Gastric Cancer
Introduction
Gastric cancer is often diagnosed at an advanced stage. Among the risk factors include age, gender, genetic factors, smoking, smoke or salt preserved food, diet less of fruits and vegetables, infection with H.Pylori and Epstein Barr Virus. About 90–95% of the tumors are adenocarcinoma.
Management:
Surgery is the primary treatment for early stage gastric cancer.
Total or partial gastrectomy is performed together with lymph node dissection. Bypass surgery is done to relieve obstructive symptoms.
Signs and Symptoms
Diagnostic criteria
• Epigastric pain worsened by food intake, early satiety
• Distal tumours may present with obstructive symptoms
• Occult of manifest bleeding may be a feature
• Other symptoms include epigastric mass, pallor, weight loss, supraclavicular nodes, hepatomegaly, periumbilical nodes
Investigation
• FBC, LFTs, stool for occult blood, carcinoembryonic antigen
• CXR, Ba meal (double contrast), abdominal USS
• Abdominal and pelvic CT scan
• Endoscopy and biopsy for histology
Staging: TNM
Treatment
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Pharmacological
- There are several chemotherapy regimens for locally advanced and metastatic gastric adenocarcinoma. Few of them include
• Paclitaxel 175mg/m2 IV plus carboplatin AUC 5 IV on day 1, cycled every 3 weeks for 6 cycles
OR
• Docetaxel IV 60mg/m2 day 1 +IV cisplatin 60mg/m2 day1 + 5–FU 750mg/m2 IV continuous infusion over 24 hours on day1–4, cycled every 3 weeks for 6 cycles
Note:
• Radiotherapy with IMRT technic may be given as adjuvant to surgery otherwise is used in palliative setting to control bleeding and pain
• Gastric lymphoma are primarily managed with chemotherapy.
• Patients with CD 117 positive gastro intestinal stromal tumor respond well to imatinib.
Hepatocellular Carcinoma Associated with chronic Hepatitis B infection
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Non-pharmacological
-
Prevention
Updated on,
5 Novemba 2020 11:25:15
References
1.STG