위암 (Stomach Cancer)

위암 (Stomach Cancer): Comprehensive Overview for Medical Professionals

개요 (Overview)

위암은 위장에서 발생하는 악성 종양으로, 전 세계적으로 높은 사망률을 보이는 주요 암 중 하나입니다. 위암은 주로 위 점막의 상피세포에서 발생하며, 조기 발견이 어렵고 진행된 상태에서 진단되는 경우가 많습니다.

Stomach cancer, also known as gastric cancer, is a malignant tumor that arises from the stomach lining. It is one of the leading causes of cancer-related deaths worldwide. Stomach cancer primarily originates from the epithelial cells of the stomach mucosa and is often diagnosed at an advanced stage due to the difficulty of early detection.

원인 (Etiology)

1. 헬리코박터 파일로리 감염 (Helicobacter pylori Infection): 위암의 주요 위험 요인.

2. 식이 요인 (Dietary Factors): 짠 음식, 훈제 음식, 질산염이 높은 음식.

3. 흡연 (Smoking): 위암 위험 증가.

4. 유전적 요인 (Genetic Factors): 가족력 및 특정 유전자 돌연변이.

5. 환경적 요인 (Environmental Factors): 낮은 사회경제적 상태, 불량한 위생 상태.

6. Helicobacter pylori Infection: Major risk factor for stomach cancer.

7. Dietary Factors: High salt, smoked foods, foods high in nitrates.

8. Smoking: Increases the risk of stomach cancer.

9. Genetic Factors: Family history and specific genetic mutations.

10. Environmental Factors: Low socioeconomic status, poor sanitation.

발생빈도 (Incidence)

위암은 특히 동아시아, 동유럽, 남미 등에서 높은 발생률을 보입니다. 한국에서는 위암이 가장 흔한 암 중 하나로, 발생률이 높습니다.

Stomach cancer has high incidence rates particularly in East Asia, Eastern Europe, and South America. In Korea, stomach cancer is one of the most common cancers with a high incidence rate.

임상증상 (Clinical Presentation)

1. 소화불량 (Dyspepsia): 식사 후 불편감.

2. 복통 (Abdominal Pain): 특히 상복부 통증.

3. 체중 감소 (Weight Loss): 원인 불명의 체중 감소.

4. 식욕 부진 (Loss of Appetite): 식욕 감소.

5. 구토 (Vomiting): 특히 음식 섭취 후.

6. Dyspepsia: Discomfort after eating.

7. Abdominal Pain: Especially in the upper abdomen.

8. Weight Loss: Unexplained weight loss.

9. Loss of Appetite: Decreased appetite.

10. Vomiting: Especially after meals.

진단 (Diagnosis)

1. 임상 평가 (Clinical Evaluation): 병력 청취 및 신체 검사.

2. 내시경 검사 (Endoscopy): 위 내부를 시각화하고 조직 생검.

3. 영상 검사 (Imaging Studies):

   • CT 스캔 (CT Scan): 종양의 크기, 위치, 전이 여부 평가.
   • MRI: 종양의 상세한 평가.

4. 조직 생검 (Biopsy): 조직학적 확인.

5. Clinical Evaluation: History taking and physical examination.

6. Endoscopy: Visualization of the stomach and biopsy of suspicious areas.

7. Imaging Studies:

   • CT Scan: Assess size, location, and metastasis of the tumor.
   • MRI: Detailed evaluation of the tumor.

8. Biopsy: Histopathological confirmation.

병리조직 (Pathology)

• 조직학적 유형 (Histological Types): 선암, 점액성 암, 반지세포암 등.

• 면역조직화학 (Immunohistochemistry): 종양 기원과 특성 확인.

• Histological Types: Adenocarcinoma, mucinous carcinoma, signet ring cell carcinoma, etc.

• Immunohistochemistry: To confirm the origin and characteristics of the tumor.

영상검사 소견 (Imaging Findings)

• 내시경 소견 (Endoscopic Findings): 궤양, 종괴, 점막 불규칙성.

• CT/MRI 소견 (CT/MRI Findings): 종양 크기, 위치, 림프절 침범 평가.

• Endoscopic Findings: Ulcers, masses, mucosal irregularities.

• CT/MRI Findings: Assess tumor size, location, and lymph node involvement.

Detailed Explanation of TNM Staging for Gastric Cancer

The TNM staging system is a globally recognized standard for classifying the extent of cancer spread. It is based on three key components: Tumor size and extent (T), regional lymph Nodes involvement (N), and distant Metastasis (M).

T - Tumor

• TX: Primary tumor cannot be assessed.
• T0: No evidence of primary tumor.
• Tis: Carcinoma in situ; intraepithelial tumor without invasion of the lamina propria.
• T1: Tumor invades the lamina propria, muscularis mucosae, or submucosa.
  • T1a: Tumor invades the lamina propria or muscularis mucosae.
  • T1b: Tumor invades the submucosa.
• T2: Tumor invades the muscularis propria.
• T3: Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures.
• T4: Tumor invades the serosa (visceral peritoneum) or adjacent structures.
  • T4a: Tumor invades the serosa.
  • T4b: Tumor invades adjacent structures such as the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.

N - Regional Lymph Nodes

• NX: Regional lymph nodes cannot be assessed.
• N0: No regional lymph node metastasis.
• N1: Metastasis in 1-2 regional lymph nodes.
• N2: Metastasis in 3-6 regional lymph nodes.
• N3: Metastasis in 7 or more regional lymph nodes.
  • N3a: Metastasis in 7-15 regional lymph nodes.
  • N3b: Metastasis in 16 or more regional lymph nodes.

