Special gastric cancer.

see also cancer of the digestive tract


Why stomach cancer occurs? What are the reasons that favor it and the conditions that are associated with cancer? Is there a genetic predisposition?

Etiology

There are factors contributing stomach cancer, ie substances that may help in genetically susceptible individuals the onset of stomach cancer. In particular there are some young people already ill with cancer before age 40 because they have a mutated gene in a single copy and can send children to cancer in 50% of cases:

-Hereditary Diffuse Gastric cancer (HDGC)

-Gastric cancer may also be one of the clinical manifestations of certain syndromes of hereditary predisposition to cancer: HNPCC, Li-Fraumeni syndrome, FAP, Peutz-Jeghers syndrome and Cowden.

a) eating meat sausage, without observing a proper diet (see food pyramid) that contain nitrites that interact with some amino acids and form the nitrous mines, substances that can alter and denature the DNA.

b) substances of meat and smoked fish, polyaromatic hydrocarbons, benzopyrene and dibenzantracene, for example in subjects like the "steak" grilled or smoked meats.

c) Even a tasty diet, as well as expose you to risk of hypertension, causes a slow gastric emptying and predisposes to cancer of the stomach, slowing down for emptying.

d) Mycotoxins, contained in contaminated food dall'aspergillus flavus, that molds that contaminate food, such as certain beans and grains imported from the east!

e) carbohydrates, rice and potatoes that modify the production of gastric mucus and predispose to cancer.

f) industrial workers, those in oil refineries (see risk of cancer and petrochemicals), the miners of nickel and coal, asbestos workers, solvent.

g) Helicobacter pylori, responsible for epithelial proliferation and repair processes and chronic gastritis.

h) Sex male

i) Smoke

j) Age> 60 years

k) Blood group A Rh positive or Rh-positive group 0

There are precancerous lesions that are the portals of stomach cancer, ie a state of gastric mucosa, defined as altering histopathology that are similar to what conditions risk.

.
....... They are:

Others Chronic atrophic gastritis

b. Intestinal metaplasia. E 'characterized by the replacement of gastric epithelial cells of glandular type and surface with cells similar to those of the intestinal mucosa.

c. Helicobacter pylori.

d.Polipi. We have identified two types of gastric polyps: hyperplastic polyps (or regenerative) and adenomatous polyp.
endoscopy.



SYMPTOMS AND DIAGNOSIS


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Symptoms

The early symptoms were vague and nonspecific, often underestimated even by medical disorders epigastric vague (ie abdominal pain localized in the upper left quadrant, the "mouth" of the soul, that is just below the sternum), feeling swollen belly, feeling digestion slow and laborious, of fullness, heartburn, nausea and vomiting, anorexia and disgust or rejection for meat and meat broth, anemia and anemia from chronic loss, with positive occult blood. The commonest site is the lower third (49%), followed by the third medium (23%), the cancer spread to more regions, organ (10%), the cardia (6%) and bottom (4.5% ).

Diagnosis

Endoscopy.
Endoscopy is a technique now well tolerated and safe, very accurate and precise, with accuracy, in experienced hands, even 98%. You can associate with cromoendoscopia, a vital staining technique for clarifying the paintings and the echo endoscopy, which allows a study of wall and lymph nodes. Biopsy is essential! Each ulcer although considered benign, if bioptizzata be located in your stomach!

TAC.
Consideration of great value in cancers of the upper third or sweeping the gastric wall with compression or infiltration of neighboring organs.

Cancer markers.
Laboratory tests are serum whose sensitivity and specificity increases if combinations of them. Some authors believe they have a diagnostic weight, but also in clinical practice are required along with the occult blood stool. They are: CEA, CA19-9, 72-4 AC

Chest x-rays.
Allows you to exclude any lung metastases

CLASSIFICATION


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Macroscopic classification

It is based on the issue of cancer and recognizes different classifications according to the stage of malignancy.
In the primordial stages, when it is confined to the mucosa and submucosa, the classification is described in Fig. One, while in advanced cancer is based on the classification of Borrmann alongside.


TNM classification

The classification of cancers principally used classifies the degree of infiltration of cancer according to depth (T) according to the number of infiltrated lymph nodes (N) and the presence of distant metastasis (M).
A different classification based on the Japanese invasion of lymphatic present several stations around the stomach
TNM classification according to UICC 1997
Category T
Tis limited to the mucosa without invasion of the basement membrane
T1a limited to the mucosa (lamina propria invasion)
T1b submucosal invasion
T2a Invasion of muscularis propria
T2b Invasion of subserosa
T3 penetration of serosa without invasion of surrounding tissue
T4 Invasion of tissues / organs adjacent
Category N
N0 no lymph node involvement
Involvement of N1 lymph nodes 1-6
Involvement of N2 nodes 7-15
N3 Involvement of more than 15 lymph nodes
N ratio Ratio of lymph intresse / removed
Category M
M0 No distant metastasis
M1 Distant metastases
Category R
R0 No residual tumor
R1 Microscopic residual
R2 macroscopic residual

Treatment

The treatment options in gastric cancer based on stage of disease, as some Early stage lesions are currently treated by definitive endoscopic mucosal resection, while others require a very advanced lesions preventive chemotherapy to achieve better results.


Limited resection (endoscopic mucosal resection or EMR)

For a small percentage of injuries early (Early) is currently proposing the endoscopic resection of the tumor, but if the lesion is confined to the mucosa of the stomach, ie surface, not sinking, so to speak, "roots" in the layer muscular and does not affect the lymph nodes. Only then will the endoscopic treatment is considered therapeutic.

In most cases, however, it is essential to operate:



Subtotal gastrectomy, if the only cave is interested and can expand to 2.5 resection;

Total gastrectomy, if the lesion is extensive and can not discern his home with precision, if for example affects the gastric fundus;

Gastrectomy enlarged organs and lymph nodes nearby, this case perhaps more frequently.

Gastroenteroanastomosi if the cardia is concerned.

The lymph nodes must always be cleared until the second level and following chemotherapy can significantly improve the prognosis.

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