Gastric Cancer Flashcards
What is the blood supply of the stomach?
- Right and left gastric artery
- Left and right gastroepiploic artery
- Short gastric artery
What is the innervation of the stomach?
- Parasympathetics via Vagus nerve
- Sympathetics via greater splanchnic nerve
What are the risk factors for gastric cancer?
Diet,
Obesity,
Smoking,
H.pylori
Age
Ethnicity
Biological sex
Heavy alcohol use
What are the signs and symptoms of gastric cancer?
Symptoms - weight loss, abdo pain, nausea, dysphagia, melena, early satiety, ulcer type pain.
Signs - Palpable abdominal mass, palpable supraclavicular node (left - Virchow’s node), periumbilical nodules (sister mary joseph) and ascites
What are the different types of stomach cancer?
- Adenocarcinoma (94%). Signet ring has poor prognosis
- Lymphoma
- GI stromal tumours
- Mets
Explain the pathophysiology of H.pylori leading to cancer
H.pylori excretes ammonia which nutrelises acid and creates an alkaline environment. This leads to damage of epithelial cells causing inflammation, ulceration and gastric neoplasia
What is the eradication therapy for H.pylori?
Omeprazole, clarithromycin and metronidazol/amoxicillin for 7 days
What is the Lauren classification of gastric cancer?
Intestinal type or diffuse type
What location of gastric cancer is more aggressive?
Proximal cancers (near fundus) are more aggressive as there is less acid here so must be a more carcinogenic cause
Distal cancer are less aggresive
What is linitis plastica
Diffuse type of cancer which invades stomach, thickening the wall of the stomach causing a leather bottle stomach
What is autoimmune gastritis?
Autoimmune destruction of parietal cells. Resulting in achlorhydria, hypergastrinaemia, B12 deficiency
What are the two patterns of H.pylori gastritis?
Antral predominate (Low IL-8, lower risk of cancer)
Pangastritis (High IL-8 and high risk of cancer)
What are the investigations for gastric cancer?
Diagnosis - OGD with biopsy
Staging - CT CAP
Bloods
What is the treatment for gastric cancer?
Proximal cancer - total gastrectomy
Distal cancer - subtotal gastrectomy
+/- chemotherapy
What are the complications of gastrectomy?
Anastamotic leak,
Dumping syndrome (N+V, diarrhoea and hypovolaemia)
B12 def
MI
Stroke
Resp failure,
DVT/PE
