34. gastric cancer Flashcards
(24 cards)
What are benign tumours of the stomach and where do they originate from
4-5%=polyps from epithelial cells
1-3%= mesenchymal tumours
What sre the types of gastric polyps
80-90%=hyperplastic
10%= adenomatous
= hamartomas ( peutz jeghers syndrome
Incidence and age of gastric cancer
bg=24.6/100,000 (higher than avergae)
age-55-70 and occur more men
What are some risk factors for gastric cancer
Profession: rubber industry, fishermen who use nitrates
Chemicals and meat dyes
High temp/humidity when storing foods like rice, peanuts potatoes
Many substances become carcinogens after metabolizing in liver eg zinc copper iron
g.c in family
What are the 9 predisposing factors of gastric cancer
Pernicious anemia=risk 6-10 x higher. Multifocal tumours then adenoma
Atrophic gastritis= type b more common than type a gastritis but b not rlly cancer related. Loss of HCL -bacteria can colonize
H.pylori=risk 6x higher - first line carcinogen
Polyps=villous adenomas easily malignant
Hereditary syndromes=risk in parents with gc is 5x higher
After gastroectomy=bile reflux-atrophic gastritis-
Gastric ulcer=carcinoma ex ulcere, ulcus carcinoma, carcinoma ulcerataum
Menetrier disease- mucus folds large
Blood group A- secretion of mucopolysaccarides impaired
95% of maLIGNANT tumours in stomach are what
adenocarcinoma
Barrets oesphgagus is this also
Laurens classification of gc
intestinal type: Glandular cancer, origin is intestinal metaplasia , well defined tumour, blood metastaes. affect elderly
Diffuse type: made of single clusters,extensive and diffuse infiltration, metasasizes to peritoneal cavity and lymphatics, affects young
WHO classification of gc
Papillary
Tubular
Mucinous
Signet ring cell
Where can the gc be located, which is most common site
Antrum and pylorus = over 50%
Body and small curve
Cardia
Large curvature
last 2 rare but often maligant
Microscopic type carcinoma classification
ulcee type - 75%
polypoid
diffuse (linitis plastica - poor progniss
superficyal location
Bormanns classification
type 1: solitary polypoid w/o ulceration
type 2 : Ulcerative carcinoma , raised edges, shrp boders
type 3 : ulcerated carcinoma, raised edges, diffuse spread
type 4: diffuse carcinoma
Metastases: direct invasion
esophagus, large/small intestine, pancreas, kidneys, abdo wall, etc
Metastases: regional lymph nodes
in early gastric cancer
along small and large curvature of stooamch, celiac nodes, lymph nodes around sup mesteric vein
Metastases: hematogenous
can metastazie to liver via portal vein
to lung via lymphatic sytem
to bones and adrenal gladns
Metastases: distant lymph nodes
left supraclavicular region- Virchows gland
left axilla- irish node
Metastases: diffuse implantation
peritoneal carcinomatosis……..
What are the stages of gastric cancer based on
Primary tumour-tx,t0,t1,t2,t3,t4
Lymph node metastases- nx,n0,n1,n2,n3
Distant etastases-mx,m0,m1
Clinical symptoms
6-12 months- no complaints
gastroscopy indicated: pain/upper dyspepsia 1 month and or anemic syndrome
- mild epigastric discomfort, feleig of fullness , rapid satiety after eating, fatigue
- Anorexia, nausea, vomit, pain, weight loss, dysphagia
What are paraneoplastic syndrome
Acantosis nigricans, hemolutic anemia, thromocytopenia, DIC etcccc
What establishes diagnosis
How many biopsies
gastoscopy
8-12 biopsies
What is early gastric cancer divided into
Type 1
Type 2 (abc)
Type 3
Other methods of diagnisis
x ray
endoscopic ultrasound
CT
Laparoscopy
Tumour markers
Treatment
gastoectomy, omentectomy, splenectomy
FAM( 5-flurouracil, adriamtcin,mitomycin c
