Carcinoma of the Stomach

Question 1

What is the most common type of gastric carcinoma?

Answer 1

Most are adenocarcinoma

Question 2

What is the typical patient group affected by gastric carcinoma?

Answer 2

Male 50 to 70 years old

Question 3

What are the risk factors for developing gastric carcinoma?

Answer 3

Pernicious anaemia, H. pylori, smoking, alcohol, male, diet (high salt, pickling, low vitamin C).

Question 4

What are the two types of adenocarcinoma in the stomach and what are the differences in histology?

Answer 4

1. Intestinal-type - gland formation, lined by mucus secreting cells, bad prognosis.
2. Diffuse-type - signet ring cells, diffuse pattern of infiltration, very aggressive and worse prognosis.

Question 5

What is this a presentation of?
Often non-specific, dyspepsia especially treatment-resistant, ALARM Signs, weight loss, vague epigastric pain, progressive dysphagia, anaemia.

Answer 5

Gastric carcinoma

Question 6

How is suspected gastric carcinoma investigated?

Answer 6

1. Gastroscopy endoscopy and multiple ulcer edge biopsies.

2. CT/MRI for staging using TNM.

Question 7

What is the treatment for gastric carcinoma?

Answer 7

1. Early cancers can be resectable endoscopically, chemo and radiotherapy.
2. Partial gastrectomy for more advanced distal tumours.
3. Locally advanced/metastatic, chemotherapy can improve quality of life.
4. Palliative surgery to reduce haemorrhage, obstruction.

Question 8

What is the prognosis of gastric carcinoma?

Answer 8

5% 5-year survival, 20% for those undergoing radical surgery.