gastric cancer

Question 1

Types

Answer 1

Intestinal and diffuse

Question 2

Types: Intestinal
1. Associations
2. Commonly on […] of stomach

Answer 2

H. pylori, tobacco smoking, achlorhydria and chronic gastritis
Lesser curvature

Question 3

Types: diffuse
1. Is it associated with H pylori
2. Associated with […] cells

Answer 3

Diffuse
1. No
2. Signet

Question 4

Specific forms or precancerous forms of gastric cancer

Answer 4

Menetrier’s disease (pre-cancerous)
Krukenberg tumour
Sister Mary Joseph nodule
Linitis plastica

Question 5

Menetrier’s disease

Answer 5

hyperplasia of the gastric mucosa
large, gastric folds on the body and stomach –> increased mucus production
parietal cell atrophy –> reduced HCl secretion

Question 6

Krukenberg tumour

Answer 6

‘signet ring’ tumour
secrete mucin and readily metastasize to the ovaries.

Question 7

Sister Mary-Joseph nodule

Answer 7

Subcutaneous peri-umbilical metastasis

Question 8

Linitis plastica

Answer 8

leather bottle stomach
stomach muscles become more rigid –> holds less food

Question 9

Risk factors
- Smoking
- H pylori
- >6 units of alcohol daily
What else?

Answer 9

Pernicious anaemia
Dietary nitrosamines (found in smoked foods and gastric cancer has higher incidence in Japan)
Atrophic gastritis
Blood group A
Adenomatous polyps
Achlorhydria (as seen in Menetrier’s disease)

Question 10

Is GORD a RF for gastric cancer?

Answer 10

No –> for Barret’s oesophagus (intestinal metaplasia)

Question 11

Features
- Anaemia
- Weight loss
- Anorexia
What else?

Answer 11

Recent onset/progression of symptoms
Melaena/haematemesis
Swallowing difficulty (dysphagia)

Question 12

2ww
- […] at any age
- Aged over […] with weight loss AND
* […] or reflux or dyspepsia
- […] consistent with stomach cancer

Answer 12

• Dysphagia
• 55
• Upper abdominal pain
• Upper abdominal mass

Question 13

Non urgent OGD - 6ww
- […] at any age
- Aged 55 and over with either –
* […]
* Upper abdominal pain and […]
* […] AND any of the following –
Nausea, vomiting, reflux, weight loss, dyspepsia epigastric pain

*[…] AND any of the following –
Weight loss, reflux, dyspepsia, epigastric pain

Answer 13

• Haematemesis
  *Treatment resistant dyspepsia
  *Low Hb
  *Raised platelet count
• Nausea or vomiting

Question 14

Imaging
- […] used for staging
- For oesophageal cancer, use […]

Answer 14

CTCAP
endoscopic USS (no metastasis info thugh)

Question 15

Mx
1. Local
2. Metastasis: radio + chemo e.g. […]

Answer 15

1. Partial or total gastrectomy
2. fluorouracil