Gasrict Tumor Flashcards by Iseoluwa Ojo

Benign gastric tumours-mesenchymal

List 5

Fibroma
Lipoma
Neurofibroma
Leiomyoma
Gastrointestinal stromal tumour (GIST)

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Benign gastric tumours-epithelial

List 3

Adenomas

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Malignant Gastric Tumours: epithelial

Mainly _______

 Represents _____-___% of all malignant gastric tumours

adenocarcinoma

90-95

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Malignant Gastric Tumours: mesenchymal

__________ or ________

Malignant GIST
Leiomyosarcoma et

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Gastric Cancer- Epidemiology

Gastric cancer is the ____ most common malignancy worldwide accounting for 5.6% of total the _____ leading cause of cancer death (7.7%) in both sexes worldwide

5th ; 4th

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Gastric Cancer- Epidemiology

 The highest occurs in _____ while the lowest incidences are found in ——— and _______
 Over ____% occurs of the world total occurs in Asia

Asia

Africa and Northern America

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Age and Gender prevalence

In Nigeria:
 Peak age prevalence- _____-______yrs-

M:F ratio is ___:____

 81% of our cases occur above ____yrs

55-65

2:1

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Risk factor-Helicobacter pylori

 Hp has been categorized as a class- ___ carcinogen.

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H.pylori

is a _______ shaped ,

Oxygen: _________

gram- _____ bacterium discovered in 1983.

spiral

microaerophilic

negative

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African Enigma

 The prevalence of Hp in Africa is ____ (about ____%)and infection occurs (early or late?) in childhood

 Despite this, gastric cancer incidence is (low or high?) with ASR of less than 4.5 compared to 12 per 100,000 in South-East Asia

High; 90; early ;low

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most strains of Hp are positive for the virulent factors, and there is a consistent association with GC

T/F

Although most strains of Hp are positive for the virulent factors, there is no consistent association with GC

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African Enigma

This phenomenon of _____________________ in spite of _______ prevalence of Hp infection is what is referred to as African Enigma

low prevalence of GC

high

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EBV associated Gastric Cancer

Accounts for ____% of gastric carcinoma worldwide

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EBV associated Gastric Cancer

Distinct characteristics

(Male or Female?) predominance,
 (Proximal or Distal ?) stomach,
 Most often _______-type gastric carcinomas.

Male

Proximal

diffuse

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Dietary Risk factors for gastric cancer

High _____ diet
Nitrate, nitrite and N-nitroso compounds, and benzopyerene
Lack of _________ and _______

salt

fresh fruit and leafy vegetables

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Dietary Risk factors for gastric cancer

Lack of _______
Lack of _________- Vitamin C, E , A, selenium, etc
_______ and ______ foods

refrigeration

antioxidants

Smoked and salted

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↑Salt in diet→ ———- of _________

destruction of mucosa barrier

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Environmental & occupational Risk factors

alcohol,
 Cigarette smoking.
 iodizing radiation
 coal,
 tin mining,
 steel, iron and rubber manufacturing industries increase risk

Okay?🌚🌚

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Genetic syndromes associated with Gastric cancer

 _______________________ cancer
 ______________________
 ___________ and ___________ of the stomach

Hereditary nonpolyposis colorectal

Familial adenomatous polyposis(MLH1, MSH2,MSH6)

Gastric adenocarcinoma and proximal polyposis

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Genetic syndromes associated with Gastric cancer

_________-associated polyposis
_____________ syndrome
_______-_______ syndrome
__________ syndrome

MUTYH

Juvenile polyposis

Peutz–Jegher

Li–Fraumeni

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Host factors that predispose to gastric cancer

 Chronic ___________,
 __________ —————-
__________ anemia
 _________ oesophagus.

atrophic gastritis

Autoimmune gastritis

Pernicious

Barrett’s

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Host factors that predispose to gastric cancer

 Gastric ________
 ______ ________ – [reflux]
 Peptic!______ <1%

adenomas

Partial gastrectomy

ulcer

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Gastric cancer is one of the most common causes of cancer mortality worldwide.

