Cancer of the Stomach

Question 1

State the incidence of Stomach Cancer.

Answer 1

More common in men. 50% aged > 75. Link to Blood Group A, H. pylori, Atrophic Gastritis, Adenomatous Polyps, Smoking, High nitrate/High salt.

Question 2

State a risk factor for Stomach Cancer.

Answer 2

Blood Group A. H. pylori. Atrophic Gastritis. Adenomatous Polyps. Smoking. High nitrate/High salt.

Question 3

State a symptom of Stomach Carcinoma.

Answer 3

Difficult swallowing (dysphagia). Weight loss. Persistent indigestion (dyspepsia). Sickness. Vomiting. Melena/haematemesis (vomiting of blood). Feeling full after small amounts of food. Epigastric pain.

Question 4

State an investigation of Stomach Cancer.

Answer 4

Endoscopy - oesophageal-gastroduodenoscopy (OGD). Blood tests - FBC, U&Es, LFTs.
CT scan - chest, abdomen, pelvis.

Question 5

Define Stage 0 of Stomach Cancer.

Answer 5

High grade dysplasia - carcinoma. in situ.

Question 6

Define Stage 1A of Stomach Cancer.

Answer 6

Cancer in the mucosa/submucosa. T1, N0, M0.

Question 7

Define Stage 1B of Stomach Cancer.

Answer 7

Cancer in the mucosa/submucosa. 1-2 Lymph Nodes T1, N1, M0.

Question 8

State a treatment for Stage 0 Stomach Cancer.

Answer 8

Endoscopic mucosa resection (EMR). Endoscopic submucosal dissection (ESD).

Question 9

Define Stage 1B of Stomach Cancer.

Answer 9

Cancer into muscles. T2, N0, M0.

Question 10

State a treatment of Stage 1A Stomach Cancer.

Answer 10

Endoscopic submucosal resection (ESD). Surgey.

Question 11

State a treatment of Stage 1B Stomach Cancer.

Answer 11

Chemotherapy (epirubicin, cisplatin, fluorouracil).

Question 12

Define Stage 2A Stomach Cancer.

Answer 12

1) Cancer within submucosa - T1, N2, M0 (3-6 lymph nodes)
2) Cancer into the muscles - T2, N1, M0 (1-2 lymph nodes)
3) Cancer involves the serosa - T3, N0, M0

Question 13

Define Stage 2B Stomach Cancer.

Answer 13

Cancer within the submucosa (T1, N3, M0) (>7 lymph nodes)
Cancer within the muscles (T2, N2, M0) (3-6 lymph nodes)
Cancer involves the serosa (T3, N1, M0) (1-2 lymph nodes)
Cancer through the serosa (T4)

Question 14

State a treatment for Stage 2 Stomach Cancer.

Answer 14

Surgery (gastrectomy). Chemotherapy - before and after surgery.

Question 15

Define Stage 3A Stomach Cancer.

Answer 15

Cancer involves muscle (T2, N3, M0) (>7 lymph nodes)
Cancer involves serosa (T3, N2, M0) (3-6 lymph nodes)
Cancer involves serosa (T4a, N1, M0) (1-2 lymph nodes)

Question 16

Define Stage 3B Stomach Cancer.

Answer 16

Cancer involves serosa (T3, N3m M0) (>7 lymph nodes)
Cancer through the serosa (T4a, N2, M0) (3-6 lymph nodes)
Cancer involves nearby organs (T4b, N0 to N1, M0) (0-2 lymph nodes)

Question 17

Define Stage 3C Stomach Cancer.

Answer 17

Cancer through the serosa (T4a, N3, M0) (>7 lymph nodes)

Cancer through the stomach into nearby lymph organs (T4am N2 to 3, M0) (3-7 lymph nodes)

Question 18

State a treatment for Stage 3 Stomach Cancer.

Answer 18

Surgey. Chemotherapy - given before surgey, usual to have further 3 courses of chemotherapy post-operatively). Chemoradiation may be given post-op if no chemo pre-operatively.

Question 19

State the surgery used in Stomach Cancer.

Answer 19

Gastrectomy (Roux-en-Y) - part of the stomach is removed.
Billroth II gastrectomy - gastro-jejunal anastomosis (loop from intestine gone to the stomach).
Gastrectomy: oesophago-gastric anastomosis (upper part of the stomach removed).
Total gastrectomy: oesophago-jejunal anastomosis (stomach anastomosed to oesophagus).

Question 20

Define Stage 4 Stomach Cancer.

Answer 20

Distant metastases e.g. lungs, brain or bones (Any T, N, M1).

Question 21

State a treatment of Stage 4 Stomach Cancer.

Answer 21

Chemotherapy. Palliative surgery for symptom control. Trastuzumab (Herceptin) biological therapy with chemotherapy if adrenocarcnioma expresses HER2 protein.

Question 22

What is the HER2 gene?

Answer 22

A proto-oncogene that increases cell mutation if mutates.

Question 23

State the survival of Stomach Cancer.

Answer 23

Stage 1A - 80%. Stage 1B - 70%. Stage 2A - 60%. Stage 2B > 40%. Stage 3A > 25%. Stage 3B > 20%. Stage 3C > 10%. Stage 4 > 5%.

Question 24

Where is Bile Duct Cancer and Gall Bladder Cancer common?

Answer 24

Thailand. Japan. Korea. Eastern Europe.