Evaluation of cases with carcinoma stomach

Sumathi, M (2013) Evaluation of cases with carcinoma stomach. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Gastric Carcinoma, one of the oldest disease which dates back to 980-1037 BC. Aricena was the great person who gave first inputs regarding Gastric carcinoma. In 1761 Morgagni, was the person, who provided elaborate findings related to carcinoma stomach. Passing through the years, it has become, one the leading cause which contributes to death across the world. The various reviews across the world now states that gastric malignancy is on declining pattern but, in India malignancy of stomach still a major factor which has an impact over low income and people who are below poverty line.So this study was chosen to find out the various factors which will affect the occurrence of Gastric cancer Malignancies related stomach has maximum occurrence among southeast Asian countries. Among these, Japan bears the major brunt. This may be mainly due their food habits, radiation, obesity. In India, Gastric carcinoma is one the leading disease which causes morbidity and mortality. North-eastern states, especially Mizoram is the leading contender in occurrence of carcinoma stomach. The main contributing factors for the increased incidence of gastric cancer will be food habits and environmental factors. Among food habits, having salt content more in food and, increased consumption of grilled foods are the major determinants. In the environmental factors smoking, alcohol consumption, tobacco chewing are the main culprits for the occurrence of gastric malignancy. The etiopathogenesis of gastric malignancy will be mainly related to interaction between genetic and environmental factors. Diet and H.pylori will be the major contributing factors with regarding to environmental causes. With recent advancements in molecular biology enlights us, the concealed facts regarding genomic association of gastric malignancy. Over expression of abnormal genes and lack of heterogenisity in tumour suppressor genes are the important factors with genetic association. Among the types of gastric malignancy adenocarcinomas predominates. The rest of the types will be lymphoma and stromal tumours. Adenocarcinoma has two histological types. Well differentiated or diffuse type and intestinal or undifferentiated types. The morbidity and mortality related to gastric malignancies is mainly related to the time when the patient comes to the hospital. Early detection and intervention will increase the five year survival rate. AIMS AND OBJECTIVES: 1. To study the prevalence of carcinoma stomach as occurring in Tirunelveli Medical College Hospital. 2. To find out the etiology and risk factors for carcinoma stomach. 3 To study the presenting clinical signs and symptoms of carcinoma stomach. 4. To study the anatomical location of carcinoma stomach with respect to the age and sex. 5. To analysize the histopathological type in relation to the site growth and age of the patient. 6. To study the surgical modalties of treatment. METHODOLOGY: This is prospective study for EVALUATION OF CASES WITH CARCINOMA STOMACH in Tirunelveli Medical College Hospital, Tirunelveli during the period of 18 months, from Feb 2011 to July 2012. Formal ethical committee approval was obtained. Patients were informed about the study and consent was obtained. SOURCE OF DATA: Patients admitted in the Department of General Surgery, Tirunelveli Medical College who were diagnosed as carcinoma stomach. Design of study: Prospective study. Period of study: 18 months. Sample size: 103 cases of carcinoma stomach. Stastical method: Our data is represented in tabulation, graphs. Method of Collection of Data: The present study was, made out from 103 patients of carcinoma stomach admitted in Tirunelveli medical college and hospital during period of Feb 2011 – July2012.After obtaining an informed written consent, clinical history, detailed examination and relevant investigations were done. After confirming the diagnosis, evaluating the nature of the disease and considering the patient general conditions, treatment planned including both surgical and non surgical measures. If needed secondary analysis of medical records of these patient will be referred if required. The pathology report of the patient are been followed up with an earnest attempt to study all the cases in detail and to profile my observation made out of them. Inclusion criteria: 1. Male and females with complaints and investigations suggestive of carcinoma stomach. 2. Both operable and inoperable cases. 3. Advanced cases. SUMMARY: Gastric carcinoma is the disease of old age as the incidence increases with advancing age. The incidence has declined in the world because of changing diet, food preparation and environmental factors. This study was done to study the incidence of gastric carcinoma in Tirunalveli Medical College Hospital, Tirunelveli. The incidence of gastric carcinoma is more among males(3:2). The age of incidence ranges from 25 – 75 years, most commonly over 45 years. The youngest being at the age of 25 years. Increased incidence of carcinoma stomach was found in patients of both sex taking spicy food. Smoking and Alchohol also contributes the occurrence of Gastric carcinoma. The patients with A positive blood group were found to be more susceptible to gastric carcinoma. The common symptoms presented in this study were abdominal pain, nausea and vomiting, loss of appetite/weight. Anemia, mass abdomen and visible gastric peristalsis were the common signs. This shows the patients with advanced stage are turning up to the hospital. The most common site observed were the pylorus and antrum. The male patients commonly showed well differentiated tumors, whereas the females had higher incidence of moderately differentiated tumors. Most of the well differentiated tumors were found in the oesophagealgastric junction, whereas pyloric antal tumors showed moderate differentiation. As most of the patients in the study presented in advanced stages treatment was palliative in the form of gastro jejunostomy and jejunojejunostomy. CONCLUSION: Gastric cancer mortality rate have remained relatively unchanged over the years in India, inspite of various investigative and treatment modalities. This may be due late detection of disease, which is the important factor in relation to the prognosis and outcome of the disease. Although there are lot of screening investigations for early detection of gastric carcinoma, in India due to cost benefit ratio it becomes impossible .This was well noted in this study as the most of the patients were presented with advanced symptoms and signs. So the palliative treatment was the major treatment modality observed in this study. So in future ,early detection of of Gastric carcinoma should be our main objective, so that we can reduce the mortality rate, and importantly to improve the quality of life in patients suffering from Gastric carcinoma.

Item Type: Thesis (Masters)
Uncontrolled Keywords: carcinoma stomach ; Evaluation ; cases.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 18:10
Last Modified: 09 Jun 2018 18:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/8367

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