T/F

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Gastric cancer

Risk factors can be _______ and ________

modifiable and nonmodifiable

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Gastric cancer ___________,_________, and ________ are important modifiable risk factors.

H. Pylori, diet, and smoking

Pathology: Classification of gastric cancer Can be classified based on:  Anatomic- _______,________, and _____  Clinical- ______ and ______  Histologic-90% are _________

proximal cardia, fundic and antral early and advanced adenocarcinoma

Pathology: Classification of gastric cancer Can be classified based on:  Anatomic, clinical, histological and molecular subtypes Histologic-  Lauren’s criteria – _______,_______, and _________  WHO(2010): _______,_________,__________, and ____________ types, uncommon variants

intestinal, diffuse and indeterminate tubular, papillary, mucinous and signet ring

Early Gastric cancer; Advanced Gastric Cancer Extent: Size: Location

Confined to mucosa and /submucosa ± lymph node metastasis or size; Beyond submucosa Small 2-5cm; >5cm Lesser curvature; Any

Early Gastric cancer; Advanced Gastric Cancer Gross appearance Histologic Prognosis

Polypoid, flat, excavating, diffusely infiltrating Exophytic, Fungating Ulcerating, diffusely infiltrative (linitis plastica) Well differentiated tubular and papillary; Mixed patterns Excellent -5yrs SR-90%; 60% or less

Histologic classification: Lauren’s  Intestinal-____%  Diffuse-___%  Indeterminate-____%

54 32 15

Diffuse-type tumors were associated with a significantly (better or worse?) prognosis than were intestinal- type tumors (P = .______)

Worse 018

Differences btw intestinal and diffuse types of gastric cancer Age Gender Race Incidence

Older. ; Younger Male>female ; M=F Black; nil Decreasing; increasing

Differences btw intestinal and diffuse types of gastric cancer By Association

Corpus-dominant gastritis with gastric atrophy and intestinal metaplasia H.Pylori Pangastritis without atrophy

Well-differentiated Papillary adenocarcinoma- (intestinal) Papillary- (common or rare?) , seen also in _____.  In (younger or older?) patients  (Proximal or distal?) stomach  Frequently associated with ____ metastasis and (lower or higher?) rate of lymph node invasion

Common; EGC Older Proximal liver; higher

Mucinous carcinoma  Mucinous-____%  Extracellular mucin pools in _____% of tumour volume

10 50

Regional Lymph Nodes (pN) 35  pNx:__________  pN0:_____ regional lymph node metastasis  pN1: Metastasis in ______ perigastric nodes  pN2: Metastasis in _______ perigastric nodes  pN3: Metastasis in _______ perigastric lymph nodes  pN3a: Metastasis in _______ perigastric lymph nodes  pN3b: Metastasis in ________ perigastric lymph nodes

Cannot be assessed No 1 to 2; 3 to 6 7 or more 7 to 15 16 or more

Histologic Grading-gastric  Grade x-__________  Grade 1-_____ differentiated (_____% of tumor are glands)  Grade 2 - _______ differentiated ( ______% )  Grade 3 - _______ differentiated (______ % or)  Signet ring are ____ grade (grade__)while small cell carcinoma are classified as grade ____

Cannot be assessed Well; >95 Moderately; 50- 95 Poorly;

Tumour Spread Local spread →involve the ____ → ______,_____,_______and retroperitoneum Regional lymph node spread. Distant lymph node-________ node– [_______ node] or and _____ node (anterior axillary) can be 1st clinical sign of ________ Distant spread by blood → _____,_____, _____,______ .etc. Peritoneal seedling, one or both ____ (Krukenberg’s tumor –ref. breast, pancreas and bladder)

wall; serosa, duodenum, pancreas supraclavicular; Virchow’s Irish; occult Ca Liver, lung, bone, brain ovaries

Clinical presentation Non-specific  Indigestion  Nausea or vomiting  Dysphagia ________ fullness  Loss of appetite ______ or _____ from anemia  _________  Abdominal pain  Weight loss __________ stomach with _______  Enlarged lymph nodes such as _______ node or _____ node

