Clinic-Gastric Neoplasms

Question 1

globally, gastric cancer is the ___ leading cause of cancer mortality

Answer 1

2nd

Question 2

(males/females) are 2x more likely to get gastric cancer

Answer 2

males

Question 3

gastric cancer is more prevalent in (developed/developing) countries

Answer 3

developING

Question 4

what is the major cause of steady decrease in gastric cancer in the US over the past century?

Answer 4

food safety, refrigerators (no salting or smoking meat anymore)

Question 5

nutritional contributors to gastric cancer

Answer 5

nitrates, salt, mold (note: selenium is protective)

Question 6

environmental contributors to gastric cancer

Answer 6

coinfection with EBV, parasites; tobacco

Question 7

longtern _____ infection is a large contributor to development of gastric cancer

Answer 7

h pylori

Question 8

there is a (predictable/unpredictable) sequence of mutations that lead to gastric ca

Answer 8

predictable (like colon cancer) = TP53 mutation (chronic inflammation) + RAS mutation or loss of DCC (additional)

Question 9

h pylori contains ______ which buffers the periplasm and enables it to survive in the acidic stomach

Answer 9

cytoplasmic urease

Question 10

risk factors for h pylori

Answer 10

household crowding, developing nation, unclear water or food, child/sibling infected, age/race in US

Question 11

in the US, h pylori is most common in (younger/older) (whites/blacks/latinos)

Answer 11

older, blacks + latinos

Question 12

transmission of h pylori occurs through?

Answer 12

vomitus, aerosol, saliva, stool

Question 13

H pylori is particularly associated with what conditions?

Answer 13

chronic gastritis (80-90%), duodenal/non-NSAID gastric ulcers (75%), and gastric cancers

Question 14

invasive dx of HP is through?

Answer 14

histology or rapid urease testing (both require biopsy and both are followed to document eradication)

Question 15

less accurate but non-invasive tests for HP are?

Answer 15

IgG ELISA (doesn’t tell if active), active tests (radiolabeled urea breath test, stool antigen test)

Question 16

treatment of HP

Answer 16

PPI + 2 ABX for 10-14 days (note: increased resistance to clarithromycin)

Question 17

what genetic factors contribute to gastric cancer pathogenesis?

Answer 17

cytokine polymorphisms (IL-1B, IL-10, TNFa)

Question 18

non-specific presentations of gastric ca

Answer 18

dyspepsia, nausea, early satiety, weight loss

Question 19

advanced sx of gastric ca

Answer 19

emesis, GI bleeding, palpable mass, enlarged LN (Virchow’s, Sister Mary Joseph)

Question 20

dx of gastric cancer

Answer 20

endoscopy (can be staged using CT, EUS, PET, laparoscopy)

Question 21

tx of MALToma (lymphoma of the stomach)

Answer 21

antibiotics (81% complete remission at 5 mo)

Question 22

gastric polyps are _____ benign

Answer 22

always? Sounded like it

Question 23

name 5 gastric subepithelial lesions

Answer 23

lipoma, ectopic pancreatic tissue, carcinoid tumor, leiomyoma, GIST

Question 24

gene associated with GIST

Answer 24

c-kit

Question 25

treat GIST with?

Answer 25

imatinib