CNCER GSTRICO

Guatemala, 11 marzo 2013 E/

Elizabeth Gmez
EPIE!IO"OGI#

El $ar$i%oma &'(tri$o e( la (e&u%)a $au(a )e mortali)a) *or

$'%$er e% el mu%)o+

E( m'( ,re$ue%te e% *a-(e( (ub)e(arrolla)o(, %ormalme%te e%

hombre(+

e(*u.( )e lo( /0 *ero a *artir )e 3/ a0o( (e *re(e%ta% al&u%o(

$a(o(+
1a$tore( )e Rie(&o
Ge%.ti$a

#%eu*loi)-a e% el N# $elular
e% u% 203 )e lo( $a(o(+

P.r)i)a )e o%$o&e%e(
(u*re(ore( $omo el */3, #PC,
!CC 4 CC+

Co% me%or ,re$ue%$ia (e

re&i(tra am*li5$a$i% )e
o%$o&e%e( $omo el $6met, el 76
(am e% el $'%$er )i,u(o 4 el erb6
82 e% el ti*o i%te(ti%al+

!uta$i% )e otro( o%$o&e%e(

$omo lo( ra(, (ie%)o la
i%e(tabili)a) mi$ro(at.lite m'(
,re$ue%te e% lo( $'%$ere( *o$o
)i,ere%$ia)o(+
1#CTORES !9ICOS

Ciru&-a &'(tri$a a%terior

Ga(triti( atr5$a 4 &a(triti(

E%,erme)a) )e !e%etrier

Re:u;o biliar
<eli$oba$ter P4lori
C"INIC#
1a(e Tem*ra%a

olor ab)omi%al

P.r)i)a )e *e(o
1a(e #=a%za)a

!a(a e*i&'(tri$a

Ga%&lio )e >ir$ho?,

Si&%o )e 8lumer

N)ulo umbili$al

#($iti(

Tumor )e @ru7e%ber&
Cer$a )el A/3 )e lo(
$'%$ere( &'(tri$o(
$orre(*o%)e% a lo(
a)e%o$ar$i%oma(, mie%tra(
Bue el 1/3 re(ta%te lo
$o%(titu4e% li%,oma( 4
tumore( )el e(troma
)i&e(ti=o
#ENOC#RCINO!# G#STRICO
Se (ub)i=i)e% e% )o( ti*o( )e a$uer)o a la Cla(i5$a$i% )e
"aure%C
INTESTIN#"
Se $ara$teriza *or $.lula( %eo*l'(i$a( $ohe(i=a( Bue ,orma%
e(tru$tura( tubulare( (imilare( a &l'%)ula(+
E(ta( le(io%e( (uele% (er ul$era)a(D (o% m'( ,re$ue%te( e% el
a%tro 4 la $ur=atura me%or )el e(tma&o+
!e;or *ro%o(ti$o
<+ P4lori
i(emi%a$i% <emato&e%a
"e(io%e( *re$a%$ero(a(
<ombre( a%$ia%o(
I1ESO
No eFi(te $ohe(i% $elular+
Se rela$io%a $o% el ti*o )e $.lula( e% Ganillo de selloH (e&I% la
$la(i5$a$i% hi(tol&i$a )e la O!SD *are$e (ur&ir )e la( $.lula(
mu$i%o(a( )el $uello )el e*itelio &'(tri$o+
So% m'( ,re$ue%te( e% *a$ie%te( ;=e%e(,
$om*rometie%)o to)o el e(tma&o

li%iti( *l'(ti$a o a(*e$to e% Gbota )e $ueroH+
Gru*o Sa%&ui%eo #
Peor *ro%o(ti$o
C"#SI1IC#CION !OR1O"OGIC#
1a(e a=a%za)a
E% ba(e a TN!
T-6 Tumor *rimario
T1 "imita)oC A) mu$o(a B) (ubmu$o(a
T2 I%=a)e mu($ulari( mu$o(ae o (ub(ero(a
T3 Pe%etra (ero(a $o% i%=a(i% )e *erito%eo =i($eral+
T4 I%=a(i% a e(tru$tura( =e$i%a(: A) )ia,ra&ma, bazo, et$+ BJ
)uo)e%o o e(,a&o+
NotaC i%=a(i% a lo( li&ame%to( &a(tro$oli$o, &a(trohe*ati$o, e*i*l%
ma4or 4 me%or e( $o%(i)era)o T2+Per,ora$i% =i($eral e( $o%(i)era)o
T3+
N66 Ga%&lio( re&io%ale(
NO No6i%=a(i%
N1 I%=a(i% )e 1 a 2 &a%&lio(
N2 I%=a(i% e%tre 3 a K &a%&lio(
N3 A) 2 a 1/ B) L1K
NotaC el eFame% hi(tol&i$o )ebe )e te%er 1K o m'( &a%&lio(
M-6 !et'(ta(i(
MO %o met'(ta(i(
M1 I%=a(i% a )i(ta%$ia
Diagnstico
Clnico
"o i%e(*e$-5$o )e la( ma%i,e(ta$io%e( $l-%i$a( 4 el Bue el
*a$ie%te ma%te%&a )ura%te ba(ta%te tiem*o u% bue% e(ta)o
&e%eral, ori&i%a% la )emora )e()e el i%i$io )e lo( (-%toma(
ha(ta el )ia&%(ti$o e%treC

