Gastric Cancer

Question 1

Where to most gastric cancers arise from?

Answer 1

Most arise form gastric mucosa as adenocarcinomas.

The remainder from mixture of connective tissue, lymphoid or neuroendocrine malignancies

Question 2

What are the risk factors for gastric cancer?

Answer 2

Male gender 
H.pylori infection 
Increasing age 
Smoking 
Alcohol consumption 
Salt in diet 
Positive family history 
Pernicious anaemia

Question 3

What are the clinical features of gastric cancer?

Answer 3

Vague and non-specific - usually presenting late

Dyspepsia, dysphagia, early satiety, melena, vomiting

Anorexia, weight loss, anaemia - late

Epigastric mass - late

Troiseier sign - palpable left supraclavicular node (Virchow node) - metastatic abdominal malignancy

Metastatic - hepatomegaly, ascities, jaundice or acanthosis nigricans

Question 4

What are the differential diagnosis of gastric cancer?

Answer 4

PUD
GORD
Gallstone disease
Pancreatic cancer

Question 5

What are the investigations for gastric cancer?

Answer 5

Urgent bloods

OGD +/- biopsy - sent for histology, CLO test, HER2/neu protein expression (targets monoclonal therapies if present)

CT chest-abdo-pelvis and staging laparoscopy - for staging and plan treatment

Question 6

What nutritional support may a patient with gastric cancer need?

Answer 6

Nutritional status assessment and reviewed by dietician.

May need definitive nutritional support. Both pre and post op - via NG tube or RIG (radiologically-inserted gastrostomy) tube.

Question 7

What is the mainstay treatment of gastric cancers?

Answer 7

Surgery with peri-op chemotherapy and post op

Question 8

What is the surgery for proximal gastric cancers?

Answer 8

Total gastrectomy

Question 9

What is the surgery for distal gastric cancers (antrum and pylorus)?

Answer 9

Subtotal (partial) gastrectomy

Question 10

What is the method used for reconstruction in gastric cancer surgery?

Answer 10

Roux-en-Y reconstruction

Question 11

What may be offered to early gastric cancers e.g. T1a tumours?

Answer 11

Endoscopic mucosal resection (EMR)

Question 12

What are gastrectomy complications?

Answer 12

Death 
Anastomotic leak 
Re-operation 
Reduced quality of life for up to 6 months 
Vit B12 deficiency

Question 13

What is the palliative approach to gastric cancers?

Answer 13

Chemotherapy
Best supportive care
Stenting if causing gastric outlet obstruction

Distal gastrectomy or gastric bypass if stenting failed

Question 14

What are the main complications of gastric cancers?

Answer 14

Gastric outlet obstruction

Iron-deficiency anaemia

Perforation

Malnutrition

Death - 10 year survivals rate = 15%