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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [38] Gastric Cancer > Flashcards

[38] Gastric Cancer Flashcards

1
Q

What is the incidence of gastric cancer?

A

23/100,000

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2
Q

When is gastric cancer most common?

A

50’s

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3
Q

What is the male to female ratio of gastric cancer?

A

M:F = 2:1

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4
Q

Where is gastric cancer more common?

A

Japan
Eastern Europe
China
S. America

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5
Q

What are the risk factors for gastric cancer?

A 
Atrophic gastritis
Diet 
Smoking
Blood group A
Low socio-economic background
Familial
Partial gastrectomy
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6
Q

How can atrophic gastritis increase the risk of gastric cancer?

A

It can cause intestinal metaplasia

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7
Q

What can cause atrophic gastritis?

A

Pernicious anaemia

H. Pylori

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8
Q

What dietary factors increase the risk of gastric cancer?

A

Increases nitrates

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9
Q

What foods have high nitrates?

A

Foods that are smoked, pickled, or salted

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10
Q

How do nitrates increase the risk of gastric cancer?

A

Nitrates form carcinogenic nitrosamines in the GIT

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11
Q

How can gastric cancer risk be familial?

A

If there is a familial E. cadherin abnormality

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12
Q

What kind of cancers are gastric cancers?

A

Mainly adenocarcinomas

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13
Q

Where are gastric cancers usually located?

A

On gastric antrum

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14
Q

What gastric cancer might H. Pylori lead to?

A

MALToma

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15
Q

On what basis can gastric cancers be classified?

A

Depth of invasion
Microscopic appearance
Bormann Classification

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16
Q

Where do early gastric cancers invade?

A

The mucosa or submucosa

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17
Q

Where do late gastric cancers invade?

A

Muscularis propria

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18
Q

What are the classifications of gastric cancers based on their microscopic appearance?

A

Intestinal

Diffuse

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19
Q

How do intestinal gastric cancers appear?

A

Bulky, glandular tumours with heaped ulceration

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20
Q

How do diffuse gastric cancers appear?

A

Infiltrate, with signet ring cell morphology

21
Q

What is the Bormann classification of gastric cancers?

A
  1. Polypoid/fungating
  2. Excavating
  3. Ulcerating and raised
  4. Linitis plastica
22
Q

How does linitis plastica appear?

A

Leather-bottle like thickening, with flat rugae

23
Q

What are the symptoms of gastric cancer?

A

Weight loss and anorexia
Dyspepsia
Dysphagia
Nausea and vomiting

24
Q

What is meant by dyspepsia?

A

Epigastric or retrosternal pain/discomfort

25
Q

What is the problem with the symptoms of gastric cancer?

A

They usually present late

26
Q

What are the signs of gastric cancer?

A 
Anaemia
Epigastric mass
Jaundice
Ascites
Hepatomegaly
Virchow's node 
Acanthosis nigricans
27
Q

What are the complications of gastric cancer?

A

Perforation
Upper GI bleed
Gastric outlet obstruction

28
Q

How might an upper GI bleed caused by gastric cancer present?

A

Haematemesis

Melaena

29
Q

How might gastric cancer spread?

A 
Within the stomach
Direct invasion
Lymphatic 
Blood
Transcoelomic
30
Q

What develops when gastric cancer spreads within the stomach?

A

Linitis plastica

31
Q

Where might gastric cancer spread through direct invasion?

A

Pancreas

32
Q

What might occur with lymphatic spread of gastric cancer?

A

Enlarged Virchow’s node

33
Q

Where might gastric spread by blood?

A

Liver

Lung

34
Q

What can result from the transcoelomic spread of gastric cancer?

A

Krukenberg tumour

Sister Mary Joseph nodule

35
Q

What is a Krukenberg tumour?

A

A ovarian tumour with signet ring morphology

36
Q

What causes Sister Mary Joseph nodules?

A

Umbilical mets

37
Q

What investigations are done in gastric cancer?

A

Bloods
Imaging
Staging

38
Q

What bloods should be done in gastric cancer?

A

FBC
LFTs
Clotting

39
Q

What imaging should be done in gastric cancer?

A

CXR
USS
Gastroscopy (and biopsy)
Barium meal

40
Q

What is the purpose of CXR in gastric cancer?

A

Look for mets

41
Q

What is the purpose of US in gastric cancer?

A

Liver mets

42
Q

What investigations are done for staging in gastric cancer?

A

Endoluminal US
CT/MRI
Diagnostic laparoscopy

43
Q

What are the options in the management of gastric cancer?

A

Medical palliation
Surgical palliation
Curative surgery

44
Q

What is involved in medical palliation in gastric cancer?

A

Analgesia
PPI
Secretion control
Chemotherapy

45
Q

What chemotherapy may be used in palliation for gastric cancer?

A

Epirubicin
5FU
Cisplatin

46
Q

What is involved in surgical palliation in gastric cancer?

A

Pyloric stenting

Bypass procedures

47
Q

What are the options for curative surgery in gastric cancer?

A

Early gastric cancer may be resected endoscopically

Partial or total gastrectomy

48
Q

What is the overall 5 year survival rate for gastric cancer?

A

<10%

49
Q

What is the 5 year survival rate for people with gastric cancer who have surgery?

A

20-50%

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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