1 4 3 me(e( e% u% M03 )e lo( $a(o(

E%tre 3 4 12 me(e( e% u% K03

Radiolgico
Se%(ibili)a) A03 / E(*e$i5$i)a) A/3+
Co% $o%tra(te barita)o a*orta (lo i%,orma$i% $om*leme%taria+
El )ia&%(ti$o ra)iol&i$o %u%$a )ar' u%a $erteza total a$er$a )e
la be%i&%i)a) o mali&%i)a) )e u%a ima&e%, e(*e$ialme%te e% el
$a(o )e la( le(io%e( ul$era)a(+
Imagen Radiolgica de
ulcera maligna en curvatura
mayor de estmago
Endoscpico
"a &a(tro($o*ia e( u%a t.$%i$a eF*loratoria, mole(ta *ero
*er,e$tame%te (o*ortable *ara u% a)ulto+
El $'%$er &'(tri$o (e )ia&%(ti$a $o% la eF*lora$i% =i(ual e% m'(
)el N03+
Estdio d! !"t!nsin
E$o&ra,-a
Se%$illez, i%o$ui)a), )i(*o%ibili)a) 4 ba;o $o(to+
Primera eF*lora$i% a realizar e% el e(tu)io )e
eFte%(i% )el $'%$er &'(tri$o+
Permite =alorar la eFi(te%$ia )e met'(ta(i(
he*'ti$a(+
To#og$a%a Co#pta$i&ada 'TC)
!.to)o mu4 em*lea)o *ara el e(tu)io )e la eFte%(i%
tumoral 4 )e a)e%o*at-a( a )i(ta%$ia 4 met'(ta(i(+
E( $om*leme%taria $o% la e$oe%)o($o*-a
Visin tomogrfca Axial
Computarizada de un cncer
Gstrico, visualizando
engrosamiento de la pared
gstrica con disminucin del
lumen
Re(o%a%$ia !a&%.ti$a OR!J
Su utili)a) (e limita al $'%$er a=a%za)o, $o% a,e$$i% Bue reba(a
la (ero(a+

Re%)imie%to )ia&%(ti$o &lobal e( )el AA3
Serie &a(troi%te(ti%al OGIJ (u*erior
OE(o,a&o&ra,-aJ
EFami%a lo( r&a%o( )e la *arte (u*erior )el (i(tema
)i&e(ti=oC el e(,a&o, el e(tma&o 4 el )uo)e%o Ola *rimera
(e$$i% )el i%te(ti%o )el&a)oJ+
TR#T#!IENTO
"a re(e$$i% BuirIr&i$a $om*leta )el tumor, $o% eFtir*a$i% )e lo(
&a%&lio( =e$i%o(, o,re$e la I%i$a *o(ibili)a) )e $ura$i%D (i% embar&o,
e(to (lo e( *o(ible e% #!nos d!l 33( d! los paci!nt!s)
E% el $a(o )e lo( $ar$i%oma( )i(tale(, el tratamie%to m'( a*ro*ia)o e( la
gast$!cto#a s*total, mie%tra( Bue e% lo( $ar$i%oma( m'(
*roFimale( e( %e$e(ario realizar u%a gast$!cto#a total o casi total
G#STRECTO!I#
I%)i$a$io%e(
Problema( &'(tri$o( $r%i$o(
El$era(
Obe(i)a)
C'%$er
"IN1O!# G#STRICO PRI!#RIO

!e%o( )el 1/3 )e tumore( &'(tri$o( mali&%o( 4 23 )e

li%,oma(+

i5$ill )i(ti%&uir )e #)e%o$ar$i%oma+

Se ob(er=a% Il$era( e% *atr% )e(hila$ha)o 4 e%&ro(a)o+

Ce*illa)o Citolo&i$o )e la mu$o(a &'(tri$a+

"a &a(tre$tom-a (ubtotal P Buimiotera*ia $ombi%a)a u%a

(u*e=i=e%$ia )e / a0o( )e M03 a K03+
S#RCO!# G#STRICO O No "i%,oi)eJ

"eiomio(ar$oma( 4 GIST re*re(e%ta% el 13 4 33 +

Pri%$i*alme%te e% *are)e( a%terior 4 *o(terior )el ,o%)o

&'(tri$o+

+Al c,nc!$ g,st$ico no -a.
/! !sp!$a$lo0 -a. /!
*sca$lo1)
2!d$o 3lo$!ns)
Mc-as 4$acias)