Gastric cancer Flashcards
How does H pylori cause gastric cancer
acute gastritis, chronic inactive H pylori infection (mucosal atrophy, metaplasia, dysplasia, well-differentiated gastric Ca) then poorly-diff. NOT EVERYONE
Why does WC have more Gastric Cancer cases?
Nutrition (more salts)
SMOKING
Smoke contains NO (SM relaxant, relaxes LES-GORD, relaxes pylorus with bile reflux)
Risk factors
H pylori (African strain less virulent)
Smoking
High salt diet, preservatives
Obesity-Barrets cascade due to more reflux (metaplasia etc)
Genetics: E-cadherin (AD)
More males, developed countries, european countries: BMI high (more intraabdo pressure)
why is H pylori weird
Protects against OG junction tumours (chronic gastritis is atrophic which means that less acid is produced, more protective)
BUT CAUSES DISTAL GASTRIC TUMOURS
risk factors for non-cardia gastric cancers
H pylori
low SES
lots of salt, preservatives
few fruit and vegetables
which tumour type is more common
ADENOCARCINOMA (95%)
GIT Stromal tumour (from muscle, nice and round)
lymphoma
where are most tumours located
adeno-1/3 upper prox, 15 percent lower down
WC-antrum (here, symptoms present much earlier)
which location is the worst
middle zone
endoscopic vs surgical management
endoscope: T1a (just through mucosa)
Surgical: submucosa breached
also preoperative chemo (FLOT), 4 cycles
siewerts classification
which way are you going to treat patient
type 3: treat as gastric ca
type 1: oesoph ca
symptoms of Ca
dyspepsia
perf/bleed/gastric outlet obstruction
weight loss, anaemia, jaundice-ca spreads to LNs (chain in portal triad), extrinsic compression
gastric outlet obs
succession splash
vomiting old food, halitosis, tremendous burping
linitis plastica
tumour cells grow longitudinally, VERY STIFF stomach
present late
younger patients
goo
plan of action
gastroscopy with biopsy +- ba meal
then CT scan to stage
mets/local invasion: palliative
if resectable on imaging: periop chemo and surgical resection
if large tumour do staging laparoscopy
surgery options for distal tumour
Partial gastrectomy
distal: Bilroth 1 (benign), duodenum onto remaining stomach (remove antrum)
Bilroth 2: staple off due, bring jejenum and attack to stomach, not really involved anymore because bile refluxes into stomach
BEST: Roux en Y, duo stapled off, jejenum attached to stomach, duodenal end attached to end that moved up
distance between anastomosis should be at least 40cm otherwise bile reflux
