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#Phase 2.1: Peri Op > Gastric Cancer > Flashcards

Gastric Cancer Flashcards

1
Q

What are 90% of gastric cancers?

A

Adenocarcinomas arising from gastric mucosa

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2
Q

What are the rest (10%) of gastric cancers?

A

CT / lymphoid / neuroendocrine malignancies

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3
Q

What are the risk factors of gastric cancer? (8 things)

A
  1. Male
  2. H Pylori infection
  3. Age
  4. Smoking
  5. Alcohol
  6. Salt diet
  7. FHx
  8. Pernicious anaemia
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4
Q

What are pathophysiology steps of gastric cancer? (5 steps)

A
  1. Prolonged exposure to risk factor
  2. Atrophic gastritis
  3. Achlorhydria / hypochlorhydria (no / low stomach acid)
  4. Increased stomach pH
  5. Microbial colonisation + loss of cells
    (Cells prod GF needed to regen damaged tissue)
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5
Q

How does Chronic gastritis progress into Adenocarcinoma? (5 steps)

A
  1. Chronic gastritis
  2. Chronic atrophic gastritis
  3. Metaplasia
  4. Dysplasia (direct precursor to cancer)
  5. Adenocarcinoma
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6
Q

What is a histological feature of gastric cancer?

A

Signet ring cells

  • Has large vacuole of mucin
  • Vacuole pushes nucleus to one side
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7
Q

What does a large number of Signet ring cells in gastric cancer indicate?

A

Bad prognosis

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8
Q

Why do patients only present at advanced stages of gastric cancer?

A

Because symptoms are vague + unspecific

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9
Q

What are the clinical features of gastric cancer? (11 things)

A
  1. Jaundice
  2. Anaemia (late)
  3. Dyspepsia
  4. Dysphagia (late)
  5. N+V
  6. Troisier sign (palpable L supraclavicular node aka Virchow’s node)
  7. Acanthosis nigricans (hyperpig @ skin creases e.g armpit)
  8. Epigastric mass
  9. Hepatomegaly
  10. Ascites
  11. Weight Loss
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10
Q

What are some differentials that present similarly to gastric cancer? (4 things)

A
  1. GORD
  2. PUD
  3. Gall stones
  4. Pancreatic cancer
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11
Q

What lab tests should be done for suspected gastric cancer? (2 things)

A
  1. FBC’s
  2. LFT’s
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12
Q

What is the gold standard imaging for gastric cancer?

A

Upper GI Endoscopy (OGD)

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13
Q

What is the use of OGD in gastric cancer imaging? (2 things)

A
  1. Direct visualisation of malignancy
  2. Biopsy can be taken
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14
Q

What are the findings of OGD in gastric cancer? (2 things)

A
  1. Friable ulcerated mass
  2. Gastric ulcer w irreg / thickened margins
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15
Q

What should the biopsy of suspected gastric cancer be sent for? (3 things)

A
  1. Histology = classify + grade any neoplasia
  2. CLO test = presence of H Pylori
  3. HER2 / neu prot expression = allows for targeted monoclonal therapies if present
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16
Q

What are the disadvantages of CT scans in gastric cancer? (3 things)

A
  1. Only shows thickness of gastric wall
  2. Doesn’t allow direct visualisation of malignancy
  3. Can’t do biopsy
17
Q

How can gastric cancer be staged? (2 things)

A
  1. CT chest-abd-pelvis
  2. Staging laparoscopy (to look for peritoneal metastases)
18
Q

What is the staging system for gastric cancer?

19
Q

What do the different values of T mean in TNM staging of gastric cancer?

A 
T0 = no tumour 
T1 = invasion up to submucosa 
T2 = invasion of muscularis propria 
T3 = invasion of serosa 
T4a = perforates serosa 
T4b = adj structures affected
20
Q

What do the different values of N mean in TNM staging of gastric cancer?

A 
N0 = No regional lymph nodes 
N1 = 1-2 regional lymph nodes 
N2 = 3-6 regional lymph nodes 
N3 = 7+ regional lymph nodes
21
Q

What do the different values of M mean in TNM staging of gastric cancer?

A 
M0 = no distant metastases 
M1 = confirmed metastases
22
Q

What is the curative treatment for gastric cancer?

A

Surgery

+ if fit enough perioperative chemo

23
Q

What does the type of operation depend on in gastric cancer?

A

Region of cancer

24
Q

What operation is done for Early gastric cancer (confined to mucosa / submucosa)?

A

Endoscopic submucosal resection

25
Q

What operation is done if the gastric cancer is 5+ cm away from OGJ (oesophagogastric junction)?

A

Subtotal gastrectomy

26
Q

What operation is done if the gastric cancer is less than 5cm away from OGJ (oesophagogastric junction)?

A

Total gastrectomy

27
Q

What operation is done if the for Type 2 junctional tumour (extended into oesophagus)?

A

Oesophagogastrectomy

28
Q

What procedure is always done with gastrectomy of gastric cancer?

A

Lymphadenectomy

29
Q

Why are most patients w gastric cancer treated palliatively?

A

Bc late presentation

30
Q

What is the palliative treatment for gastric cancer (3 things)

A
  1. Chemo
  2. Stenting (for pt w gastric outlet obst)
  3. Palliative surgery (if stenting fails)
31
Q

What are the types of palliative surgery for gastric cancer? (2 things)

A
  1. Distal gastrectomy
  2. Bypass (gastro-jejunostomy)
32
Q

What are the complications of gastric cancer? (4 things)

A
  1. Gastric outlet obstruction
  2. Iron deficiency anaemia
  3. Perforation
  4. Malnutrition

#Phase 2.1: Peri Op (24 decks)

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