资源描述
Cancer Staging:Gastric CancerMedical Univ.ofSouth CarolinaDigestive Disease Center Dr.Ian Penmanand Dr.David Williams.Cancer Staging:Gastric Can1TNM staging and grouping of Gastric Cancer(AJCC Cancer Staging Manual.Fifth Edition.1997.Lippincott-Raven,publishers).Depth of invasion correlates with reduced survival while regional nodal metastases are the most powerful prognostic indicator.TNM staging and grouping of Ga2.3.4Gastric Cancer,T1On EUS,gastric cancers appear as irregular hypoechoic lesions with variable penetration of the gastric wall.An irregular heterogenous polypoid tumor can be seen extending into the submucosa.The underlying hypoechoic layer corresponding to the muscularis propria remains intact.Gastric Cancer,T1On EUS,gas5.6Gastric Cancer,T3A large irregular heterogenous tumor is seen with disruption of gastric wall layer structure.The anechoic triangular space adjacent to the tumor represents ascites.Gastric Cancer,T3A large irr7.8Gastric Cancer,T3The hypoechoic layer corresponding to the muscularis propria has been breached by an irregular hypoechoic tumor(arrow)with complete disruption of the gastric wall layer structure.Gastric Cancer,T3The hypoech9.10Gastric Cancer,celiac axis invasionUsing a linear array echoendoscope(Pentax FG-32UA)a large hypoechoic mass can be seen invading the celiac axis(CA)at its origin from the aorta.Gastric Cancer,celiac axis in11.12Gastric Cancer,linitis plastica5-15%of tumors are diffusely infiltrating,spreading mainly in the submucosa and muscularis.The gastric wall is markedly thickened(11mm;normally 5mm by EUS)and is completely replaced by hypoechoic tumor.The anechoic triangular structure adjacent to tumor is ascites.Gastric Cancer,linitis plasti13.14Perigastric TumorA 70-year-old woman with past history of ovarian carcinoma presented with melena and abdominal pain.At EGD there was the suggestion of an extramural mass resulting in gastric compression.EUS confirmed a large irregular heterogenous mass extending upto but not invading the gastric wall.(slide 21).The hypoechoic tumor can then be seen invading through the gastric wall with erosion onto the mucosal surface(slide 22).Perigastric TumorA 70-year-ol15.16.17.18
展开阅读全文