Gastric Tumours

 Tumours from mucosa predominates than

mesenchymal.
 Benign and malignant
 90% of the polyps are hyperplastic polyps
 Carcinoma is the most important and most
common malignant tumours of stomach.
 Second most common carcinoma in world.
 Incidence varies with the country.
 High in Japan and China and relatively low
in USA.
 Common in males above 50 yrs
 Risk factors
 H. pylori – 60 – 70 %
 smoking
 alcohol
 pernicious anaemia
 adenomatous gastric polyps
 familial adenomatous polyposis
 Blood group A
 1st degree relatives of patients
 Pathology
 Adenocarcinoma arising from mucus
secreting cells from base of glands

Histologically arising from

- intestinal : intestinal metaplasia
- diffuse : normal gastric mucosa
 site of tumour
: 50 % - antrum
: 20 – 30% - gastric body
: 20 % - cardia
 Macroscopically
- polypoid, ulcerative, fungating, diffuse
 Clinical Features
 Most of the patients are in advanced stage
while presentation.
 Epigastric pain
 Dysphagia , nausea, anorexia, vomiting
 weight loss
 Anaemia
 Malena
Metastasis
- Virchow’s node ( Troisier’s sign )
- umbilicus (Sister Mary Joseph nodule)
- ascites, jaundice
- ovaries ( krukenberg’s tumour )

- pelvic mass
 Diagnosis
 Ba study
 Endoscopy
 CT scan
 Laparoscopy for peritoneal mets
Adenocarcinoma stomach
Adenocarcinoma
 Carcinoma of Stomach

 Surgical options
 Proximal tumours

 Total or proximal subtotal gastrectomy with Roux –N-

reconstruction

 Mid-body tumours
 Total gastrectomy

 Distal tumours
 Distal subtotal gastrectomy with or without regional
lymphadenectomy
 Carcinoma of Stomach

Surgical treatment
- cardia : gastrectomy with distal esophagectomy

Chemotherapy
- 5 FU , Doxorubicin , Mitomycin – C ( FAM )
- Epirubicin, Cisplatin , 5 FU ( ECF )
 Palliative therapy in inoperable tumours
- endoscopic laser therapy
- endoscopic dilation for cardia tumours
- metallic stenting
 Gastric Lymphoma
 5% of all GI malignancies
 60% of all extranodal non-hodgkins
 polypoid or ulcerative lesion
 Therapy
- surgery
- chemotherapy
- radiotherapy
 Zollinger Ellison syndrome
Triad of
- peptic ulcer
- gastric acid hypersecretion
- non-beta islet cell tumour of pancreas
( Gastrinoma )

 Common in both sexes & between

30 - 50 yrs of age
 Pathophysiology
- gastrin stimulates excess secretion of
acid
- inactivation of pancreatic lipase
- diarrhoea & steatorrhoea
Pathology
- 90% : head of pancreas
- multiple , size 1mm to 20 cm
- associated parathyroid & pituitary
adenomas in 20 – 60 %
Clinical features
- multiple ulcers in duodenum, jejunum
- bleeding & perforation common
- unresponsive to standard therapy for
PUD
- Diarrhoea
 Investigations
- serum gastrin levels increased 1000
times normal
- Endoscopic USG
Treatment
- single lesion : Resection
- multiple lesion : control of complication
: PPI – Omeprazole
: Somatostatin analogue for decreasing
gastrin secretion