48 - Stomach

Question 1

What are the risk factors for stomach cancer?

1) Sex __
2) countries ___ (4)
3) __ socioeconomic
4) Bacteria ___
5) habits
6) diet (2)
7) obesity
8) pernicious anemia
9) virous
10) hereditary

Answer 1

men
japan/china/Chile/Ireland 
low
H. Pylori
smoking
smoked/rich in nitrates
obesity
EBV
HNPCC/Li–Fraumeni syndrome/FAP

Question 2

Name the types of stomach cancer (5)

Answer 2

adenocarcinoma
SCC
GIST
non Hodgkin lymphoma
carcinoid

Question 3

Which syndromes are associated with gastric cancer? (6)

Answer 3

hereditary diffuse gastric cancer
HNPCC
FAP
BRCA
Li–Fraumeni syndrome 
Peutz Jeghers syndrome

Question 4

Gastric adenocarcinoma may present itself with ___pain, early ___, decreased __/__, ___, ___ and heartburn, bleeding (___/___), para neoplastic syndrome.

Answer 4

epigastric
fullness
weight/apatite
dysphagia
dyspepsia 
anemia/hematemesis

Question 5

What are the 3 main complications of stomach tumors?

Answer 5

bleeding
obstruction
perforation

Question 6

How do gastric tumors usually spread? LN (5)

Answer 6

sister Mary Joseph node
Virchow node
Blumer's shelf
Krukenberg tumor 
hepatic metastasis

Question 7

Sister Mary Joseph is a ____ state, pointing at a ___ spread of GI/gynecologic malignancy through the lymphatic vessels going with the ___ vein or ___. The meaning is stage 4

Answer 7

subclinical
peritoneal
umbilical
hematogenic

Question 8

Virchow node is found in the left ___.

Answer 8

supraclavicular

Question 9

Blumer’s shelf are tumors in the pelvic ___. We can palpate it in the __ when performing __

Answer 9

peritoneum
Douglas pouch
PR

Question 10

Krukenberg tumor originate from the ___ and reaches the ___, growing to massive size

Answer 10

stomach

ovaries

Question 11

__% of gastric tumors are diagnosed in ___ stages, and are considered untreatable

Answer 11

50

late

Question 12

Gastric cancer diagnosis is made with the following imaging methods: (4), the following markers: (2), and staging laparoscopy.

Answer 12

endoscopy
EUS
chest/abdomen/pelvic CT
PET CT
CA 19-9, CEA

Question 13

Gastric tumor stage T IS-T1a should be treated with EMR in the following indications: (4)

Answer 13

in situ
<2 cm
no lymph vascular involvement
no ulceration

Question 14

Gastric tumor T1b and above should be treated with ____ keeping clean ___ (__ cm)

Answer 14

surgery
borders
6

Question 15

Stage T IS - T1a is considered ___, while the rest are ___

Answer 15

early gastric cancer

advanced gastric cancer

Question 16

Stage II tumors can be treated with ___ treatment with the following protocol: (4)

Answer 16

neoadjuvant 
5-FU
Herceptin 
Rituximab
KEYTRUDA (pembrolizumab)

Question 17

Distal tumor should be treated with distal gastrectomy involving the resection of the ___ and ___ until the proximal __, or sub-total gastrectomy + ___ 2 or __ en _

Answer 17

body
antrum
duodenum 
billroth 
roux
y

Question 18

Proximal tumor should be treated with ___ gastrectomy + Roux en Y (connecting the ___ and __)

Answer 18

total
esophagus
jejunum

Question 19

Large/infiltrative tumor should be treated with ___ gastrectomy with _____

Answer 19

total

Roux en Y

Question 20

In gastric cancer we should always resect lymph nodes:
D1 ___
D2 ___
D3 ___

Answer 20

• perigastric 15
• hepatic, left gastric, celiac, splenic arteries, splenic hilum
• D2+periaortic +porta hepatic