Gastric Ca

Question 1

Stem: a 60- year- old lady who is chronic alcoholic was diagnosed with gastric cancer. She underwent gastrectomy and splenectomy due to iatrogenic injury. Patient has also osteoarthritis.
Pathology Report:
- Signet ring cell carcinoma.
- Positive LNs.
- R1
- Spleen involved

Q1: Discuss this pathology report with the patient’s family in four simple sentences.

Answer 1

Gastric Ca – incompletely resected – need further op – pt need chemtherpy after that and there’s a high chance of coming back.

Question 2

Q2: What’s the plan for the patient post- splenectomy?

Answer 2

Vaccination for oppurstnic infection after 2 wks (Pneumococci- H.influenza- N. meningtidis)
Abx; Long acting Penicilline for 2 yrs.

Question 3

Q2: Mention 4 important risk factors for gastric cancer?

Answer 3

H.pylori Inf. / Pernicious anemia / Ch. Atrophic gastritits / Intestinal metaplasia

Question 4

Q3: How does gastric cancer develop?

Answer 4

Chronic irritation of mucosa by infection like gastritis – > Metaplesia – > Dysplasia – > invasion of BM – > Invasive Ga Ca

Question 5

Q5: do you know any classification for gastric cancer?

Answer 5

WHO Classification: 5 Main Types
1. Tubular Adenocarcinoma: Composed of small branching tubes.
2. Papillary Adenocarcinoma: Outward-growing tumor with finger-like projections.
3. Mucinous Adenocarcinoma: Contains abundant mucin outside the cancer cells.
4. Poorly Cohesive Carcinomas: Includes signet ring cell carcinoma; arranged in clumps.
5. Mixed Carcinoma: Contains a mix of different adenocarcinoma types.
Lauren Classification: 2 Main Types
1. Intestinal Type: Well-differentiated cells, slow-growing, gland-forming, more common in older men.
2. Diffuse Type: Poorly differentiated cells, aggressive, scattered growth, equal in men and women, often occurs at a younger age.

Question 6

Q. Countries implement Ga Ca Screening prog. ?

Answer 6

Japan / S.Korea

Question 7

Q6: 10 days after resection the patient developed diffuse, painful swelling of the left arm.
What do you think has happened? What are the predisposing factors in this patient?

Answer 7

Axillary V. Thrmbosis
Hypercoagulable stasis / Veins stasis from compression by vircow triad / Mets from Cancer to the vein.

Question 8

Q4: What’s the commenest histological type of gastric cancer?

Answer 8

Adenocarcinoma / GIST /Liemyosarcoma / B-Cell lymphoma

Question 9

Q7: How can you define paraneoplastic syndromes?
Q.Do you any paraneoplastic syndromes. associated with gastric carcinoma?

Answer 9

Symptom complexes that occur in patients with cancer and that cannot be readily explained by local or distant spread of the tumor or by the elaboration of hormones
Ex; Dermatomyositis, Acanthos nigricans, HyperCa

Question 10

Q8: How does gastric cancer spread first?

Answer 10

Mainly by lymphatic spread

Question 11

What are the other routes of spread?

Answer 11

Direct invasion, Hemtogenous, Transcelomic

Question 12

• 6 months later the patient presented with abdominal distension, positive shifting.
  Q9: What’s your diagnosis now?

Answer 12

Hepatic mets lead to ascites
Test; Ascitic tap analysis, Liver biopasy, CEA marker, Alpha Feto ptn marker
plan; palliative mngmnt– > Pain (Morphine) Feeding (Feeding jujenostomy)

Question 13

Q10: How does ascitis develop in this case?

Answer 13

Increase hydrostatic pressure and decr. Oncotic pressure

Question 14

Q11: What are the procedure specific complications of total gastrectomy?

Answer 14

Early;
Inf. /
Bleeding /
Anastmosis leak /
Cholecystitis /
Pancreatitis.
Lat;
Damping $,
Vit b12 Deficincy,
Recurrence.

Question 15

Q12: What’s damping syndrome?

Answer 15

Dumping Syndrome
Dumping syndrome occurs when the stomach’s ability to act as a reservoir is compromised, often following gastrectomy. This leads to the rapid movement of highly osmotic substances into the duodenum after meals.
Types and Symptoms:
1. Early Dumping Syndrome:
o Timing: 30–60 minutes after a meal.
o Mechanism: Rapid transit of hyperosmolar gastric contents into the small bowel causes a fluid shift from the intravascular compartment into the gastric lumen.
o Symptoms: Small bowel distension, colicky abdominal pain, diarrhea, tachycardia, and postural hypotension.
2. Late Dumping Syndrome:
o Timing: 1–3 hours after a meal.
o Mechanism: Rapid transit of carbohydrates leads to sudden absorption of glucose, causing compensatory hyperinsulinemia and subsequent hypoglycemia.
o Symptoms: Hypoglycemia-related symptoms such as weakness, sweating, dizziness, and palpitations.

Question 16

Q. The name of familial type of Gastric Ca? Genetic Mutation? Mode of iheretance?

Answer 16

Herediatry diffuse Ga Ca
CDH-1 gene
AD

Question 17

Q. what’s age when we start screen for CDH-1 gene?

Q. If pt carries the gene what age to do prophylactic surgery?

Answer 17

At 18 yrs
..
Btw 20-30 yrs

Question 18

Q. What are the other types of Malignancy assoc. with CDH-1?

Answer 18

Lobular breast Ca. /
Prostate Ca /
Colorectal Ca

Question 19

Q. In which pt is screening for CDH-1 gene indicated?

Answer 19

1- ≥2 cases of gastric cancer in family regardless of age, with at least one diffuse gastric cancer (DGC).
2- ≥1 case of DGC at any age, and ≥1 case of lobular breast cancer at age <70 years in different family members.
3- ≥2 cases of lobular breast cancer in family members <50 years of age.

Question 20

Q. How can you ttt Malig. Ascitis?

Answer 20

(1) Simple drainage. …
(2) Peritoneovenous shunting (PVS) …
(3) Cell-free and concentrated ascites reinfusion therapy (CART)
(4) Treating the underlying cancer with chemotherapy and/or surgery may control ascites as well

Question 21

(( READ MORE ON CDH-1 Gene ))

Answer 21

(( READ MORE ON CDH-1 Gene ))