| Abstract | Posljednjih nekoliko desetljeća zabilježen je pad incidencije karcinoma želuca. Usprkos njegovu padu stopa mortaliteta ostaje nepromijenjena. Karcinom želuca ostaje među vodećim uzrocima smrtnosti od karcinoma. U Hrvatskoj se rak želuca nalazi na trećem mjestu dok je u pojedinim dijelovima svijeta poput Japana, Istočne Azije, Južne Amerike te Istočne Europe, njegova incidencija vrlo visoka. Muškarci su znatno češće zahvaćeni ovom bolešću te oboljenje nastupa nakon 50-te godine života. Neki od čimbenika rizika koji pogoduju nastanku bolesti su stanja poput kroničnog gastritisa, želučanih polipa, pušenje, pozitivina obiteljska anamneza, prehrana soljenom, dimljenom te konzerviranom hranom koja je siromašna svježim povrćem i voćem. Većina karcinoma želuca pojavljuje se sporadično, dok ih svega 10% ima obiteljsku podlogu. U procesu karcinogeneze iznimno važnu ulogu nosi infekcija H. pylori. Adenokarcinomi čine najčešći oblik karcinoma želuca. Laurenova klasifikacija intestinalnog i difuznog tipa karcinoma do danas ostaje najčešće upotrebljavanom histološkom klasifikacijom. Karcinom želuca je često asimptomatski u najranijim fazama bolesti. Naime, čak 90% pacijenata se prezentira tijekom uznapredovale bolesti s proširenim metastazama kada su mogućnosti izlječenja veoma slabe. Neki od simptoma su anoreksija, gubitak težine i bol u trbuhu. Mučnina, povraćanje i osjećaj rane sitosti nastupaju kod velikih tumora koji opstruiraju lumen. Ulcerirani tumori uzrokuju krvarenje koje se manifestira kao hematemeza, melena ili hemoragija iz gornjeg intestinalnog trakta. Najvažnije mjesto u dijagnostici nosi endoskopija,a od ostalih pretraga ističu se CT, MR te radiološke kontrastne metode. Prije započinjanja terapije potrebno je odrediti stadij tumora prema TNM (tumor, limfni čvor, metastaze) klasifikaciji. Kirurška metoda izbora ovisna je o veličini, lokaciji i mogućnosti postizanja čistih rubova bez mikroskopskih znakova bolesti. Svaka kurativna resekcija uz kiruršku resekciju, gastrektomiju ili subtotalnu resekciju, uključuje pridruženu limfadenektomiju. Postoje različita mišljenja o opsegu limfadenektomije. Današnji standard predstavlja disekcija druge etaže limfnih čvorova, iako se poimanje druge etaže razlikuje u japanskoj i zapadnoeuropskoj, odnosno američkoj literaturi. Osim kirurške terapije postoji i adjuvantna terapija poput kemoterapije, radioterapije, kemoradioterapije ili imunoterapije, s ciljem produženja preživljenja. Ukoliko je bolest uznapredovala te se ne može radikalno kirurški liječiti važnu ulogu ima i palijacijska terapija s ciljem poboljšanja kvalitete života i smanjenja boli. Prognoza ovog tumora u zapadnoeuropskim zemljama i SAD-u prilično je loša zbog kasnog otkrivanja bolesti. |
| Abstract (english) | Over the past few decades, incidence of gastric cancer slowly decreases, but unfortunately its mortality rates have remained relatively unchanged. Gastric cancer continues to be one of the leading causes of cancer related death. In Croatia, gastric cancer is the third most common malignancy, while worldwide incidence is highest in Japan, Eastern Asia, South America, and Eastern Europe. Stomach cancer is more common in men than in women and rates in people over the age of 50. The risk factors linked to stomach cancer include conditions such as chronic gastritis, stomach polyps, smoking, positive family history, diet with lot of salted, smoked and canned food, poor with fresh vegetables and fruits. Most gastric cancers occur sporadically, whereas 10% has an inherited familial component. An important development in the epidemiology of gastric carcinoma has been the recognition of the association with Helicobacter pylori infection. The most common type of stomach cancer is adenocarcinoma. The Lauren classification divides gastric cancer into 2 major histologic types: intestinal or diffuse and nowadays stays most commonly used histological classification. Gastric carcinoma often remains asimptomatical while it is surgically curable. Consequently, 90% of patients with gastric cancer present with locally advanced or metastatic tumors that have poor rates of resectability. Patients may present with anorexia, weight loss and abdominal pain. Nausea, vomiting, and early satiety may occur with bulky tumors that obstruct the gastrointestinal lumen. Ulcerated tumors may cause bleeding that manifest as hematemesis, melena, or massive upper gastrointestinal hemorrhage. Endoscopy is regarded as the most sensitive and specific diagnostic method, although the CT, MRI and radiographic contrast examinations are also being used. Before gastric cancer therapy, staging must be defined by TNM (tumor, node, metastasis) classification. Choice of surgical procedure in resectable stomach cancer is dictated by size, location, and ability to achieve surgical margins free of microscopic disease. In general, curative therapy involves surgical resection, most commonly a total or subtotal gastrectomy, with an accompanying lymphadenectomy. Extended or limited lymphadenectomy remains the procedure of choice in specialized centers,although D2 dissection remains recomended standard. Patients with lymph node involvement, which is statistically a significant predictor of survival, can be treated with adjuvant therapy such as chemotherapy, chemoradiotherapy, radiation, or immunotherapy, in hope to improve results. If there is presence of ascites as a result of massive metastasis patient is declared inoperable. Those patients are given palliative therapy to improve the quality of life and release the pain. The prognosis of stomach cancer is generally poor, due to the fact the tumour has often metastasied by the time of discovery. |
