1. Gastric Cancer(GC) Xu da-zhi Department of gastro-pancreas, Cancer Center E-mail:xudzh@sysucc.org.cn Mobile:13660677656

2. What is gastric cancer?

3. GC is not far from us…… Napoleon‘s gastric cancer ： tumor found on the lesser curvature of the stomach: What cause? How to treat? Ambition is never content , even on the summit of greatness . He conquered the larger part of Europe, but he could not conquer gastric cancer

4. How to diagnose What is epidemiology and etilogy What is the pathology How to treat Content

5. How to diagnose What is epidemiology and etilogy What is the pathology How to treat Content

6. GC Worldwide incidence In terms of geographic distribution, high rates apply to Japan, China and Eastern Europe and low rates to North America. Almost 40% of cases occur in China . Pazdur R et al. Cancer management: A multidisciplinary approach. edition,2002 Male 16.4 Female 8.2 Male 36.3 Female 16.9 Male 77.9 Female 33.3 Male 10.8 Female 4.9 Male 43.6 Female 19.0 Male 5.9 Female 2.6 Male 11.5 Female 4.3 Male 18.6 Female 13.3 Male 8.4 Female 4.0 Eastern Europe Japan Australia/ New Zealand China Northern Africa Southern Africa Central America Western Europe North America

7. Distribution of mortality in China In China, there is an obvious clustering of geographic distribution of GC, high mortality located in rural areas.

8. Etiological Factors of G C Gastric Cancer H. pylori Precancerous changes Genetic factors Diet

13. Why Napoleon died of GC “ The new study suggest he was chronically infected with the bacteria Helicobacter pylori.” “ full of salt-preserved foods but sparse in fruits and vegetables--common fare for long military” H. pylori Genetic factors “ his father had also died of stomach cancer which led to the theory that he had inherited the disease.” Diet Precancerous changes chronic atrophic gastritis?

14. How to diagnose What is epidemiology and etilogy What is the pathology How to treat Content

29. Have a rest

30. How to diagnose What is epidemiology and etilogy What is the pathology How to treat Content

34. Sister Mary Joseph’s node

40. How to diagnose Napoleon , GC Endoscopic diagnosis? Endoscopic Ultrasonography? CT scan? Preoperative staging ...... Why?

41. How to diagnose What is epidemiology and etilogy What is the pathology How to treat Content

42. Treatment Surgical resection EMR/ESD Adjuvant therapy Palliative therapy

48. How to treat Napoleon , GC Surgical resection? EMR? ESD? Adjuvant therapy? Palliative therapy? ...... Why?

51. Thank you!