Stomach

Grade 2: also known as moderate grade, cells look abnormal, less differentiated Grade 3: also known as high grade, rapid growth, poorly differentiated, higher propensity to metastisize.⁵ || Another staging system that can be used is a modified version of the Astler-Coller Rectal System and it is compared to the TNM system as follows⁷: ||
 * Epidemiology: ||  Distal gastric cancer and intestinal-type malignancey increase in association with Helicobacter pylori. No increased risk due to Gastric ulcer although gastrotomy for benign desease confers a 1.5-3.0 fold relative of deleveloping gastric cancer with a latency period of 15-20 years. H. pylori increases the risk of gastric cancer 3-6 times more than those uninfected. 1 ||
 * Etiology: || Smoke and salty foods, low intake of fruits and vegetables, low socioeconomic level and decreased use of refrigeration 1 ||
 * Signs & Symptoms: || Loss of appetite, abdominal discomfort, weight loss, weakness (from anemia), nausea and vomiting and tarry stools. 1 ||
 * Diagnostic Procedures: ||  Upper GI films and endoscopies are the usual way of diagnosing the patient with gastrointestinal cancer. A double contrast UGI reveals small lesions on x-ray while endoscopy gives a visual confirmation while allowing cytology. CT's of the abdominal area is appropriate to help with extent of the disease. Also, endoscopic ultrasound is good for preoperative assessment of the tumor. ² ||
 * Histology: ||  Adenocarcinoma makes up about 90-95% of the histological types, while the second most is lymphoma. ² ||
 * Lymph Node Drainage: ||  "Lymphatic drainage follows the arterial supply." The places of lymphatic drainage include splenic hilum, suprapancreatic, porta hepatis, and gastroduodenal areas which all sooner or later make their way to the celiac nodal area. ² ||
 * Metastatic Spread: || Stomach cancer can extend locally into the omenta, pancreas, diapgragm, transverse colon or mesocolon and the duodenum.³ Common sites of distant metastatic disease include the liver and the lungs.⁴ ||
 * Grading: || Grade 1: also known as low grade, slow growing and well-differentiated.
 * Staging: ||  The major staging system for stomach cancer is the American Joint Committee on Cancer TNM system⁶:
 * Radiation Side Effects: || Side effects from radiation therapy for stomach cancer can include:
 * mild skin problems at the site where the radiation was aimed
 * nausea and vomiting
 * diarrhea
 * fatigue
 * low blood cell counts⁹ ||
 * Prognosis: || <span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;">Five-year relative survival rates for stomach cancer by race and sex were:

·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Verdana','sans-serif'; font-size: 10pt;">19.9 percent for white men ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> 23.9 percent for white women ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Verdana','sans-serif'; font-size: 10pt;">21.5 percent for African American men ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Verdana','sans-serif'; font-size: 10pt;">24.2 percent for African American women. <span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;"> The corresponding five-year relative [|**stomach cancer survival rates**]<span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;">were:

·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;">58.0 percent for localized <span style="color: #ff00ff; font-family: Symbol,sans-serif; font-size: 10pt;">·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="color: #ff00ff; font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="color: #ff00ff; font-family: 'Verdana','sans-serif'; font-size: 10pt;">21.9 percent for regional ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Verdana','sans-serif'; font-size: 10pt;">3.1 percent for distant ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Verdana','sans-serif'; font-size: 10pt;">12.4 percent for staging that was unknown.⁸ ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> In the United States and most of the Western world, the 5-year survival rate ranges from 5-15%. In Japan, where stomach cancer often is diagnosed early, the 5 year survival rate is about 50%. Five year survival rates for more advanced stomach cancers range from, around 20% for those with regional disease to almost nil for those with distant metastases. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Treatment for metastatic stomach cancer can relieve symptoms and sometimes prolong survival, but long remissions are not common. The survival of inoperable stomach cancer is usually only a few months if untreated. With chemotherapy the average survival is about 12 months. If cancer is found before it has spread, the five-year relative survival rat  e is about  61%.⁹ || Esophagus 60 Gy, 58 Gy, 55 Gy Kidney 50 Gy, 30 Gy, 23 Gy Heart 60 Gy, 45 Gy, 40 Gy Lung 45 Gy, 30 Gy, 17.5 Gy Small bowel 50 Gy, xx, 40 Gy Liver 50 Gy, 35 Gy, 30 Gy Spinal cord 50 Gy, 50 Gy, 47 Gy¹⁰ ||
 * Treatments: || <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">The main treatments for stomach cancer are surgery, chemotherapy, and radiation therapy. Often the best approach uses 2 or more of these treatment methods.based on the site of locoregional failure the gastric tumor bed, anatomosis and stump, and regional lymphatics should be included in all patients. Major nodal chains at risk include lesser and greater curvature, celiac axis, pancreaticoduodenal, splenic, suprapancreatic, and portal hepatis. Parallel opposed AP fields are the most practical arangements for major portion of tumornodal irradiaton. in view of the posterior extent fo the gastric fundus, it is often impractial to use lateral portals for 10-20 Gy to spare the spinal cord or kidney. the average irradiationfield is 15cn X 15cm. with single daily fractions, the usualy dose is 45-52 Gy delivered in 1.8 -2.0 Gy fractions over 5 to 5.5 weeks, with field reduction after 45Gy. reduced boost fields to small areas of residual disease can sometimes be cautiously carried to doses of 55- 60 Gy. for proximal gastric lesions, 50% or more of the left kidney is commonly within the irradiation portal, and the right kidney must be appropriatly spared. for distal lesions with narrow or postivie duodenal margins, a similar amount of right kidney often is included. with proximal gastric lesions or those at ethe G-E junction, a 3-5cm margin of distal esophagus should be included.⁹ ||
 * TD5/5: || Organ (1/3), (2/3), (3/3)

<span style="color: #008000; display: block; font-family: Arial,sans-serif; font-size: 13pt; text-align: left;">Figure 1: Stomach field diagram¹⁰<span style="color: #0000ff; font-family: arial,helvetica,sans-serif; font-size: 13px; line-height: 19px;"> <span style="color: #008000; display: block; font-family: Arial,sans-serif; font-size: 13pt; text-align: left;">Figure 2: Gastropharangeal Junction¹⁰ References 1. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002. 2. Chao KS, Perez CA., Brady LW. // Radiation Oncology - Management Decisions //. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002. 3. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:377. 4. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:377. 5. Gupta A. //Staging and grading of stomach cancer.// Available at: []. Accessed on January 18, 2010. 6.Gunderson LL, Haddock MG, Goldberg, R, et. al. Alimentary Cancer. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:701. 7.Gunderson LL, Haddock MG, Goldberg, R, et. al. Alimentary Cancer. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:702. 8. Prognosis and statistical data at: [|www.acs.org/stomach/prognosis]. 9. Chao KS, Perez CA, Brady LW. Radiation Oncology- Management Decisions. 2nd ed. <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif; font-size: 10pt;">Philadelphia, PA: Lippincott, Williams & Wilkins; 2002 <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt;"> 10. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002. <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt;">