10. Tumors of the stomach (symptoms, diagnosis, treatment)

Question 1

Gastric cancer: epidiology

Answer 1

• Sex: ♂ > ♀
• Peak incidence: 70 years
• Geographical distribution: strong regional differences
• High incidence in South Korea and Japan

Question 2

Gastric cancer: Exogenous risk factors

Answer 2

• Diet rich in nitrates and/or salts
• Nicotine use
• Low socioeconomic status

Question 3

Gastric cancer: Endogenous risk factors

Answer 3

Diseases associated with a higher risk of gastric cancer

• Atrophic gastritis
• H. pylori infection
• Gastric ulcers
• Partial gastrectomy

Question 4

Gastric cancer: “early” GI symptoms

Answer 4

• Abdominal pain
• Early satiety
• Nausea or vomiting
• hematemesis or melena

Question 5

Gastric cancer: late symptoms

Answer 5

• Gastric outlet obstruction
• Hepatomegaly, ascites
• Virchow’s node
• Sister Mary Joseph’s node
• Malignant acanthosis nigricans

Question 6

Lymph node metastasis

Answer 6

• Compartment 1 – around stomach
• Compartment 2 – around duodenum, aorta, gall
  bladder, splenic artery, hepatic artery
• Compartment 3 – around aorta, IVC, SMA, pancreas

Question 7

Subtypes

Answer 7

• Adenocarcinoma (90%)
• Mucinous adenocarcinoma
• Round cell carcinoma
• Planocellular carcinoma

Question 8

Surgery

Answer 8

• Radical gastrectomy and lymphadenectomy (operative standard)
• Roux-en-Y gastric bypass

Question 9

Treatment options (general)

Answer 9

• Endoscopic resection
• Surgery
• Trastuzumab is indicated for HER2+ gastric
  adenocarcinomas

Question 10

Staging

Answer 10

• T1-T4 (infiltration)
• N0-N2
• M (Krukenberg tumor)