Treatment_of_Gastric_Cancer_Advanced.pptx

Gastric cancer treatment

1. Treatment of Gastric Cancer Final Year MBBS Presentation Vizhina Shree

2. Epidemiology & Rationale Major cause of morbidity & mortality worldwide Most patients present late → advanced disease Treatment must be stage‑appropriate (cure vs palliation) [Insert image: Global gastric cancer map]

3. Staging & Decision Factors Depends on tumour location, T stage, N stage, M stage Staging: CT, Endoscopic US, Diagnostic laparoscopy Patient factors: age, comorbidities, performance status [Insert diagram: TNM staging / Lymph node stations]

4. Radical Surgery Distal gastrectomy – antral/distal tumours Total gastrectomy – proximal/mid-body tumours R0 resection = negative margins essential Lymphadenectomy: D1 vs D2 (D2 = standard) [Insert diagram: D1 vs D2 dissection]

5. Reconstruction Billroth I – gastroduodenostomy Billroth II – gastrojejunostomy Roux‑en‑Y esophagojejunostomy after total gastrectomy Aim: restore continuity, reduce reflux, maintain nutrition [Insert diagrams of Billroth I, II, Roux‑en‑Y]

6. Chemotherapy Neoadjuvant: before surgery, improves resectability Common regimen: FLOT (5-FU, Leucovorin, Oxaliplatin, Docetaxel) Adjuvant: after surgery, esp. node‑positive/advanced Trials: MAGIC, FLOT4, CLASSIC, ACTS‑GC [Insert flowchart: Perioperative chemotherapy strategy]

7. Radiotherapy Not routine for all Adjuvant chemoradiation: positive margins, locally advanced Western practice (INT‑0116 trial) vs Asian practice (D2 surgery) [Insert image: Radiotherapy field planning]

8. Targeted & Immunotherapy HER2 positive → Trastuzumab with chemo PD‑1 inhibitors: Nivolumab, Pembrolizumab Used in advanced/metastatic settings [Insert image: HER2/PD-L1 pathway schematic]

9. Palliative Treatment Unresectable or metastatic disease Options: palliative gastrectomy (bleeding/obstruction) Bypass: gastrojejunostomy / endoscopic stenting Systemic chemo, supportive care [Insert photo: Endoscopic stent / GJ anastomosis]

10. Complications & Post-op Care Immediate: leak, bleeding, infection, pancreatic injury Late: dumping syndrome, nutritional deficiencies (B12, iron) Long‑term follow‑up: diet, supplementation, surveillance [Insert diagram: Dumping syndrome mechanism]

11. Prognosis Early gastric cancer → 5-year survival > 70-90% Advanced disease → < 30% survival Prognosis depends on stage, margin status, LN yield [Insert survival curve diagram]

12. Treatment Algorithm Stage disease → Assess resectability → Decide plan Resectable + fit: Neoadjuvant chemo → Surgery (D2) → Adjuvant therapy Early/localised: Surgery ± adjuvant Unresectable/metastatic: Palliative chemo / stent / supportive [Insert flowchart: Gastric cancer management algorithm]

13. Conclusion Surgery with D2 lymphadenectomy = cornerstone of cure Chemo (perioperative/adjuvant) improves survival Targeted therapy and immunotherapy in advanced cases Palliative care essential for quality of life [Insert summary diagram: multimodal treatment approach]