KEGANASAN

GASTROINTESTINAL
DAYU SATRIYA WIBAWA
TOPIK BAHASAN
1. Kanker Esofagus
2. Kanker Lambung
3. GIST
4. Kanker Pancreas
KANKER ESOFAGUS
SITE
TYPE
PATHOLOGY
STAGE
KANKER LAMBUNG
 Benign Malignant

1.Primary
Epithelial Adenocarcinoma
Gastrointestinal stromal tumors ‘GIST’
Mesenchymal Lymphoma

2. Secondary:
invasion from adjacent tumors.
 Risk Factors

Predisposing : Environmental: Genetic:

1. Pernicious anemia 1.H.pylori infection 1.Blood group A

& atrophic gastritis Sero(+)patients 2.HNPCC:
(achlorhydra) have 6-9 folds risk Heriditory non-
2. Previous gastric 2.low polyposis colon
resection socioeconomic cancer.
3. Chronic peptic ulcer Status
(give rise to 1%) 3. Nationality
4. Smoking. (JAPAN)
5. Alcohol. 4. Diet (prevention)
Most patients present with advanced stage..
why?
They are often asymptomatic in early stages.
SIGNS

-Anemia.
-Wt.loss ( cachexia)
-Epigastric mass,Hepatomegaly,Ascitis
-Jaundice.
-Blumers shelf
-Virchows node
-Sister mary joseph node
-Irish node
MORPHOLOGY
INVESTIGATION
GASTRO INTESTINAL STROMAL
TUMOR
(GIST)
 Gastrointestinal Stromal Tumor ‘GIST’
Previously leiomyoma & leomyosarcoma.
<1 %
Rarly cause bleeding or obstruction.
The origion: Intestinal Cells of Cajal ‘ICC;s’ autonomic nervous system.
The distinction b\w benign & malignant is unclear. In general terms, the
larger the tumor & greater mitotic activity, the more likely to metastases.
The stomach is the most common site of GIST.
Usually are discovered incidentally on
endoscopy or barium meal
The endoscopic biopsies may be
uninformative bcz the overlying mucosa
is usually normal
Small tumorswedge resection
Larger onesgastrectomy
KANKER PANKREAS
PANCREATIC CANCER: EPIDEMIOLOGY

•Incidence of 10 per 100,000

•80% ductal adenocarcinoma
•10% other exocrine tissue–
Acinar cell,
cyst adenocarcinoma,
intraductal papillary mucinous
neoplasm (IPMN)
•10% neuroendocrine
DIAGNOSTIC

Lab studies •Imaging modalities

– Tumor markers i.e.CA19-9 – CT scan
– Glucose intolerance – EUS
– ERCP
– MRI/MRCP
– PET scanning
– Staging laparoscopy
COURVOISIER'S LAW

(or Courvoisier syndrome, or Courvoisier's sign or Courvoisier-Terrier's sign)

states that in the presence of a palpably enlarged gallbladder

which is nontender and accompanied with mild painless jaundice,
the cause is unlikely to be gallstones
WHIPPLE PROCEDURE
DISKUSI