8. GASTRIC CANCER
Incidence of Gastric cancer, by contrast with
tumours of other
organs, has
been decreasing during recent
decades. In age
adjusted mortality
rate from gastric
cancer in the
white
population fell from 29 to 3-6/100000.
Gastric cancer
has become more
prevalent in Japan,
Chile,
Iceland, Finland and the Scandinvian
countries.
Countries with
more gastric cancer can
also have a
higher
incidence of benign gastric ulcer .
8.1 ETIOLOGY
Although the
cause of gastric cancer
remains unkown, several
clues may eventually clarify its
etiology.
8.1.1 ATROPHIC GASTRITIS
Patients with gastric ulcer often have
a diffuse pangastritis.
a
similar type of chronic gastritis
often accompanies gastric
cercinomas. These
atrophic changes apparently
cause the
Achlorhydria usually accompanying this
condition.
8.1.2 DIET
Cabbage is
the only dietary factor correlating
with gastric
cancer. This
vegetable is a stable diet of
countries where
gastric cancer
is common. Countries with a
high incidence of
gastic cancer also have a high
consumption of fish. Others have
incriminated the salty and spicy
foods.
8.2 SYMPTOMS
In
the early stages the disease is symptomless. Later
patients
present with :
*
Vague indigestion
*
Fullness after meals
*
Pain epigastrium not reduced by anything
*
Loss of weight
*
Anaemia
Diagnosis is by
*
Barium studies
*
Fibro endoscopy
8.3 TREATMENT
Surgery by radical gastrectomy in early mucosal
lesions can aim
for a cure .
The incision is upper midline or
bilateral subcostal for a total
gastrectomy and
thoroabdominal incision may
be required.
Identify the lesion and assess its
operatibility.
The stomach is freed by ligating its
arteries as close to them as
their origins to include the draining
lymph glands. The greater
omesutum and spleen are removed with
the stomach.
The
jejunim is mobilised to anaetoma with the oesophagus.
The
cut end of duodenum is closed.
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