Gastric Cancer Flashcards
What are 90% of gastric cancers?
Adenocarcinomas arising from gastric mucosa
What are the rest (10%) of gastric cancers?
CT / lymphoid / neuroendocrine malignancies
What are the risk factors of gastric cancer? (8 things)
- Male
- H Pylori infection
- Age
- Smoking
- Alcohol
- Salt diet
- FHx
- Pernicious anaemia
What are pathophysiology steps of gastric cancer? (5 steps)
- Prolonged exposure to risk factor
- Atrophic gastritis
- Achlorhydria / hypochlorhydria (no / low stomach acid)
- Increased stomach pH
- Microbial colonisation + loss of cells
(Cells prod GF needed to regen damaged tissue)
How does Chronic gastritis progress into Adenocarcinoma? (5 steps)
- Chronic gastritis
- Chronic atrophic gastritis
- Metaplasia
- Dysplasia (direct precursor to cancer)
- Adenocarcinoma
What is a histological feature of gastric cancer?
Signet ring cells
- Has large vacuole of mucin
- Vacuole pushes nucleus to one side
What does a large number of Signet ring cells in gastric cancer indicate?
Bad prognosis
Why do patients only present at advanced stages of gastric cancer?
Because symptoms are vague + unspecific
What are the clinical features of gastric cancer? (11 things)
- Jaundice
- Anaemia (late)
- Dyspepsia
- Dysphagia (late)
- N+V
- Troisier sign (palpable L supraclavicular node aka Virchow’s node)
- Acanthosis nigricans (hyperpig @ skin creases e.g armpit)
- Epigastric mass
- Hepatomegaly
- Ascites
- Weight Loss
What are some differentials that present similarly to gastric cancer? (4 things)
- GORD
- PUD
- Gall stones
- Pancreatic cancer
What lab tests should be done for suspected gastric cancer? (2 things)
- FBC’s
- LFT’s
What is the gold standard imaging for gastric cancer?
Upper GI Endoscopy (OGD)
What is the use of OGD in gastric cancer imaging? (2 things)
- Direct visualisation of malignancy
- Biopsy can be taken
What are the findings of OGD in gastric cancer? (2 things)
- Friable ulcerated mass
- Gastric ulcer w irreg / thickened margins
What should the biopsy of suspected gastric cancer be sent for? (3 things)
- Histology = classify + grade any neoplasia
- CLO test = presence of H Pylori
- HER2 / neu prot expression = allows for targeted monoclonal therapies if present
What are the disadvantages of CT scans in gastric cancer? (3 things)
- Only shows thickness of gastric wall
- Doesn’t allow direct visualisation of malignancy
- Can’t do biopsy
How can gastric cancer be staged? (2 things)
- CT chest-abd-pelvis
- Staging laparoscopy (to look for peritoneal metastases)
What is the staging system for gastric cancer?
TNM
What do the different values of T mean in TNM staging of gastric cancer?
T0 = no tumour T1 = invasion up to submucosa T2 = invasion of muscularis propria T3 = invasion of serosa T4a = perforates serosa T4b = adj structures affected
What do the different values of N mean in TNM staging of gastric cancer?
N0 = No regional lymph nodes N1 = 1-2 regional lymph nodes N2 = 3-6 regional lymph nodes N3 = 7+ regional lymph nodes
What do the different values of M mean in TNM staging of gastric cancer?
M0 = no distant metastases M1 = confirmed metastases
What is the curative treatment for gastric cancer?
Surgery
+ if fit enough perioperative chemo
What does the type of operation depend on in gastric cancer?
Region of cancer
What operation is done for Early gastric cancer (confined to mucosa / submucosa)?
Endoscopic submucosal resection
