Stomach Cancer

GROUP 6

 JOSEPH NDEGWA
 FRANCIS CHEGE
 ADOW MUHAMMED
 PATRICK MWENDWA
 RACHAEL KAMAU
 CHRISTINE ABENZA
 STOMACH CANCER

 Stomach cancer is a cancer that forms in tissues lining

the stomach. Most stomach cancers start from cells in
the inner layer of the stomach (the mucosa) which
normally make and release mucus* and other fluids.
These cancers are called adenocarcinomas and
represent about 90% of stomach cancers.
 CONT..

 Layers of the Stomach

 Mucosa
 The innermost layer, the mucosa, is lined with simple columnar
epithelial cells that secrete mucus and gastric juices. This layer is crucial
for protecting the stomach lining from its own acidic environment and
aids in digestion. It features numerous gastric pits that lead to gastric
glands, which produce digestive enzymes and acids necessary for
breaking down food12.
 Submucosa
 The submucosa is a layer of connective tissue that houses blood
vessels, lymphatics, and nerves, including the submucosal plexus. This
layer provides structural support and flexibility to the stomach wall
while facilitating nutrient absorption and secretion regulation
 Muscularis Externa
 This layer consists of three layers of smooth muscle: an inner oblique
layer, a middle circular layer, and an outer longitudinal layer. This
unique arrangement allows for vigorous churning and mixing of food,
essential for mechanical digestion. The muscularis externa also
contains the myenteric plexus, which coordinates peristaltic
movements12.
 Serosa
 The outermost layer, known as the serosa, is made up of a thin layer
of connective tissue covered by mesothelium (simple squamous
epithelium). This layer provides a smooth surface that reduces
friction between the stomach and surrounding organs in the
abdominal cavity
CONT..
 Types of Stomach Cancer
 Adenocarcinoma: The most common type, arising from the glandular
cells of the stomach lining.
 Gastric lymphomas, which are cancers originating from cells of the
immune system found in the wall of the stomach. Most gastric
lymphomas are non-Hodgkin lymphomas. More information on non-
Hodgkin lymphoma can be found
 Gastro-intestinal stromal tumors or GIST, which are rare tumors
that are believed to originate from cells in the wall of the stomach
called interstitial cells of Cajal. Information on gastro-intestinal stromal
tumor can be found
 Neuroendocrine tumors which are tumors originating from nervous
or endocrine cells of the stomach. Information on gastric
neuroendocrine tumors can be found
 STAGES
Stage 0 The abnormal cells are only found in the inner layer of the mucosa* of
the stomach, called the epithelium. This stage is also called carcinoma in
situ.
Stage I The tumor invades the complete mucosa with or without affecting lymph nodes*,
or invades the muscle layer or the subserosa* without affecting any of the lymph
nodes*. Stage I is divided into stages IA and IB.

Stage IA The abnormal cells are found in the deepest layer of the mucosa* (called lamina
propria) or in the submucosa*, but no lymph nodes* are affected.

Stage IB  The abnormal cells are found in the deepest layer of the mucosa* (called
lamina propria) or in the submucosa* and in 1 to 6 lymph nodes* OR
 The abnormal cells are found in the muscle layer or the subserosa* of the
stomach, but no lymph nodes* are affected.
Stage II Stage II groups various combinations of depth of tumor invasion and
number of lymph nodes* involved.  Either the abnormal cells are found in
the deepest layer of the mucosa* (called lamina propria) or in the
CONT
submucosa* and in 7 to 15 lymph nodes* OR  the abnormal cells are found
in the muscle layer or in the subserosa* of the stomach and in 1 to 6 lymph
nodes* OR  the abnormal cells are found in the serosa*, but no lymph
nodes* are affected.
Stage III The tumor has spread to the muscle layer, the subserosa*or the serosa* and to up to
15 lymph nodes*, or has invaded the structures that surround the stomach without
affecting any lymph nodes*. The tumor has not spread to distant organs such as
liver, lungs or lymph nodes* in other parts of the body. Stage III is divided in stage
IIIA and IIIB.
Stage IIIA  The abnormal cells are found in the muscle layer or the subserosa* of the stomach
and in 7 to 15 lymph nodes* OR  The abnormal cells are found in the serosa* and in
1 to 6 lymph nodes* OR  The tumor has invaded the structures that surround the
stomach, but no lymph nodes* are affected.

