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DR. MABEL HM SIHOMBING, SPPD-KGEHDR.ILHAMD SPPD

DIVISION OF GASTROENTERO-HEPATOLOGY DEPARTEMENT OF INTERNAL MEDICINE FACULTY OF

MEDICINE / NORTH OF SUMATERA H. ADAM MALIK HOSPITAL

TUMOR LAMBUNGTUMOR LAMBUNGTUMOR LAMBUNGTUMOR LAMBUNG

TUMOR LAMBUNG

EPIDEMIOLOGY

INSIDENSI :

JAPAN :100/100000USA : 6 /100000

TYPE :

ADENO CARCINOMAGASTRIC LYMPHOMALEIOMYOSARCOMASCARCINOID TUMORS

SYMPTOM :

NOT SPECIFIC & FREQUENT VAGUE(EPIGASTRIC PAIN, HEARTBURN, ULCER PAIN, BB↓↓↓↓,MUAL, ANEMIA, HEMATEMESIS)

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RISK FACTORS FOR GASTRIC ADENOCARCINOMA

DEFENITE/SURVEILLANCE SUGGESTED

FAMILIAL ADENOMATOUS POLIPOSIS (FAP),GASTRIC ADENOMA DYSPLASIA

DEFENITE

HP INFECTION, CHRONIC ATROPHIC GASTRITIS,INTESTINAL METAPLASIA,HERED. NONPOLYPOSIS COLORECTAL CANCER (HNPCC)POSTGASTRECTOMY,FIRST-DEGREE RELATIVE WITH GASTRIC CANCER

PROBABLE

PEUTZ-JEGHERS SYNDROME, CIGARETTE SMOKING,LOW ASPIRIN INTAKE, HIGH SALT INTAKE,LOW INTAKE OF FRESH FRUITS AND VEGETABLES,PERNICIOUS ANEMIA, LOW ASCORBATE INTAKE

POSSIBLE

LOW SOCIOECONOMIC STATUSMENETRIER’S DISEASE, GASTRIC ULCER

QUESTIONABLE

HIGH INTAKE OF ALCOHOL HYPERPLASTIC/FUNDIC POLYPS

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HELICOBACTER PYLORI CARCINOGENIC NO. 1

PROPOSED MULTISTEP PATHWAY IN THE PATHOGENESIS OF GASTRIC CANCER

NORMAL

CHRONIC ACTIVE GASTRITIS

ATROPHIC GASTRITIS

INTESTINAL METAPLASIA

LOW – GRADE DYSPLASIA

HIGH - GRADE DYSPLASIA

GASTRIC CANCER

APC / ββββ = CATENIN

P53 MICROSATELLITE INSTABILITY

H PYLORI

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H. Pylori

AcquisitionAutoimmunity Normal Stomach

DGCA

Multifactorial

Cronic gastritisNaCl

Atropic gastritis Intestinal Metaplasia45 %

IGCA

Bacterial over growth/Inflammation

N-Nitroso-Compouns

Vitamin intake (c, carotene)

10 %

45 %

Dugaan : Pathogenesis of Gastric Carcinoma

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INVESTIGATION :

���� HISTORY

���� PHYSICAL EXAMINATION

���� BARIUM MEAL

DOUBLE CONTRAST

���� ENDOSCOPY����BIOPSY CONFIMATIVE

DIAGNOSTIC

���� SCANNING

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TREATMENT

���� CURATIVE (OPERATIVE) :

SUBTOTAL GASTRECTOMY

MORTALITAS ↓↓↓↓ & MORBIDITAS ↓↓↓↓

���� PALLIATIVE (OPERATIVE) :

SUBTOTAL GASTRECTOMY

BLEEDING ↓↓↓↓ & OBSTRUCTION ↓↓↓↓& QOL ↑↑↑↑ (QUALITY OF LIFE )

���� CHEMOTHERAPY :

PENGOBATANPENGOBATANPENGOBATANPENGOBATAN ::::

# DINI : MUNGKIN MASIH DAPAT DILAKUKAN MUCOSAL

RESECTION (EMR)

# BEDAH : - CURATIVE

- PALLIATIVE : - TANDA OBSTRUKSI

- TANDA PERDARAHAN

# KEMOTERAPI

# RADIASI

Prognosis :Prognosis :Prognosis :Prognosis :

Sangat ditentukan oleh :

1. Derajat invasi dinding lambung

2. Adanya penyebaran ke kelenjar lymph

3. Anak sebar di peritoneum dan tempat lain

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COMPLICATION POST OPERATIVE (SUBTOTAL GASTRECTOMY)

1. MEGALOBLASTIC ANEMIA ←←←← SUPP. VIT B 12

2. DUMPING SYNDROME : NAUSEA, VOMITING

ABD. FULLNESS, TACHYCARDIA,WEAKNESS, DIZZINESS

SMALL MEAL & LOW CHO

3. BUND LOOP SYNDROME

REFRACTORY DIARRHEA ←←←← BACTERIAL

OVER GROWTH ←←←← MALABSORBTION

ANTIBIOTICS

INTRA OPERATIVE STAGING

TUMOR 5 YEARS SURVIVAL

STAGE I MUCOSA-SUBMUCOSA 85 %

STAGE II PENETRASI���� SEROSA 45 – 55 %

STAGE III REGIONAL LYMPHNODE (+)

17 %

STAGE IV DISTAN METASTASIS < 5 %