M - Distant Metastasis

• M0: No distant metastasis.
• M1: Distant metastasis is present.

Staging Groupings

Combining the T, N, and M classifications, gastric cancer can be staged as follows:

Stage 0

• Tis, N0, M0: Carcinoma in situ.

Stage I

• Stage IA:
  • T1, N0, M0
• Stage IB:
  • T1, N1, M0
  • T2, N0, M0

Stage II

• Stage IIA:
  • T1, N2, M0
  • T2, N1, M0
  • T3, N0, M0
• Stage IIB:
  • T1, N3, M0
  • T2, N2, M0
  • T3, N1, M0
  • T4a, N0, M0

Stage III

• Stage IIIA:
  • T2, N3, M0
  • T3, N2, M0
  • T4a, N1, M0
• Stage IIIB:
  • T3, N3, M0
  • T4a, N2, M0
  • T4b, N0-N1, M0
• Stage IIIC:
  • T4a, N3, M0
  • T4b, N2-N3, M0

Stage IV

• Any T, Any N, M1

병기에 따른 치료 (Treatment by Stage)

• 0기 (Stage 0): 내시경 점막 절제술.

• I기 (Stage I): 수술적 절제.

• II기 (Stage II): 수술적 절제 및 보조 화학요법.

• III기 (Stage III): 수술적 절제, 보조 화학요법 및 방사선 치료.

• IV기 (Stage IV): 전신 화학요법 및 표적 치료.

• Stage 0: Endoscopic mucosal resection.

• Stage I: Surgical resection.

• Stage II: Surgical resection followed by adjuvant chemotherapy.

• Stage III: Surgical resection, adjuvant chemotherapy, and radiation therapy.

• Stage IV: Systemic chemotherapy and targeted therapy.

수술 (Surgery)

• 적응증 (Indications): 대부분의 병기에서 사용.

• 목표 (Goal): 종양의 완전 절제.

• 기술 (Techniques): 위절제술, 부분 위절제술, 림프절 절제술.

• Indications: Used in most stages.

• Goal: Complete resection of the tumor.

• Techniques: Gastrectomy, partial gastrectomy, lymph node dissection.

방사선치료 (Radiation Therapy)

Radiotherapy in Gastric Cancer

English:

• Dose: Typically ranges from 45 to 50.4 Gy, administered in fractions of 1.8 to 2 Gy per session.
• Anatomical Range: The radiotherapy field generally includes the stomach or the gastric bed post-surgery, the regional lymph nodes, and sometimes the areas where there is a high risk of microscopic disease spread, such as the celiac axis, perigastric, and para-aortic nodes.

Korean:

• 선량: 일반적으로 45에서 50.4 Gy 범위로, 세션당 1.8에서 2 Gy의 분할 선량으로 투여됩니다.
• 해부학적 범위: 방사선 치료 범위는 일반적으로 위 또는 수술 후 위 베드, 지역 림프절 및 미세 질병 전이의 고위험 영역(예: 복강축, 위 주위 및 대동맥 주위 림프절)을 포함합니다.

항암제 (Chemotherapy)

1. 적응증 (Indications): 진행성 및 전이성 질환.

2. 약제 (Agents): 시스플라틴, 5-FU, 옥살리플라틴 등.

3. 프로토콜 (Protocols): 다양한 병용 요법.

4. Indications: Advanced and metastatic disease.

5. Agents: Cisplatin, 5-FU, oxaliplatin, etc.

6. Protocols: Various combination regimens.

병기별 예후 (Prognosis by Stage)

1. 5년 생존율 (5-year Survival Rate):
   • 0기: 약 90-95%.
   • I기: 약 70-90%.
   • II기: 약 50-70%.
   • III기: 약 20-50%.
   • IV기: 약 5-20%.
2. 국소 재발율 (Local Recurrence Rate): 약 30-50%.

The prognosis for stomach cancer varies by stage, with a 5-year survival rate of approximately 90-95% for stage 0, 70-90% for stage I, 50-70% for stage II, 20-50% for stage III, and 5-20% for stage IV. The local recurrence rate is about 30-50%.

참고문헌 (References)

1. Crew, K. D., & Neugut, A. I. (2006). Epidemiology of gastric cancer. World Journal of Gastroenterology, 12(3), 354-362.
2. Van Cutsem, E., Sagaert, X., Topal, B., Haustermans, K., & Prenen, H. (2016). Gastric cancer. The Lancet, 388(10060), 2654-2664.
3. Thompson, G. B., & Van Heerden, J. A. (2000). Adenocarcinoma of the stomach: a review of 1,497 cases. Archives of Surgery, 135(10), 1090-1096.

위암 (Stomach Cancer) 요약표 (Summary Table)

항목 (Item)한국어 (Korean)영어 (English)

참고문헌 (References)

1. Crew, K. D., & Neugut, A. I. (2006). Epidemiology of gastric cancer. World Journal of Gastroenterology, 12(3), 354-362.
2. Van Cutsem, E., Sagaert, X., Topal, B., Haustermans, K., & Prenen, H. (2016). Gastric cancer. The Lancet, 388(10060), 2654-2664.
3. Thompson, G. B., & Van Heerden, J. A. (2000). Adenocarcinoma of the stomach: a review of 1,497 cases. Archives of Surgery, 135(10), 1090-1096.

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