2.5. Gastric Disease - Gastric Cancer

Question 1

What is the Majority of Gastric Cancer caused by?

Answer 1

H. Pylori Inefction

Question 2

What are 2 big risk factors for Gastric Cancer?

Answer 2

1. Poor Diet

2. Smoking

Question 3

Is there a Large Genetically Inherited component?

Answer 3

No

Question 4

What is Gastric Cancer dependent on?

Answer 4

Both Genetics and Environmental Factors

Question 5

What percentage of Gastric Cancer can be put down to Hereditary?

Answer 5

1-3%

HDGC, AD, CDH-1 gene

Question 6

What percentage of Gastric Cancer can be put down to Family Clustering?

Answer 6

15%

Question 7

What is the Family Clustering Aetiology mostly associated with?

Answer 7

The Definitive Germline Mutation

Question 8

What type of Gastric Cancers are there?

Answer 8

1. Adenocarcinoma (Most Common)
2. Mucosal Associated Lymphoid Tissue (MALT)
3. Gastrointestinal Stromal Tumour (GIST)

Question 9

Where can the Adenocarcinomas be found?

Answer 9

Originating from the Epithelial Cells

Question 10

What is the Pathology of Gastric Cancer?

Answer 10

1. Damage of the Gastric Cancer Cells due to the Aetiology (usually H. Pylori) causes a constant need for regenerating cells
2. Some of the regenerated cells can mutate, to form Metaplasia (As a defence against further harm)
3. The Metaplasia can continue until there si the Dysplasia, and Cancer occurs

Question 11

What are the Clinical Signs / Symptoms of Gastric Cancer?

Answer 11

1. Dyspepsia
2. Weight Loss / Anorexia
3. Vomiting
4. Haematemesis
5. Melena

Question 12

What investigations are necessary in Gastric Cancer?

Answer 12

1. Upper G.I. Endoscopy with Biopsy

2. CT/PET Scan

Question 13

What is the purpose of the Upper G.I. Endoscopy with Biopsy?

Answer 13

1. To view the location, and the size of, the Tumour

2. To assess the Differentiation (Grading) of the Cancer

Question 14

What is the purpose of the CT/PET Scan?

Answer 14

To look for Metastases

Question 15

What staging is used for Gastric Cancer?

Answer 15

TNM:
T = Tumour (Invading Structures)
N = Nodes (Lymphatic Spread)
M = Metastases (Distant Spread)

Question 16

What is the Treatment for Gastric Cancer?

Answer 16

1. Subtotal Gastrectomy
2. Gastrectomy
3. Chemotherapy

Question 17

What happens in a Subtotal Gastrectomy?

Answer 17

The removal of the Stomach, surrounding the Cancer - Above the Highest point where the Cancer is found

Question 18

What happens in a Gastrectomy?

Answer 18

The removal of the Stomach, followed by a “Roux en Y” reconstruction - where the Oesophagus is linked straight to the Duodenum

Question 19

When is Chemotherapy used?

Answer 19

Once the Cancer has Metastasized - This is Palliative

Question 20

What is the Prognosis of Gastric Cancer?

Answer 20

Very Poor - A 5 Year Survival of 20%