Postprandial Melena or pallor Hematemesis Palpable enlarged ; succussion splash Virchow; Irish

Diagnosis of gastric cancer  Clinical-symptoms and signs  Lab test  LFT  Tumour markers-  elevated CEA in ______% of cases  elevated CA 19-9 in about _____% of cases  Imaging-CTScan, etc  Endoscopic Biopsy to confirm, type and stage the tumour

45-50 20

 Tumour markers-  elevated ____ in 45-50% of cases  elevated _____ in about 20% of cases

CEA CA 19-9

Management Multidisciplinary team with combination of Surgery and chemotherapy or targeted immunotherapy T/F

Prognosis Prognosis depends on –  ________ of invasion  extent of _______ and ________

depth nodal and distant metastases

5yr Survival rate after surgical resection for EGCa is ______%, for advance GCa is ____%

90-95 15

Intestinal Type Grossly appears as (small or large?) ulcer with (regular or irregular?) margins Similar to _________________

Large ; irregular colonic adenocarcinoma

Intestinal Type Results from intestinal metaplasia •__________;_________ Common in ________ (where ulcers form!)

H. pylori; autoimmune gastritis lesser curvature

Intestinal Type Risk Factors More common among (younger or older?) men Other risk factors Smoking ______ consumption ______________ Type ____ blood

Older Alcohol Nitrosamines A

Diffuse Type (More or Less?) common form (Plenty of Few?) established risk factors Made up of _________ cells, _______ cells

Less Few gastric mucosa Signet ring

Diffuse Type is Not associated with metaplasia, H. pylori T/F

Diffuse Type Stomach diffusely thickened • __________ is a common symptom •Linitis plastica: stomach thickened like ________

Early satiety leather

Diffuse Type Signet ring cells •_______ forms → _______ pushed to periphery

Mucin nucleus

Metastasis of gastric cancer Most common site is ______

liver

Clinical Features Early curable gastric cancer: It may present with ________ features. Advanced cancer: It presents with early satiety, bloating, distension and vomiting. The tumor frequently ———-  causing _______________ Tumor in the pyloric region may present with _______________

nonspecific bleeds; iron-deficiency anemia. gastric outlet obstruction.

Gastric Carcinoma Special Clinical Findings Acanthosis Nigricans •_______________ on skin •__________ sites (folds) •Classically ______ and ______

Hyperpigmented plaques Intertriginous neck and axillae

Gastric Carcinoma Special Clinical Findings Associated with _________ ———- (Frequently or Rarely?) associated with malignancy _______________ is the most common

insulin resistance Rarely Gastric adenocarcinoma

Gastric Carcinoma Special Clinical Findings Leser-Trelat sign •“________ onset” of multiple _____________ •Probably caused by _________ Associated with (No or Many?) malignancies

Explosive; itchy seborrheic keratosis cytokines many

Gastric Carcinoma Special Clinical Findings Virchow’s node (_____ sign) •(right or left?) ___________ node (drains stomach) Sister Mary Joseph nodule •Metastasis to _____________ •________ on exam

Troiser’s; Left supraclavicular periumbilical region Palpable

Gastric Carcinoma Special Clinical Findings Trousseau’s sign: (Metastatic or Non-metastatic?) effects may be in the form of ______________ (Trousseau’s sign) and __________ thrombosis. These are due to the effects of the tumor on _______ and ———— mechanisms.

Non-metastatic migrating thrombophlebitis deep venous thrombotic and hemostatic

Gastric Carcinoma Special Clinical Findings Krukenberg tumor •_______ tumor secondary to metastasis from another site •Most common from gastric adenocarcinoma •___lateral _______ metastasis •________ cells often seen on pathology

Ovarian Bi ovarian Signet

Gastric Carcinoma Special Clinical Findings _________ tumor _______ node (______ sign) ______________ nodule ____________ sign ___________ sign ___________________

Krukenberg Virchow’s; Troiser’s Sister Mary Joseph Trousseau’s Leser-Trelat Acanthosis Nigricans