Gastric Cancer Flashcards
Main risk factors of Gastric Ca
Exogenous: diet rich in nitrates/salts H pylori infection Ebv virus Obesity Alcohol Smoking
Endogenous: chronic atrophic gastritis Achlorhydria Gastric ulcers Partial gastrectomy Pernicious anemia
Hereditary:
Blood type A
HNPCC
Mutation in cdh1 gene(codes for e cadherin) which is a major risk for diffuse type adenocarinoma
What’s the main type of gastric cancer
Adenocarcinoma (95%)
Others: GIST, Lymphomas, carcinoid tumours(from G cells)
Where along the stomach do you mainly find gastric ulcers
Along the lesser curvature
However those along greater curvature more likely malignant
Clinical features of gastric Ca
General: Weight loss Palpable tumor in epigastric region Signs of chronic iron def anemia Epigastric pain Early satiety
Signs of gastric outlet obstruction:
Dysphagia
Abd pain
Vomiting
Upper GI bleeding:
Hematemesis
Melena
Signs of metastasis Hepatomegaly Ascites Virchow node( left supraclavicular) Sister Mary joseph node( periumbilical node) Krukenburg tumor( mass/mets in ovary ) Irish nodes: left axillary Blumer shelf: mass in pouch of Douglas for females (palpable mass on dre) and rectovesical for males
Paraneoplastic syndromes:
Leser trelat syndrome( brown spots)
Acanthosis nigricans
Investigation of choice for gastric CA
Esophagogastroduodenoscopy and multiple biopsy(4 quadrant biopsy) is GOLD STANDARD
Carcinoembryonic antigen CEA elevated in 30% of cases(elevated most commonly in colon and rectal cancers)
Barium meal(bad at detection of small ulcers)
What is the treatment of choice for a proximal or mid body lesion
Total gastrectomy and oesophajejunostomy with D1 lymph node dissection(nodes along greater and lesser curvature)
Treatment of choice for distal lesions
Distal gastrectomy with bilroth 2 reconstruction(greater curvature connected to first part of jejunum in end to end anastomosis
