ABSTRACT. Instrumentgal Studies

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MINISTRY OF EDUCATION AND SCIENCE OF RUSSIAN FEDERATION

Federal State Autonomous Educational Institution of Higher Education

< < V. I. VERNADSKY CRIMEAN FEDERAL UNIVERSITY> >

Medical Academy named after S. I. Georgievsky ( structural subdivision)

ABSTRACT

Subject: Gastric Cancer: Diagnosis and Treatment

Student: VORA GAURAV

Faculty: Hospital practice Course: 3 course IMF Group: La1 co 182(2)

Name of Practice: Physical assistant in in-patient medical department

Simferopol 2021

Introduction:

Gastric cancer (GC) remains an important cancer worldwide and it is estimated that there will be over 1, 000, 000 new cases and 783, 000 deaths from Gastric Cancer in 2021, making it the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide.

The incidence of distal stomach tumors has greatly declined, but reported cases of proximal gastric carcinomas, including tumors at the gastroesophageal junction, have increased. Early diagnosis of gastric cancer is difficult because most patients are asymptomatic in the early stage. Weight loss and abdominal pain often are late signs of tumor progression. Chronic atrophic gastritis, Helicobacter pylori infection, smoking, heavy alcohol use, and several dietary factors have been linked to increased risks for gastric cancer. Esophagogastroduodenoscopy is the preferred diagnostic modality for evaluation of patients in whom stomach cancer is suspected. Accurate staging of gastric wall invasion and lymph node involvement is important for determining prognosis and appropriate treatment. Endoscopic ultrasonography, in combination with computed tomographic scanning and operative lymph node dissection, may be involved in staging the tumor. Treatment with surgery alone offers a high rate of failure. Chemotherapy and radiotherapy have not improved survival rates when used as single modalities, but combined therapy has shown some promise. Primary prevention, by control of modifiable risk factors and increased surveillance of persons at increased risk, is important in decreasing morbidity and mortality.

GC shows marked age variation and tends to be more frequently diagnosed in elderly patients with an average onset age of 68 years in the United States; more than 95% of all new cases are diagnosed in patients older than 40 years.

Although young adults are less commonly affected by GC, previous reports have suggested that approximately 5. 0% of GC patients are diagnosed before the age of 40. This is still a huge medical burden worldwide, especially for countries with a high incidence of GC. GCYA presents a challenge, in part because it is characterized by a high aggressive growth pattern and a more advanced stage at diagnosis, and many questions remain regarding carcinogenesis, treatment, prognosis, and prevention. Therefore, some authors have proposed that GCYA should be considered a different clinical entity, raising the necessity of differential management. In this review article, I summarize the epidemiology, risk factors, molecular and clinical features, prognosis, and strategies for the prevention of GCYA, and provide some considerations for future perspectives. Focusing more on diagnosis and Treatment.

Stomach cancer is often either asymptomatic (producing no noticeable symptoms) or it may cause only nonspecific symptoms (which may also be present in other related or unrelated disorders) in its early stages. By the time symptoms are recognized, the cancer has often reached an advanced stage, and may have metastasized (spread to other, perhaps distant, parts of the body), which is one of the main reasons for its

relatively poor prognosis. Stomach cancer can cause the following signs and symptoms:

Early cancers may be associated with indigestion or a burning sensation (heartburn). However, fewer than one in every 50 people referred for endoscopy due to indigestion has cancer. Abdominal discomfort and loss of appetite, especially for meat, can occur.

Risk Factors

What characterizes cancer is a shared constellation of abnormal cell behaviors, such as rapid cell division and the invasion of surrounding tissue, which are linked to changes in DNA. Cancer can affect anyone, while different genetic, environmental, and lifestyle factors may place some people at higher risk than others.

1. H. pylori Infection

H. pylori is accepted as the main etiological factor in gastric carcinogenesis. The bacteria can synthesize many different virulence factors to disrupt the balance between cell proliferation and apoptosis, which is an important driving force for the occurrence and development of Gastric Cancer. Although H. pylori infection is considered to be a risk factor for the development of well-differentiated, intestinal-type Gastric Cancer in middle-aged or elderly populations, the etiological role of H. pylori infection in both diffuse-type and intestinal-type Gastric cancer in young adult has also been elucidated.

Studies have also reported that the prevalence of H. pylori infection and the incidence of precancerous lesions were high among the first-degree relatives of GC patients, and relatives of GC patients are more frequently colonized by the most virulent H. pylori cagA and vacA genotypes.

3. Hormones

Since the discovery of the presence of the estrogen receptor (ER) in some cases of GC, considerable controversy exists among studies on the relation between the ER and GC in the general population. A large case-control study also found that in females, frequent use of oral contraceptives without progesterone, older age at first delivery, a lack of lactation history, and nulliparity were significantly associated with an increased risk of GC [29], which may support the harmful role of estrogen in GCYA in females. A higher frequency of bone metastases in young patients may also be associated with estrogen receptor positivity, which has been demonstrated in other cancer types 4. Lifestyle

Other acquired risk factors, such as socioeconomic status, lifestyle, psychosocial environment, and dietary habits, are significantly associated with GC. Any use of tobacco products, weekly use of alcoholic beverages, higher intake of beef and barbecued/smoked foods, and lower intake of fresh fruits/vegetables are all associated with an increased risk of GC in young men, although their effects are present in different subsites. A relationship between obesity and GC has not been identified definitely, although a hypothesis exists that increasing rates of gastroesophageal reflux disease (GERD) associated with obesity may predispose individuals to more proximal tumors.

