gastric cancer

Question 1

which histopathology is associated with worse prognosis for gastric cancer?

Answer 1

• singet ring cells

- higher numbers are associated with worse prognosis

Question 2

what is the histopathology for gastric cancers?

Answer 2

90-95% are adenocarcinoma

Question 3

what are the risk factors for gastric cancer?

Answer 3

H.pylori infection (more common in intestinal subtype)

Autoimmune gastritis

Nitrosamines in smoked food

Blood type A

pernicious anaemia

Lynch syndrome

Question 4

what are the 2 types of gastric cancer?

Answer 4

intestinal-> arising from intestinal metaplasia and involving the lesser curvature of the stomach.

diffuse-> infiltrates the gastric wall and causes lintus plastica, which is extra thick stomach wall muscle. it also has worse prognosis and more signet ring cells

Question 5

what is lesser treat sign?

Answer 5

• a paraneoplastic effect of gastric cancer causing an eruption of seborrhoea keratosis

Question 6

what are the symptoms of gastric cancer?

Answer 6

Patients with gastric cancer may be asymptomatic or present with vague, non-specific symptoms.

• abdominal pain/ dyspepsia
• anorexia and weight loss
• difficulty swallowing
• early satiety
• nausea and vomiting

Question 7

what sings would you see for gastric cancer on examination?

Answer 7

• signs of iron deficiency anaemia
• palpable mass
• melaena on DRE
• acanthosis nigoracans
• virchows node
• lesser-trelat sign-> sudden onset seborrhoea keratosis

Question 8

what investigations would be important to do?

Answer 8

• upper GI endoscopy

- then staging scans

Question 9

what is the surgical management for gastric cancer?

Answer 9

• surgical management is indicated only if there is NO metastatic disease
• surgery: gastrectrectomy with rou en y reconstruction

Question 10

what are complications related to gastric cancer?

Answer 10

Bleeding: patients may present with melaena from a bleeding gastric tumour

Gastric outlet obstruction: tumour blocks the gastric outlet causing non-bilious post-prandial vomiting

Perforation: ulceration of a neoplastic lesion can weaken the stomach wall and if left untreated could lead to perforation

Metastasis: Virchow’s node, lung, liver, peritoneum, ovaries (Krukenberg tumour)

Question 11

what are some complications related to gastrectomy?

Answer 11

Malabsorption:
Vitamin B12 deficiency (reduced intrinsic factor)
Iron deficiency due to reduced conversion of Fe2+ to Fe3+ in the stomach and hence reduced absorption

Small bowel bacterial overgrowth:
post gastrectomy, a blind-ending bowel loop is created to allow the gall bladder to drain. Bacterial overgrowth within this portion of the bowel can lead to malabsorption

Dumping syndrome:
occurs when sugar moves too quickly into the small bowel and associated with gastrectomy
Early dumping syndrome: occurs 30 mins after a meal as fluid moves into the intestine due to the high osmotic load, resulting in dizziness and palpitations

Late dumping syndrome: occurs 2 hours after a meal. As glucose is rapidly absorbed in the intestine, this causes reactive hyperinsulinaemia and subsequent hypoglycaemia