Chapter 4. GASTRIC CANCER

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Definition and statistical data

Gastric cancer is a malignant tumor of the stomach developing out of the glandular epithelium.

The incidence of stomach cancer occupies, from different data, 2-4 place among carcinoma of lung, breast cancer and colon cancer. In Russia about 50000 new cases are registered annually. Morbidity is 40 on 100000 population. The most high morbidity in the world is marked for the men of Japan (114.7), the lowest (3.1) - in the USA among white women. Males suffer 2-3 times more often. Most patients - in the age older 60.

ETIOPATHOGENESIS

CLASSIFICATION

According to the stage
Stage 0		N0	M0
Stage IA	T1	N0	M0
Stage IB	T1	N1	M0
	T2(a,b)	N0	M0
Stage II	T1	N2	M0
	T2(a,b)	N1	M0
	T3	N0	M0
Stage IIIA	T2(a,b)	N2	M0
	T3	N1	M0
	T4	N0	M0
Stage IIIB	T3	N2	M0
Stage IV	T1-3	N3	M0
	T4	N1-3	M0
	T1-4	N1-3	M1

CLINICAL PICTURE

In the initial stages of the disease the clinical manifestations are poorly noticeable and non-specific for gastric cancer. Syndrome of minor signs according to A.I. Savitsky: - early fatigue, reduced working ability, apathy; - steady decrease of appetite right up to its loss, cibophobia (aversion to food); - feeling of heaviness in the epigastrium, nausea; - loss of weight, anaemia. They just serve the reason to undertake the sighting examination of the patient. Presence of the pronounced clinical picture is typical for neglected cancer.

DIAGNOSTICS

TREATMENT

The main method of treatment of gastric cancer is surgery.

An obligatory element of the operation is lymphodissection.

Chemotherapy is used as the additional method before and after the operation.

Radiation therapy is also used as a component of combined treatment.

Variants of lymphodissection
Lymphodissection is aimed to remove the impaired lymphatic nodes, lymphatic vessels and surrounding fatty tissue.
D0	lymphodissection is not performed
D1	lymphodissection alongside the greater and lesser curvature together with greater and lesser omentum, supra- and infrapyloric nodes
D2	D1 + lymphodissection alongside the passage of the left gastric artery
D3	D2 + lymphodissection alongside the passage of the celiac trunk
D4	D3 + paraaortic lymphodissection
Dn	D4 + resection of other organs involved into the tumorous process
Control of the adequacy of the intervention extent and the variant of lymphodissection may be provided by means of intra-operative cytological investigation of the lymphatic nodes and tissues alongside the line of resection. 5-year survival after radical surgery is 10-60% depending on the stage.

EARLY GASTRIC CANCER

Diagnosis of early gastric cancer

FGD reveals the tumor in the gastric mucosa in size from 0.3 cm, and allows to take the material for histological examination.

Endoscopic US allows to determine the prevalence of intramural process- the depth of tumor invasion into the wall of the stomach, as well as to evaluate the condition of the nearby "watch" lymphatic nodes.