Gastric Cancer

Question 1

Define Gastric Cancer

Answer 1

Neoplasm that can develop in any portion of the stomach and may spread to the lymph nodes and other organs

Question 2

Aetiology of Gastric Cancer

Answer 2

Adenocarcinoma is the most common (95%)

Up to 40% associated withH. pylori
10% genetic component (Loss of tumour suppressor p53 | Proto-oncogense: ras, c-myc, erbB2)

Question 3

Risk factors for Gastric Cancer

Answer 3

Smoking 
H. Pylori - pan-gastritis and MALT lymphoma
Pernicious anaemia
Diet
 - High salt intake
 - Low fruit and veg
 - Low fibre
 - Smoked and salted foods
 - Lack of refrigeration
Familial
EBV

Question 4

Epidemiology of Gastric Cancer

Answer 4

Uncommon before 40
Most common in East Asia
M>F

Question 5

Symptoms of Gastric Carcinoma

Answer 5

50% asymptomatic

Weight loss
Anorexia 
Abdominal pain (Epigastric | Vague)
Dyspepsia
Nausea
Melaena

Question 6

Signs of Gastric Cancer on examination

Answer 6

Lymphadenopathy
Virchow’s node - supraclavicular
Peri-umbilical - Sister Mary Joseph nodule
Left axillary - Irish node

Question 7

Investigations for Gastric Cancer

Answer 7

Endoscopy (OGD): Ulcer or mass or mucosal changes
Endoscopic ultrasound (EUS): tumour and node stage + FNA of regional nodes

Tumour markers: CEA and Ca 19-9 elevated
Immunohistochemsitry: HER2 over-expression

CT CAP: Staging - ?Mets
CXR: ? Mets
PET: ? Mets