Stomach Note Path

stomach anatomy

left hypochondriac and epigastric, muscular, inner mucosal and outer serosa layer

stomach lymphatics: left gastric artery duct

drains medial 2/3 of stomach

lymphatics: splenic artery duct

drains fundus and middle portion of greater curvature

lymphatics: hepatic artery duct

drains pyloric region & lower ½ of greater curvature

epidemiology

#7 cancer death in US, 1.5:1 MF, chile costa rica japan, lower socioeconomic connection, white: proximal black: pyloric & antral

risk factors

high salt & smoked food diet, occupational hazards, H. pylori infection, genetics

histopathology

four subtypes, adenocarcinomas, 3% lymphoma, 1-2% leiomyosarcoma

ulcerative adeno

most common

polypoid adeno

fungating, common, surgical removal

scirrhous adeno

gastric wall, thickened nodular foreshortened stomach, worst prognosis

superficial gastric adeno

uncommon

signs and symptoms

vague epigastric discomfort, weight loss

detection and diagnosis

stool exam, upper GI series, endoscopy, CT CXR MRI, laparotomy

staging based on

depth of penetration

metastatic pattern

20-30% pt have met at diagnosis. blood lymph or direct extension: pancreas, liver, lung, bone

tx

surgery only cure, chemo used unresection & mets, radiation tx regional nodes

RT

nodes, post or intra-operative, 45-50 Gy, not improve survival, AP/PA

critical structure w/ RT

kidney, spinal cord, small bowel, liver, spleen

acute radiation reactions

nausea, vomiting, esophagitis, gastritis

chronic radiation reactions

ulcers, nephritis

prognosis

very poor, 16% 5 year survival