4. Fourth most common cancer in the world
Second most common cause of cancer related
death
Marked geographic variation
High risk areas : Japan, Korea, Latin America,
USSR
Low risk areas: USA, Israel, Kuwait, Canada
5.
6.
7. But the incidence of proximal gastric cancers is
increasing in the west…
8.
9. Most common site was Antrum 48%
40% was found to be in the body
10% was found to be in the proximal stomach
11. Acquired
High salt consumption
High nitrate consumption
Poor food preparation (smoked, salt cured)
Lack of refrigeration
Diet low in Vit A and C
Smoking, heavy alcohol consumption
12. Helicobacter pylori
3 to 6 times increase in risk of gastric cancer
intestinal type of cancer in the distal stomach
Decreases acid production causing chronic
atrophic gastritis
17. Proximal Gastric Cancer Distal Gastric Cancers
Includes GEJ, Tumors of the Cardia Includes Body and Antrum
Rapidly increasing incidence in the
west
World wide incidence is declining
steadily
Mainly diffuse type Mainly intestinal type
M:F = 1:1 M>F
Younger age Older age
More aggressive Less aggressive
More in the developed countries More in developing countries
Not associated with H. pylori Associated with H. pylori
Associated with GERD Associated with atrophic gastritis
32. Type I : Adeno Ca Distal
Esophagus, infilt GEJ from
above
Type II : Adeno Ca of the
real cardia, true GEJ
Type III : Subcardial Gastric
Adenoca, infilt GEJ from above
42. Form exophytic or ulcerated growth
More in the distal stomach
Due to H. pylori
This type is declining worldwide
Older patients with a male preponderance
M:F = 2:1
Better prognosis
Form glandular elements in histology
45. Mainly affects cardia
Form infiltrative lesions
No precancerous lesions
Loss of CDH1 gene
Discohesive cells that do not form glands
Signet ring cells
Younger age, M = F
Worse prognosis
46.
47. Her2-neu amplification in 12 to 27%
More in intestinal type than diffuse type
Prognostic significance has not been
identified
4 tier scoring
Trastuzumab in Her2-neu 3+ or FISH positive
locally advanced or metastatic stomach
cancer