Gastric Cancer Flashcards
Those That Increase the Risk of Gastric Cancer:
**Hypoacidity (85% of all gastric cancers)
** H. Pylori
• Atrophic gastritis (95% of all gastric cancers)
• Adenomatous polyp (especially > 2cm)
• Genetics
• Pernicious anemia
• A blood group
• Environmental factors
• Nitrites and Smoked
fish(3,4 benzopyrene)
• Aflatoxin
• Duodenal ulcer surgery
• Residual stomach after resection (especially Billroth II operation)
• Presence of gastric ulcer
• Presence of intestinal metaplasia
• Epstein Barr Virus (EBV)
Those that Reduce the Risk of Gastric Cancer:
Aspirin(salicylates)
Diet(fresh fruits, vegies)
Vitamin C
Which condition has highest risk for premalignancy in gastric ca?
Atrophic gastritis
Which condition has lowest risk for premalignancy in gastric ca?
Hyperplastic polyp
Early stage of gastric cancer is most common in ……?
Corpus/body of stomach
In which layer of the stomach is the early stage of gastric ca confined in?
Mucosa and submucosa of stomach
Tx of early stage gastric ca?
EMR (no need for surgery)
Or ESD
**Which is the most common subtype of type 2 early gastric ca classification?
Depressed-corpus
What is the classification of type 3 EARLY gastric ca ?
Excavated -corpus
Which type of gastric carcinoma is associated with H.pylori?
Intestinal type gastric carcinoma
Which type of gastric carcinoma is associated with poorly differentiated signet ring cells?
Diffuse type gastric carcinoma
Which type of metastasis is in intestinal vs. diffuse type gastric carcinoma?
In intestinal type —>hematogenous metastasis
(Lymphatic met is lower)
In diffuse type—> lymphatic metastasis (is more)
Which type of Lauren classification is more in female and which is more in male?
In female Diffuse
While
In males it is intestinal type gastric ca
Which cancer is treated with antibiotic?
Low-grade MALT Lymphoma (MALTOMA) ;caused by H pylori
Is a 10 cm submucosal gastric cancer early or late?
It is early bcz it is sill in submucosa
Tumor size is imp in GIST(intestinal);
Lesion 1cm> may behave as malignant
Gastric tumor size is
Not imp; only the layer in which the tumor invades is imp
Tx for gastric carcinoid?
Resection
Which type of gastric carcinoma is familial vs environmental?
Diffuse type is familial
Intestinal type is environmental
** what is the mutations that occur in diffuse vs intestinal types of gastric carcinoma?
Intestinal type—>APC gene mutation
Diffuse type—> E-cadherin (CDH1) expression decreased
Which type of gastric carcinoma is endemic vs epidemic?
Intestinal type—>epidemic
Diffuse type—>endemic
Which type of gastric carcinoma secretes mucin and is infiltrative
Diffuse type gastric carcinoma
Which type of gastric carcinoma looks like a polypoid?
Intestinal type gastric carcinoma
Which type of gastric carcinoma has better vs poor prognosis and differentiation ?
Intestinal type—> better prognosis &better differentiation
Diffuse type—>poor prognosis /worse differentiation
What are the most common symptoms of gastric carcinoma?
Anorexia(restriction of food)
Weight loss
Diagnosis for gastric cancer?
Endoscopy+golden standart: Biopsy
How many lymph nodes must be resected for adequate staging of gastric ca?
15
Tx for gastric ca?
Surgical+15 lymph nodes resected
When is neoadjuvant tx of gastric adenocarcinoma being evaluated?
In cases with clinical T3 or N1 disaese
When is Endoscopic submucosal dissection (ESD) performed for gastric ca?
In mucosal and SUBMUCOSAL metastasis and in EARLY lymph node metastasis
When is Endoscopic mucosal resection (EMR) performed for gastric ca?
In differentiated MUCOSAL gastric cancer less than 2cm and have no risk for lymph node metastasis and no sign for ulcereation
(If larger than 2cm there’s a risk for perforation)
When is TNM staging used for in gastric cancer
For prognosis depends on invasion depth of layers for DIFFUSE type of gastric cancer
what is the definition of krukenberg tumor?
implantation in the ovary
def of Blummer’s shelf
implantation into the rectouterine fascia
sister joseph nodule def?
umbilicus metastasis
virchow nodule def?
left supraclavicular LN metastasis
Irish nodule def?
left axilla LN metastasis
peritonitis carcinomatosis and M1
Which protein is responsible for the pathogenesis of Menetrier’s disease (hypertrophic gastritis)?
TNF-α is responsible for the
pathogenesis. (The disease is thought to be of autoimmune origin.)
Which disease is an inflammatory disease of the gastric epithelium
Menetrier’s disease
Which disease is characterized by hypochlorhydria, hypoproteinemia, anemia, pain
MENETRIER’S DISEASE (HYPERTROPHIC GASTRITIS)
What is the scan used for gastric carcinoid?
Octreotide scan
Definitive diagnosis of menetrier’s disease (hypertrophic gastritis) is made by biopsy that shows……?
Loss of oxyntic gland/parietal cell and detection of foveolar hyperplasia
Imatinib and Sunitinib are usually drugs given for which neoplastic tumor?
Gastrointestinal stromal tumors (GIST)
If KIT rec is not expressed in GIST then which other protein is?
TNF-alpha
Where is tumor size important?
It is imp in small intestines, while it is not imp in colon
GIST tumors are mainly in which layer?
Submucosa
