gastric ca Flashcards
definition of gastric ca
gastric malignancy, most commonly adenocarcinoma, more rarely: lymphoma, leiomyosarcoma
aetiology of gastric ca
env insults in genetically predisposed people = mutation = unregulated cell growth
RF:
- H pylori
- atrophic gastritis
- diet high in smoked, processed foods, salt, pickling, and nitrate and nitrosamines exposure, low vit C
- smoking
- alcohol
- pernicious anaemia
- blood gp A
- atrophic gastritis
- adenomatous polyps
- lower social class
epidemiology of gastric ca
incidence: 23/100000/yr in UK
6th most common cancer in UK
age >50yr
common in Japan, eastern Europe, China, and south america
men more
Cancer of the antrum/body is becoming less common, while that of the cardia and gastro-oesophageal junction is increasing.
sx of gastric ca
non specific
dyspepsia - age ≥55yrs with treatment-refractory symptoms demands investigation)
reduced weight
anorexia
vomiting
dysphagia
symptoms of anaemia, haematemesis, melaena
early satiety or epigastric discomfort
Symptoms of metastases, particularly abdominal swelling (ascites) or jaundice (liverinvolvement).
signs of gastric ca
may be normal
epigastric mass
abdo tenderness
ascites
hepatomegaly
jaundice
acanthosis nigricans
eponymous signs of gastric ca
virchow’s node: troisier’s sign - lymphadenopathy in L supracalvicular fossa
sister mary joseph node: met nodule on umbilicus
Krukenberg’s tumour: ovarian met
Ix of gastric ca
upper GI endoscopy: multiquadrant biopsy of all gastric ulcers because even malignant ulcers appear to heal on drug treatment
blood:L FBC (for anaemia), LFT
CT/MRI: staging of tumour and planning surgery
US of liver - staging
bone scan - staging
endoscopic US - assess depth of invasion and lymph node spread
laproscopy - may be needed to determine if tumour is resectable
cytology of peritoneal washings - identify peritoneal met
