Gastric adenocarcinoma

Chief Complaint A 69 y/o male presented with haematemesis. He complaints of loss of appetite & 7 kg weight loss in 2 months. Vitals BP: 110/75 mmhg, Pulse: 75 bpm, Resp rate: 16 bpm, Temp: 98.8 degree F. Examination Physical examination shows no abdominal mass or lymphadenopathy. Endoscopy showed a large tumour in the gastric antrum. Endoscopic biopsies revealed a primary gastric adenocarcinoma. Treatment Advise the line of management.



Before going for treatment it is better to go for staging of the growth by going for CT abdomen and chest to see the involvement of lymph nodes and distant metastasis. As endiscopic finding is large tumour , Chemotherapy may be given to reduce the size of tumour. As the growth limited to antrum if stomach subtotal gastrectomy with reconstruction as per Bilroth1 and Bilroth2 with Raux en Y gastrojejunostomy to prevent acid reflux with vagotomy to prevent anastomotic peptic ulcer with clearance of lymph node if involved. Later on chemothraphy wit radiothrapy if distant metastasis is there.

Gastric carcinoma Needs resection followed by chemotherapy and sos radiotherapy if mets are seen

Thanx dr Sachin Ambure

Staging of the disease to be done. Either whole body PET CT scan or Ct scan abdomen and pelvis with ct thorax. Serum CEA CBC LFT If lymph nodes are enlarged then Neoadjuvant chemotherapy followed by surgery If operable then gastrectomy followed by Chemotherapy. During surgery plan for frozen section to assess the proximal and distal margins

Ref to Onco.

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