Gastric Cancer Flashcards
What classification is used for gastric cancer?
Lauren classification-Japanese Endoscopy society classification
Where is gastric cancer very common?
West
What are the risk factors for gastric cancer?
- pernicious anaemia
- Helicobacter pylori,
- exposure to N-nitroso compounds.
- 50-70
- Male sex
- Smoking
- FHx
- Blood type A
- High salt/low vit C
What is epid for gastric cancer?
male, 50-70
What are the gastro symptoms of gastric cancer?
- Abdominal pain: vague, epigastric
- Weight loss
- Sometimes ascites, jaundice, dyspepsia, anaemia
What are possible differential diagnosis for gastric cancer?
- Peptic ulcer disease
- Benign oesophageal stricture
- Achalasia
What is the 1st line investigation for suspected gastric cancer?
Upper GI endoscopy with biopsy:
What may you find in upper GI endoscopy with biopsy with gastric cancer?
- ulcer
- mass
- mucosal changes
What other investigations would you consider for gastric cancer are why?
- Endoscopic US: determines clinical tumour (T) and node (N) stage
- Ct abdo / pelvis: metastatic lesion
- Chest Xray: ml
- CT chest: ml
- Laparoscopy: ml
- PET/CT
What is the 1st line treatment for localised gastric cancer and is a surgical candidate?
1st line: surgery
Adjunct: perioperative chemo or post op chemo
What is the 1st line treatment for localised gastric cancer and is a non surgical candidate?
chemoradiation
What is the 1st line treatment for gastric cancer that is advanced and metastatic disease?
1st line: chemoradiation or chemo and/or immunotherapy
Adjunct: palliative gastrectomy
What is the 2nd line treatment for gastric cancer that is advanced and metastatic disease?
2nd line: ramucirumab plus paclitaxel
Adjunct: palliative gastrectomy
What is the 3rd line treatment for gastric cancer that is advanced and metastatic disease?
3rd line: pembrolizumab or triflurifinr/tipiracil
Adjunct: palliative gastrectomy
What are the possible complications of gastric cancer?
- Malnutrition
- gastric obstruction
- gastrointestinal bleeding
- gastric perforation
- small bowel obstruction
- postoperative gastroparesis
- postoperative dumping syndrome
- postoperative anastomotic leak
- postoperative wound infection
- postoperative myocardial infarction
- postoperative pneumonia
- chemotherapy-related complications
- radiation-related complications
What is the 5 year survival rate for gastric cancer?
<10% but usually present late
What are signs for gastric cancer?
- Epigastric mass
- Hepatomegaly
- Jaundice
- Ascites
- Virchow’s node
What is the defintion of gastric cancer?
neoplasm originating in any portion of the stomach, most commonly adenocarcinomas
What are different gastric cancers?
- adenocarcinoms
- lymphoma
- GI stromal tumours
- Carcinoid
What are the two types of gastric cancers are what are they associated with?
- . intestinal- H.pylori associated
2. diffuse- e-cadherin mutation associated
What is the gold standard investigation for gastric cancer?
upper GI endoscopy with Biopsy
What is typical presentation for gastric cancer?
- Vague but usually epigastric abdominal pain
- Weight loss common
- Lymphadenopathy
What are key metastases of gastric cancer?
Sister mary joseph nodule (umbilical) and krukenberg tumour (ovary)
What surgery is done in gastric cancer?
- Roux-en Y
2. D2 gastrectomy: gold standard remove all lymph nodes
What are post-op symptoms?
nausea, vomiting, lack of appetite
How can nutrition be affected from gastrectomy?
- Early satiety, frequent small meals
- Nutrition: feeding jujunostomy (rare), supplements
- Total (sub-total): B12 injections
What are Cx from surgery?
- Wound staples remove day 10-12
- Dumping syndrome (20%) (early and late)
- Diarrhoea
