Gastric Cancer

Question 1

Symptoms gastric cancer? (7)

Answer 1

• Nonspecific in early disease: vague epigastric discomfort, indigestion, dyspepsia. Most with advanced disease:
• constitutional symptoms: weight loss , anorexia, fatigue, vomiting
• proximal lesions: dysphasia
• distal lesions: gastric outlet obstruction
• early satiety, especially in cases of linitis plastic
• anemia of chronic iron deficiency
• rarely upper git bleed

Question 2

Signs gastric cancer? (7)

Answer 2

• Wasting, pallor
• palpable epigastric mass and tender
• hepatomegaly liver metastasis
• palpable Virchow’s node (left supraclavicular)
• peni-umbilical nodule: sister Mary Joseph
• peritoneal metastasis on pr: bloomers shelf
• palpable ovarian mass: Krukenberg’s

Question 3

What is Virchow’s node?

Answer 3

Palpable left supraclavicular lymph node

May be enlarged due to lymphoma, abdominal and breast malignancy

Question 4

Staging gastric cancer?

Answer 4

Tumour (endoscopic Ultrasound,CT)
• Tx, To
• Tis: intraepithelial tumour without invasion lamina propriae
• T 1: invade lamina propria Or submucosa
• T 2: muscularis propria Or subserosa
A: muscularis propria
B: subserosa
• T 3: serosa (visceral peritoneum) without invasion adjacent structures
• T 4: adjacent structures

Nodes (staging CT chest abdomen pelvis )
• N 1: 1-6 regional lymph nodes (new guidelines 1-2)
• N 2: 7-15 (new guidelines 3-6 )
• N 3: > 15 (new guidelines > 7)

Metastasis ( cxr, CT abdomen)
M1

Question 5

Name 4 types gastric cancers in order of how common they are

Answer 5

1. Adenocarcinoma
   2.lymphoma
2. Gist ( gi stromal tumour)
   4 rare- neuro-endocrine tumours

Question 6

Name 10 risk factors gastric adenocarcinoma

Answer 6

• male x2
• elderly -peak 70 s
• diet: low fat and protein; salted meat and fish, high nitrates eg ham, bacon.
• poor food preparation, lack refrigeration
• smoking
• low socioeconomic status
• prior gastric surgery
• H pylori infection
• gastritis and gastric atrophy
• adenomatous polyps
• e cadherin gene

Question 7

Morphologic macroscopic classification of gastric Tumours?

Answer 7

Bormann classification
1 polyploid or fungating
2. Ulcerating lesions with elevated borders
3. Ulcers with infiltration of surrounding wall
4 diffusely infiltrating lesion (linitis plastica) with contracted gastric volume and early satiety

Question 8

Histologic classification of gastric cancer?

Answer 8

Lauren histologic classification
• intestinal type: most common. Associated with classical risk factors, older patients.
• diffuse type: familial tendency, younger females, more aggressive

Question 9

Treatment gastric cancer? (4)

Answer 9

• Cardia and proximal stomach tumours: total gastrectomy
• distal tumours: subtotal gastrectomy, providing clear margins can be achieved
• chemo and radiation, Neo adjuvant, etc.
• for gastric outlet obstruction: dilatation with stent, surgical bypass