Gastric CA

Question 1

Incidence of Gastric CA

Answer 1

High in japan

low in US

Question 2

What are the risk factors?

Answer 2

Diet - smoked meats, high nitrates, alcohol, tobacco

Environment - high risk area, poor socioeconomic status, atrophic gastritis, H.pylor, pernicious anemia, polyps

Question 3

Average age of Gastric CA

Answer 3

> 60 years

Question 4

What are the symptoms?

Answer 4

WEPON:
Weight loss
Emesis
Anorexia
Pein/epigastric discomfort
Obstruction
Nausea

Question 5

Most common early symptoms

Answer 5

Mild epigastric discomfort and indigestion

Question 6

What is the most common symptom

Answer 6

Wt loss

Question 7

What are the signs

Answer 7

Anemia, melena, heme occult, epigastric mass, hepatomegaly, Blumer’s shelf, Virchows node

Question 8

What does the patient with gastric CA have if he has proximal colon distension

Answer 8

coloni obsturction by direct invasion

Question 9

What is the symptom of proximal gastic CA

Answer 9

Dysphagia

Question 10

Solid peritoneal deposit anterior to the rectum, forming a “shelf”, palpated on rectal examination

Answer 10

Blumer’s shelf

Question 11

Metastatic gastric cancer to the nodes int the left supraclavicular fossa

Answer 11

Virchow’s node

Question 12

Periumbilical lymph node gastric cancer metastasis, presents PERIUMBILICAL MASS

Answer 12

Sister Mary Joseph sign

Question 13

Gastric cancer (or other adenocarcinoma) that metastasized to the ovary

Answer 13

Krukenburg tumor

Question 14

Left axillary adenopathy from gastric ccncer metastasis

Answer 14

Irish node

Question 15

Lab finding

Answer 15

CEA elevated

Question 16

Hisotlogy

Answer 16

adenocarcinoma

Question 17

Differentals

Answer 17

AdenoCA, leiomyoma, leiomyosarcoma, lymphoma, carcinoid

Question 18

Two histologic types gastric CA

Answer 18

Intestinal (glands)

Diffuse (no glands)

Question 19

What is the morphology

Answer 19

Ulcerative (75%)
Polypoid
Scirrhous
Superficial

Question 20

Common in Lesser or Greater curvature?

Answer 20

LESSER (less is more)

Question 21

What is more common?proximal or distal gastric CA

Answer 21

Proximal

Question 22

“LEATHER BOTTLE” sign

Answer 22

Linitis plastica - entire stomach is involved and looks thickened

Question 23

Mode of metastasis

Answer 23

Hematogenously and lymphatycally

Question 24

Which patients with gastric CA are NON operative?

Answer 24

Distant metastasis

Peritoneal implants

Question 25

Genetic alteration seen in >50% of patients with gastric cancer?

Answer 25

P53

Question 26

Distal subtotal gastrectomy is performed for tumor in the?

Answer 26

Antrum

Question 27

What is subtotal gastrectomy?

Answer 27

75% of stomach removed

Question 28

What is a total gastrectomy?

Answer 28

Stomach removed and Roux-en-Y limb is sewn to the esophagus

Question 29

Define extende lymph node dissection

Answer 29

usually D1 and D2:
D1 are perigastric LNs
D2 splenic aretery LNs, Hepatic

Question 30

What is the adjuvant treatment?

Answer 30

Stages II and III: postoperative chemo and radiation

Question 31

What is the 5-year survival rate for gastric CA?

Answer 31

25% 5 year survival rate

50% 5 year survival rate in japan