5. Genetic Factor

Germline truncating mutations in the CDH1 gene

Ras Homolog Gene Family A (RhoA)

Microsatellite instability-high (MSI-H) tumors

Diagnosis

Gastric Cancer Diagnosis includes:

Step 1 Complains:

The initial diagnosis of gastric carcinoma often is delayed because up to 80 percent of patients are asymptomatic during the early stages of stomach cancer.

late-stage gastric cancer include Weight loss, abdominal pain, nausea and vomiting, early satiety, and peptic ulcer symptoms.

Other symptoms include indigestion or heartburn, Pain and discomfort in Abdomen, nausea, vomiting, bloating after meal, loss of appetite, dysphagia, dyspepsia.

(Late complications of stomach cancer include: the presence of pathological pleural and peritoneal effusion; obstruction of the esophagus, gastroesophageal compound, gastric or small intestine output; gastrointestinal bleeding - from varicosely dilated esophageal veins or anastomosis after surgery; liver jaundice caused by massive hepatomegaly; extrahepatic jaundice (hemolytic, mechanical); distant metastases; exhaustion due to fasting or cahexia caused by tumor. Due to the use of intensive care methods by vascular access, complications in the form of hypercoagulation and thrombosis of the shoulder vessels have become more frequent. )

Step 2 Anamnesis morbi and vitae to ensure about hereditary cause of disease.

Step 3 Physical Examination:

Pale colour skin due to anemia.

Palpitation of abdomen may reveal epigastric pain, hepatomegaly, enlarged stomach,

, a primary mass (rare), an enlarged liver, Virchow’s node (i. e., left supraclavicular), Irish node (Ant. Axillary), Sister Mary Joseph’s nodule

(periumbilical), or Blumer’s shelf (metastatic tumor felt on rectal examination, with growth in the rectouterine/rectovesical space), gastric signet ring cell.

Step 4 Investigation Laboratory Studies:

• CBC: May be helpful to identify anemia, which may be caused by bleeding, liver dysfunction, or poor nutrition; approximately 30% of patients have anemia

• Electrolyte panels

• Liver function tests: may be performed to assess the function of your liver, to which stomach cancer can spread.

• Nutrition panel helps evaluate patients for deficiency of nutrients, such as vitamin D and iron. The test helps us identify the nutrients patients need replaced or boosted to support their quality of life.

• Tumor markers such as CEA and CA 19-9: Elevated CEA in 45-50% of cases; elevated CA 19-9 in about 20% of cases

Instrumentgal Studies

Double Contrast barium swallow study:

The patient swallows a packet of effervescent agent and then rapidly gulps a packet of high-density barium. frontal and left posterior oblique views are taken. two exposures are centered on the upper/mid esophagus and two on distal esophagus. It will indicate cancerous region in stomach or gastric tract.

The patient swallows a liquid containing barium and then a series of x-rays are taken. Barium coats the surface of the esophagus, making cancer or other unusual changes easier to see on the x-ray. If there is an abnormal looking area, an upper endoscopy and biopsy to find out if it is cancerous is typically performed.

Esophagogastroduodenoscopy:

It is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. Its combined with endoscopic biopsy. Multiple biopsy specimen should be obtained from any visually suspicious areas.

It is also known as an upper endoscopy, is the primary test for diagnosing stomach cancer. To undergo an EGD procedure, you first receive a sedative. A gastroenterologist then inserts an endoscope (a thin, lighted tube) into your mouth. He or she passes the endoscope through your throat, down into your esophagus and stomach, and into the first part of your small intestine. The endoscope enables your gastroenterologist to see inside these organs to check for abnormalities, such as tumors, ulcers, obstructions and inflammation. He or she obtains biopsies of abnormal tissue through the endoscope. The tissue is then analyzed in the laboratory to look for signs of cancer.

Endoscopic Ultrasonography:

It helps your gastroenterologist examine your stomach and organs, such as your pancreas, liver, gallbladder and bile duct. This test for stomach cancer uses sound waves to identify tumors and nearby lymph nodes to which the cancer may have spread. EUS allows your gastroenterologist to determine whether cancer has spread through multiple layers of your stomach, helping your doctors stage the disease and tailor your treatment plan.

Endoscopic ultrasound ( EUS ) is a minimally invasive procedure to assess digestive (gastrointestinal) and lung diseases. A special endoscope uses high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract and chest, nearby organs such as the pancreas and liver, and lymph nodes.

Computed Tomography:

CT scans can show the stomach fairly clearly and often can confirm the location of a cancer. CT scans can also show other parts of the body to which stomach cancer might have spread, such as the liver and nearby lymph nodes.

It detects metastasis greater than 5 mm in diameter, perigastric involvement, peritoneal seeding

A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body..

Magnetic Resonance:

MRI does have a fairly high rate of diagnosing various stomach cancers accurately, but the success rate goes up when MRI is coupled with other diagnostic procedures. For example, in a study of 38 patients known to have gastric cancer, MRI was 86. 64 percent accurate in diagnosing the condition.

MRI uses a magnetic field rather than X-rays, and can often distinguish more accurately between healthy and diseased tissue than a CT. An MRI gives a better picture of cancer located near bone than does CT, does not use radiation, and provides pictures from various angles that enable doctors to construct a threedimensional image of the cancer.

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