and analysis of the
lesion without the need for biopsy)
1. Virtual endoscopy
a. Uses multidetector-row computed tomography (CT) in order to recreate a three
dimensional visualisation of stomach

10. 1. PET scan (Positron Emission Tomography)
a. Good at detecting metastasis (Liver, Lymph nodes, Colon, Bone)
b. Allows assessment of metabolic rate of the tumour
c. Allows to stage the tumor
d. Very informative and accurate imaging
1. Staging laparoscopy
a. Provides additional (to preoperative radiographic) assessment on tumour’s resectability
b. Can give final decision whether to allow or prelude patient from resection surgery because
it gives more detailed information about dissemination
c. Can give additional information regarding peritoneal dissemination and extraserosal
invasion
d. Allows peritoneal lavage for cytology
Diagnosis

11. References
1. US National Library of Medicine, 10.12.2020,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444111/>
2. US National Library of Medicine, 10.12.2020,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017429/>
3. US National Library of Medicine, 10.12.2020,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730304/>
4. American Cancer Society, 10.12.2020, <https://www.cancer.org/cancer/stomach-
cancer/causes-risks-prevention/risk-factors.html>

12. Thank you