GASTRIC CARCINOMA.ppt

GASTRIC CARCINOMA Pathophysiology Adenocarcinoma characterized as intestinal or diffuse Spreads through stomach into the gastric wall to the Lymph nodes Liver Pancreas Transverse colon Omentum Peritoneum Ovaries Pelvic cul-de-sac Through portal vein into lungs, liver, and bone Advanced stage: stomach muscle Etiology H. pylori: 80 percent of gastric carcinomas result from H. pylori due to the result of free radicals Dietary nitrates (bacteria in stomach breaks down nitrites to compounds that are carcinogenic in animals) Hypochlorhydria: occurs in gastric atrophy and promotes bacterial growth in stomach Foods such as starch, pickled vegetables, salted fish and meat, smoked foods and salt People who smoke cigarettes or use alcohol are 3-5 times more likely Etiology cont. Epstein-Barr virus is now implicated as a cause Pernicious anemia Chronic atrophic gastritis Gastric polyp Achlorhydria Barrett’s esophagus Having had a Billroth 2 procedure Genetic factors include: First degree relatives Type A blood Incidence/Prevalence 3rd most common GI malignancy (after colorectal and pancreatic) 14th cause of cancer related death in U.S. 85-95% are caused by adenocarcinoma 15% are caused by Non-Hodgkin’s lymphoma leiomysosarcomas Anatomy of the stomach location 37% in the proximal third of the stomach 30% in the distal stomach 20% in the midsection Remaining 13% in the entire stomach Onset Insidious (slowly developing) Usually discovered in advanced stages MenWomen Occurs between the ages of 50-70 Increased mortality in Japanese Costa Ricans Chileans Native Americans African Americans Scandinavians Assessment History: High risk foods Alcohol/tobacco use Treated for H. Pylori infection Gastritis, pernicious anemia, gastric surgery, polyps Immediate family dx gastric cancer Blood type Physical Assessment Early gastric cancer Indigestion Abdominal discomfort initially relieved with antacids Feeling of fullness Epigastric, back, or retrosternal pain NOTE: most peo