Stage IIIB The abnormal cells are found in the serosa* and in 7 to 15 lymph nodes*.

Stage IV More than 15 lymph nodes* are involved or the tumor has spread to structures
surrounding the stomach or to other parts of the body: - The tumor has invaded the
structures that surround the stomach and there are lymph nodes* involved OR - The
tumor has not invaded structures that surround the stomach but more than 15 lymph
nodes* are affected OR - Distant metastasis* is to be found, meaning the cancer has
spread to other parts of the body.
 RISK FACTORS/CAUSES STOMACH CANCER
 Environmental factors: Helicobacter pylori or H. pylori is a bacteria and can reside
in the stomach and cause chronic inflammation or stomach ulcers*. If this situation
persists for a few decades, it can evolve into cancer.
 Medical Conditions:
 Chronic gastritis: long-term inflammation of the stomach lining can lead to thinning
of the gastric mucosa, loss of glandular cells, and intestinal metaplasia, increasing
the risk of developing stomach cancer.
 Pernicious anemia:This condition often results from autoimmune gastritis, where
the immune system attacks the stomach lining. The chronic inflammation and
destruction of stomach cells in pernicious anemia can lead to intestinal metaplasia
and increase the risk of gastric adenocarcinoma.
 Stomach polyps:The two common types are:
1. Hyperplastic polyps: Linked to chronic inflammation, such as from H. pylori
infection.
2. Adenomatous polyps: Less common but have a higher risk of becoming cancerous.
 CONT..
 Genetics:
 Family history of stomach cancer.
 Hereditary syndromes such as Lynch syndrome or hereditary diffuse
gastric cancer.
 Lifestyle:
 Nutrition: A high dietary intake of salt, including salt preserved (e.g.
smoked or pickled with salt) food, strongly increases the risk of
developing stomach cancer.
 Tobacco use.
 Heavy alcohol consumption
 PATHOPHYSIOLOGY

 The pathophysiology of stomach cancer typically begins with chronic

inflammation or irritation of the gastric mucosa, often due to factors
like Helicobacter pylori infection, dietary carcinogens, or genetic
predisposition. This leads to cellular changes, such as atrophy,
intestinal metaplasia, and dysplasia, which can progress to
malignancy. Stomach cancer commonly arises from the glandular cells
of the gastric lining, resulting in adenocarcinoma. Mutations in genes
like CDH1, TP53, and pathways such as Wnt/β-catenin and HER2
signaling contribute to uncontrolled cell growth. As the cancer invades
deeper layers of the stomach wall, it can spread via lymphatics, blood
vessels, or direct extension to nearby organs.
 CLINICAL FEATURES

  abdominal discomfort or pain

  a sense of fullness, even after eating a small meal
  heartburn, indigestion, acidity and burping
  nausea and/or vomiting, especially including blood.
  swelling or fluid build-up in the abdomen
  poor appetite
  unexplained extreme weight loss
 Difficulty swallowing
 heartburn
 INVESTIGATIONS\DIAGNOSIS

 Personal and family health history

 Physicalexam– checksabdomen for fluid, swelling or other changes
 Upper GI series – x-rays of esophagus and stomach (barium meal/sallow)
 Endoscopy– useof athin, lighted tube (endoscope) to look into the stomach
 Biopsy – checks tissue sample under microscope for cancer cells

 cont..

