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  • HISTORY

    Christian Albert Theodor Bilroth, 1829 - 1894

    The name of Bilroth is familiar to all surgeons as he is the first person to successfully perform a gastrectomy for cancer stomach. He is remembered for his pioneering work and innovations in surgical techniques. He worked as Professor of Surgery at the Allgemeine Krankenhaus of the University of Vienna. His classic work , Die Allgemeine Pathologie und Therapie was first published in 1863. In 1881 Bilroth performed the first gastrectomy while Anton Wolfler 1950 - 1917 of Praque, Czechslovakia developed GJ -gastro jejunostomy. Bilroth-I surgery is gastro duodenostomy while Bilroth-II is gastro duodenal reconstruction. This surgery is now widely performed for cancer stomach with Polya modification. Krukenberg an ophthalmic surgeon of Halle, Germany described the spread of cancer stomach to both ovaries., now referred to as Krukenberg tumour. Nepoleon died of cancer stomach while Armand Troussaeu of Paris described thrombophlebitis as a marker for Ca Stomach and suffered from the same.

    Recent Advances

    Carcinoma of the stomach is the leading cause of cancer death worldwide. In Japan stomach cancer represents the leading cause of death from malignant diseases. Stomach cancer occurs with a higher incidence in men than in women. The incidence of stomach cancer increases with advancing age and has a peak incidence in the seventies in men.

    Over the past 10 to 15 years, proximal gastric cancers and distal esophageal adenocarcinomas have become significantly more common. The most widely used classification of gastric cancer was proposed in 1965 by Lauren and divides gastric cancer into either intestinal or diffuse forms. The intestinal variety represents a differentiated cancer with a tendency to form glands. In contrast, the diffuse form exhibits very little cell cohesion and has a predilection for extensive submucosal spread and early metastases.

    Most patients with gastric cancer are diagnosed with advanced-stage disease and this is reflected in the vague, non specific symptoms that characterise the disease. Patients may have a combination of signs and symptoms such as weight loss, anorexia, fatigue, or epigastric discomfort, none of which unequivocally indicates gastric cancer. Upper endoscopy is used routinely for the initial diagnosis and staging of gastric adenocarcinoma and should be performed in any patient with localised disease for which surgical treatment is anticipated. Mass screening programs for gastric cancer have been most successful in high-risk areas, especially in Japan. A variety of screening tests has been studied in Japanese patients. This is clinically important because, early gastric cancer has a very high cure rate when treated surgically.

    The General Rules for Gastric Cancer Study in Surgery and Pathology as published by the Japanese Research Society for Gastric Cancer (JRSGC) define the primary tumour stage based upon the depth of invasion and the presence and extent of serosal invasion. Under this S-0 is further divided into m, mucosa; sm, submucosa; and pm, muscularis propria. The ss, subserosa, and S-1 tumours have been reclassified to further stratify the degree and type of serosal invasion. Ss alpha is a subserosal tumour with expansive growth, ss beta is a subserosal tumor with intermediate type growth, and ss gamma is a subserosal tumor with infiltrating growth. S-2 and S-3 are now defined as either se, cancer cells exposed to the peritoneal cavity; si, cancer cells infiltrating neighbouring tissue; or sei, the coexistence of se and si .

    Snippet: Helicobacter pylori infection as a cause of ca stomach and lymphoma of the stomach.

    Infection with Helicobacter pylori leads to chronic gastritis and evidence is available in the literature that there is a possibility of this leading to cancer of stomach.

    Two Australlian investigators Barry Marshall and Robin Warren discovered the presence of HP in gastric epithelium. It was initially called Campylobacter pyloridis but its name was changed to HP.

    Parsonnet EJ, in 1983 pointed out the relationship of helicobacter pylori and cancer. HP infection is blamed as a carcinogen in the development of intestinal variety of Ca Stomach.. This may be due to its effect on the host cell DNA and also due to formation of carcinogenic nitrosomines. Forman and Stolte pointed out the relationship of HP and lymphoma of the stomach esp MALTOMA. The European study group in 1993 estimated that HP infection increased the risk of ca stomach six fold. Isacson PG and Wotherspoon AC postulated the association of MALTOMA and HP. Type I with Vac A and Cag A genes produce vacuolation and intense inflammation and may be associated with higher cancer risk. Hence H pylori infection as a cause of cancer stomach is an accepted entity and it is important to consider its eradication.

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