 Blood tests – CBC to check for anemia andhow the liver is working
 Chest x-ray – checksfor tumors in the lungs
 CT scan– detailed pictures of the organs
 Endoscopic ultrasounds a special kind of endoscopy that can help stage the cancer. The
endoscope used has an ultrasound probe attached at its tip, that can take pictures of your
stomach. It can show if the cancer’s spread from your stomach lining to your stomach wall
 Laparoscopy – small incisions in the abdomen. The surgeon may remove
lymph nodes or take tissue samplesfor biopsy.
TREATMENT

 Local therapy - removes or destroys cancer in or near the stomach ◦

Surgery – either partial or total gastrectomy ◦ Radiation – useshigh
energy rays to kill cancer cells
 Systemictherapy – the drug enters the
bloodstream and destroys or controls
cancer throughout the body
 ◦ Chemotherapy – use santicancer drugs
cont..

Upper endoscopy. In the early stages, when the cancer is limited to your
stomach's superficial (uppermost) layers, the cancer can be removed
through an upper endoscopy. In this procedure (endoscopic submucosal
dissection or endoscopic mucosal resection), a gastroenterologist cuts the
tumor from your stomach wall and removes it through your mouth.
Gastrectomy. Once the tumor spreads beyond your stomach's superficial
layers, you'll need surgery to remove all or part of your stomach. Subtotal
gastrectomy removes the part of your stomach affected by the cancer.
Total gastrectomy removes your entire stomach. Your provider will connect
your esophagus to your small intestine so that you can still eat following
total gastrectomy.
cont...

 Other treatments
 Additional treatments attack cancer cells directly.

 Chemotherapy (chemo)... uses drugs to shrink cancer cells, making them easier to
remove before surgery. Chemotherapy can also kill the remaining cancer cells after
surgery. It’s usually used in combination with radiation. Chemo may be used with
targeted drug therapy, too.
 Radiation.... uses targeted energy beams like X-rays to destroy cancer cells.
Radiation alone isn’t effective in treating stomach cancer, but it may be used
alongside chemo before and after surgery. Radiation can also help relieve symptoms.
 Targeted drug therapy zeroes in on weaknesses in cancer cells, causing them to die.
It’s often used with chemo in cancer that recurs (comes back) or that’s advanced.
cont..

Immunotherapy .....helps your immune system identify and destroy cancer

cells that may be hard to detect. It’s most commonly used in recurring or
advanced cancer.
Palliative care helps improve your quality of life as someone with a cancer
diagnosis. Palliative care is specialized medical care that may include
doctors, nurses and other specialists who can help with symptom relief.
They can also provide additional support that complements the care you
receive from your regular providers. You can receive palliative care
alongside other treatments.
DIFFERENTIAL DIAGNOSIS

Peptic Ulcer Disease: Ulcers in the stomach or duodenum that mimic pain,
nausea, or bleeding.
Gastritis: Chronic inflammation causing dyspepsia or epigastric pain.
Gastroesophageal Reflux Disease (GERD): Presents with heartburn or
regurgitation.
Benign Stomach Polyps: Can cause similar nonspecific symptoms like
discomfort or bleeding.
Pancreatic Cancer: Epigastric pain and weight loss may overlap.
Esophageal Cancer: Especially when involving the gastroesophageal
junction, with symptoms like dysphagia.
COMPLICATIONS

 Gastrointestinal Bleeding: Tumor erosion into blood vessels can cause hematemesis
(vomiting blood) or melena (black, tarry stools).
 Obstruction: Tumors near the pylorus or cardia can block food passage, leading to
vomiting or dysphagia.
 Perforation: Advanced tumors can erode through the stomach wall, causing peritonitis.
 Metastasis: Spread to organs such as the liver, lungs, bones, or peritoneum, leading to
systemic symptoms like jaundice or ascites.
 Malnutrition and Weight Loss: Due to reduced food intake, malabsorption, or tumor-
related cachexia.
 Anemia: Chronic blood loss from the tumor leads to iron-deficiency anemia.
 Fistula Formation: Invasion of the tumor into adjacent organs can result in abnormal
connections, such as gastrocolic fistulas.
 Paraneoplastic Syndromes: Rare, involving dermatomyositis or acanthosis nigricans.
END

 THANKYOU